All:
Doesn't the Divine work through science? Should we cast medicine aside
and all start to (just) pray? To deny the genetic/ biological basis of
alcoholism is to aggressively announce one's refusal to understand the
syndrome, disease or whatever we wish to call alcoholism.  My Higher
Power is as at home in a laboratory as in a church. If the existence of
naltrexone is going to cause some AA's uneasy night's, then good. Those
folks need to come to terms with the issue of science and religion (once
and for all)---and how the two are not mutually exclusive. 

Richard Dubiel

-----Original Message-----
From: Alcohol and Drugs History Society
[mailto:[log in to unmask]] On Behalf Of Francis Hartigan
Sent: Wednesday, June 28, 2006 7:14 PM
To: [log in to unmask]
Subject: Re: An Anti-Addiction Pill? Forwarding Times article

It troubles me to see Bill Wilson so mis-represented.

He did not believe in the divinity of Jesus, that is on the record.  

AA is not a Christian fellowship.



-----Original Message-----
From: Alcohol and Drugs History Society
[mailto:[log in to unmask]] On Behalf Of Dick B.
Sent: Tuesday, June 27, 2006 11:08 PM
To: [log in to unmask]
Subject: Re: An Anti-Addiction Pill? Forwarding Times article

What a sad thing that this writer, who seems addicted to pharmacology,
did not once mention Almighty God. Then, with a sad flourish, he quotes
Moyers who has a hole in the soul. Sorry, it's nice to keep up with all
the drugs that aren't preventing alcoholism and addictions; but I didn't
want to let a long paper like this go without reminding the readers that
I'm not talking about "spirituality," or a "higher power," or "not-god,"
or some New Age substitute. When Bill Wilson and Bill Dotson said (and
they are quoted on page 191 of the Big Book) "The Lord has cured me of
this terrible disease,"
they weren't talking about drug companies or treatment centers. Nor was
Dr.
Bob Smith when he said on page 181: "Your Heavenly Father will never let
you down." If some writer doesn't favor turning to God, his best
approach in the dissertation would be what lawyers call "Confession and
avoidance." He could
start: "Of course I don't believe in God or the power of God or that God
can cure alcoholism..... BUT THERE'S THIS PILL I WANT TO TALK ABOUT.
Aloha, Richard G. Burns, J.D.

-----Original Message-----
From: Alcohol and Drugs History Society
[mailto:[log in to unmask]] On Behalf Of Courtwright, David
Sent: Sunday, June 25, 2006 2:55 PM
To: [log in to unmask]
Subject: An Anti-Addiction Pill? Forwarding Times article

June 25, 2006 New York Times

An Anti-Addiction Pill? 

By BENOIT DENIZET-LEWIS

Last month, the Picower Institute for Learning and Memory at the
Massachusetts Institute of Technology
<http://topics.nytimes.com/top/reference/timestopics/organizations/m/mas
sach
usetts_institute_of_technology/index.html?inline=nyt-org>  was host to a
conference about addiction for a small, invitation-only crowd of
neuroscientists, clinicians and public policy makers. It was an unusual
gathering. Addiction conferences are usually sober affairs, but M.I.T.
offered a lavish cocktail reception (with an open bar, no less). More
important, the conference was a celebration of the new ways scientists
and addiction researchers are conceptualizing, and seeking to treat,
addiction.
While many in the treatment field have long called addiction a
"disease,"
they've used the word in vague and metaphorical ways, meaning everything
from a disease of the mind to a disease of the spirit. Many assumed that
an addict suffers from a brain-chemistry problem, but scientists had not
been able to peer into our heads to begin to prove it.

Now they can, using advances in brain-imaging technology. And they tend
to agree on what they see, although not necessarily on how to fix it:
addiction
- whether to alcohol, to drugs or even to behaviors like gambling -
appears to be a complicated disorder affecting brain processes
responsible for motivation, decision making, pleasure seeking,
inhibitory control and the way we learn and consolidate information and
experiences. This new research, in turn, is fueling a vast effort by
scientists and pharmaceutical companies to develop medications and
vaccines to treat addiction. The National Institute on Drug Abuse and
the National Institute on Alcohol Abuse and Alcoholism are studying, or
financing studies on, more than 200 addiction medications.

The search for pharmacology to treat addiction is not new. The history
of addiction treatment in America is rife with supposed miracle
medications and "cures," most of which turned out to be useless. But
there are a handful of drugs - some developed in the mid-1900's, others
in the last decade or so - that are being used to help addicts quit. For
heroin addiction, there's methadone and buprenorphine, both of which
bind to and activate opioid receptors in the brain. Each essentially
substitutes for heroin by activating the same brain receptors as the
drug, but many addiction doctors prefer buprenorphine, which the Food
and Drug Administration
<http://topics.nytimes.com/top/reference/timestopics/organizations/f/foo
d_an
d_drug_administration/index.html?inline=nyt-org>  approved in 2002,
because it causes less of a high and less dependence.

For alcohol, Antabuse, which makes people physically ill if they drink,
has been on the market since 1948, although it isn't widely used.
Addiction scientists are more hopeful about another anti-alcoholism
drug, naltrexone, which was originally developed to treat opioid
addiction but was approved for the treatment of alcoholism in 1994.
Studies have found it can help some alcoholics abstain from or cut down
on their drinking, and two pharmaceutical companies recently teamed up
to produce Vivitrol, a long-acting, injectable form of naltrexone, which
the F.D.A. approved in April. Some hope Vivitrol will sidestep a huge
challenge facing those seeking pharmacological solutions for addiction:
unless they're getting high from it, most addicts aren't model medicine
takers. (Vivitrol requires a monthly shot from a doctor.)

None of the medications currently approved to treat addiction are
perfect, and in many ways they are the products of some of our earlier
advances in neuroscience. In the last few years, though, scientists say
they've learned a staggering amount about how addiction affects the
brain, and neuroscientists and other addiction researchers are eagerly
testing and developing a new generation of anti-addiction medications. 

"In 5 or 10 years, we will be treating addiction very differently,"
predicts Nora Volkow, a psychiatrist and the director of the institute
on drug abuse, who attended the M.I.T. conference and presented a
lecture, "Addiction: The Neurobiology of Free Will Gone Awry," in an
intense and rapid-fire speaking style. (Besides being a leading American
thinker about addiction, Volkow is the great-granddaughter of Leon
Trotsky.) What Volkow means is that in a decade or so, we may actually
start treating addiction effectively.
Addiction is one of the nation's biggest public health problems, costing
$524 billion (including lost wages and costs to the public health care
and criminal justice systems) each year. The majority of the estimated
20 million alcoholics and drug addicts in America (and millions more
compulsive gamblers, overeaters and sex addicts, if you accept an
expanded understanding of addiction) never get help. Those who do often
relapse repeatedly, sometimes returning to treatment centers 5, 10 or 15
times (if they don't die first). And many of those who "recover" simply
trade one addiction for another - addicts call this dance "switching
seats on the Titanic." 

The Dopamine Connection

For much of the past two decades, Volkow and other neuroscientists
exploring the physiological basis of addiction have tried to explain it
by studying the brain chemical dopamine, which functions as a
neurotransmitter, sending signals between cells in the brain. Dopamine
affects a variety of critical functions, including learning, memory,
movement, emotional response and feelings of pleasure and pain. 

Dopamine was originally thought to serve as a kind of pleasure signal in
the brain, telling us when something feels good or rewarding. But
scientists now believe that dopamine is more a predictor of salience -
that is, it tells us, and then helps us to remember, what we should
focus on. When you see a person you are strongly attracted to,
scientists can now see a spike of dopamine in your brain. If you are
hungry and smell a food you like, dopamine also increases. But even
unpleasant experiences - like physical pain or the fear of an intruder
in the house - can cause a dopamine spike.
(Some hypothesize that different dopamine receptor cells are responsible
for firing during rewarding or aversive situations.)

Drugs, particularly cocaine and methamphetamines, cause a large increase
in the amount of dopamine secreted and pooling between brain cells,
leading to feelings of euphoria. With regular, repeated "addictive" drug
use, though, the brain eventually responds by reducing its normal
release of dopamine.
Studies also show a simultaneous decrease in the number of dopamine
receptors created. That, in turn, makes the brain's reward system less
likely to respond to behaviors (romance, a good meal, the company of
friends) that produce a normal dopamine surge. The addicted brain
essentially becomes pathologically selective, dependent on bigger and
bigger blasts of, say, cocaine to feel rewarded.

Perhaps most fascinating to addiction researchers is how an increase in
dopamine creates a craving - and an expectation of a reward. In a study
published earlier this month in The Journal of Neuroscience, Volkow used
a brain scan to look at the dopamine releases in 18 cocaine addicts
while they watched two videos: one of nature scenes, the other of people
using cocaine.
Volkow found that dopamine increased while the addicts watched the
cocaine video and that the severity of the increase matched their
self-reported level of craving for the drug. "For these people, their
lives and experience had taught them that when they see others using
cocaine, they're probably about to get rewarded with drugs, too," Volkow
told me. "So even though they consciously knew that they weren't going
to get cocaine after watching the video, their brains had learned to
expect the reward." 

Scientists posit that cue-induced dopamine spikes and craving
essentially overpower the brain's well-meaning frontal cortex, which is
responsible for planning and decision making. The institute on drug
abuse is currently financing studies of medications that could
potentially blunt that process, interfering with the release of dopamine
when an addict sees a conditioned cue. 

Dopamine also travels to the parts of the brain responsible for
solidifying memory, like the amygdala, which learns and stores emotional
memories (including the high of drugs). Some researchers hypothesize
that through a combination of medicine and behavioral therapy, addicts
could "unlearn"
these powerful memories and associations, making them less likely to
relapse when they see a cue. "Potentially, you could put an addict in a
virtual-reality situation where you show them videotapes of friends they
used to use drugs with, or whatever their strongest triggers are," Eric
Nestler, a neuroscientist and addiction specialist at the University of
Texas Southwestern Medical Center, told me earlier this month. "But now,
the cue isn't associated with any kind of rewarding response. So then
you can give a medication, which we're making progress on developing,
that enhances memory formation. Essentially, you'd be teaching them
something new - that a line of white powder means nothing special."

Dopamine may also make some people more vulnerable to addiction. Recent
studies in both animals and humans have indicated that those with low
levels of dopamine D2 receptors, which regulate the release of dopamine
in the brain, are more likely to find the experience of taking drugs
pleasurable.
Some researchers, like Volkow, suggest that people with fewer D2
receptors experience a less intense reward signal, causing them to
overindulge in order to feel satisfied.

In one experiment, Volkow increased the level of dopamine D2 receptors
in rats that had low levels. After the increase, the rats significantly
curtailed their intake of alcohol, which they had eagerly gulped down
before. Unfortunately, we don't yet know how to safely increase the
number of dopamine D2 receptors in humans. 

In fact, we don't yet know how to do much when it comes to dopamine and
addiction. Understanding how the neurotransmitter works may help us to
understand addiction better, but it hasn't led to any effective
medications, the ultimate goal of many researchers. Because addiction
seems to disrupt so many different brain regions, neuroscientists are
now casting a wider net in their pursuit of effective medications. For
some, the new frontier involves the brain's two major "workhorse"
neurotransmitters: GABA and glutamate.

Getting the Brain's Brakes to Work

Walter Ling, a neurologist and the director of the Integrated Substance
Abuse Programs at U.C.L.A., likes to explain complex brain processes
using simple metaphors. GABA, he says, is to a brain what a braking
system is to a car. "The brain works by inhibition," he told me
recently. "At some point you realize that your car is a great car not
because of its engine but because it has a great braking system. GABA is
the brakes. If your brakes don't work well, you crash."

GABA (gamma-aminobutyric acid) is the brain's major inhibitory
transmitter, and its role, in essence, is to keep glutamate, the main
excitatory transmitter, from overwhelming us. In the extreme, too much
glutamate can cause a seizure and too much GABA can put us in a coma.
Researchers are particularly interested in the brain's critical balance
of GABA and glutamate - some hypothesize that addictive craving is the
result of too much glutamate or too little GABA. "We've been able to
measure GABA in living brains for some time, but measuring glutamate in
living human brains has just become feasible in the last few months,"
says Frank Vocci, the director of the division on pharmacotherapies and
medical consequences at the institute on drug abuse. "What's been shown
is that people with alcohol and cocaine problems have less GABA in their
brains, and we do know that medications that increase GABA have shown
some efficacy in treating addiction." (Vocci says that it isn't yet
clear whether the absence of GABA is a cause of addiction or a result.)
The seizure medication topiramate, for example, works on both GABA and
glutamate and has helped some alcoholics in initial trials quit or cut
back on their drinking. The muscle relaxant baclofen, which essentially
mimics the effects of GABA, may also help some cocaine addicts quit.
Both are being tested further by the institute.

Hythiam, a Los Angeles-based health care services management company
that made national news in the spring when it plastered Chris Farley's
face - with the words "It Wasn't All His Fault" - on a series of Los
Angeles billboards, is particularly interested in GABA's role in
addiction. The company is aggressively marketing its Prometa protocol
for cocaine, alcohol and methamphetamine addiction, which involves
therapy and medications, both oral and intravenously injected, not
usually used to treat addiction:
flumazenil, approved by the F.D.A. to treat overdoses of Valium and
Xanax, and gabapentin, approved to relieve neuropathic pain. While no
double-blind placebo studies have tested Prometa's effectiveness (two
are under way), addiction-medicine doctors around the country who have
administered the protocol report encouraging results. Prometa appears to
reduce anxiety and craving by enhancing the brain's GABA receptors, says
David Smith, the former president of the American Society of Addiction
Medicine and now the director for medical affairs at Hythiam and the
head of a Prometa treatment center in Los Angeles. Sanjay Sabnani,
Hythiam's senior vice president for strategic development, says: "It's
all hypothesis at this point, because we haven't sliced open anyone's
brain yet, but it seems that normalizing the GABA receptor takes away
the craving and anxiety that one would typically experience in the
absence of the drug. And it doesn't appear to be happening because of
will power, love, God, discipline, family support or anything else. It
seems to be happening because the protocol resets a faulty mechanism in
the brain." Yet, several addiction scientists told me they were
skeptical that Prometa works, and some criticized Hythiam for promoting
it before it has been rigorously tested. 

The Prescription Model

Hythiam was among a handful of companies publicizing their
anti-addiction medications last month at the American Society of
Addiction Medicine conference in San Diego. Several were armed with
charts, graphs and clinical-study results (particularly the ones that
found their medications most effective), and their eager young marketing
and sales teams talked about doing for addiction what the pharmaceutical
industry did for depression
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics
/depression/index.html?inline=nyt-classifier> : medicalizing it, and
destigmatizing it in the process.

They know it won't be easy. A series of recent surveys sponsored by the
National Council on Alcoholism and Drug Dependence and by Faces and
Voices of Recovery, a recovery advocacy group, found that half the
public called addiction a personal weakness. Among those who did see
addiction as a disease, most put it in a special category of diseases
that people get by making poor choices. In a 2004 poll of the general
public, two-thirds said they believed that a stigma - usually defined as
a thing that disgraces a person or injures one's reputation - exists for
people in recovery from addiction. 

The pharmaceutical companies came to San Diego to argue that addiction
is a chronic and recurring disease like diabetes
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics
/diabetes/index.html?inline=nyt-classifier>  or hypertension
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics
/bloodpressure/index.html?inline=nyt-classifier>  - and no one, they
say, tells a diabetic to try to tough it out without insulin. They don't
discount the importance of environment in inducing addictive behavior or
psychosocial interventions as part of the recovery process; in fact,
most stress therapy as an essential adjunct to their products. But they
insist that medications will stabilize addicts and make the deeper
therapeutic and spiritual work more effective. 

In the exhibition hall, the prime booth location near the entrance
belonged to Alkermes and Cephalon, the two pharmaceutical companies
producing and marketing Vivitrol, the recently approved, injectable form
of naltrexone, prescribed for alcoholics. Alkermes and Cephalon are
initially focusing on doctors who specialize in addiction, but they plan
eventually to market the drug directly to primary care physicians, most
of whom are used to sending their addicted patients to treatment centers
and groups like Alcoholics Anonymous. "It would require a complete
paradigm shift," Doug Neale, a product director at Cephalon, told me,
"but we'd like to see the day when a patient who is struggling with
alcoholism can walk into their primary care doctor's office, say, 'Doc,
I'm drinking too much and can't seem to stop,'
and the doctor will have a handful of options for medications that he
could prescribe." 

But Ling, the U.C.L.A. researcher, cautions that we still have a way to
go before we can effectively treat most addicts medically. "In general,
we have a pretty good handle on dealing with opioid addiction," he says.
But "if you look at the various studies of alcohol-abuse drugs, the
results are mixed at best," he continues, adding: "These kinds of mixed
findings mean that the drug maybe works for some people, but it's not
working all that great. And we're still far off from having a handle on
treating people addicted to stimulants like cocaine and
methamphetamine."

A Higher Power Versus Medicine

John Schwarzlose, the president of the Betty Ford Center, says he isn't
convinced that treating alcoholics and drug addicts with more drugs -
particularly if they aren't proved effective - is a good idea. He points
out that millions of addicts around the world have recovered without the
help of medication. "We're open to medications that will actually work,
but the fact is that today 12-step treatment is still the best treatment
there is," he told me. "Nothing even comes close. And until something
does, we like to try to keep most of our patients as drug-free as
possible."

Many addiction treatment centers share that view, which made for a
strange scene in the exhibition hall at the society of addiction
medicine conference. The treatment centers, most of which advocate a
behavioral and spiritual solution to addiction, promoted their centers
right next to pharmaceutical companies boasting novel medical solutions.
"Why can't these two camps come together?" Smith, the medical director
of Hythiam, said as he sat in front of the company's booth. "They need
to come together. In medicine, if something isn't working, you try
something new. In addiction, if someone goes to treatment and fails, for
years we've just sent them back again and again and expected different
results. That's insanity. And we're starting to realize that. The field
of addiction treatment is changing right before our eyes, and it's only
going to continue to change. Advances in neuroscience and pharmacology
will change everything."

Those changes could lead to addiction vaccines. Several are already in
development. The British company Xenova Group Plc has created what it
says are effective vaccines for cocaine and nicotine addiction (NABI
Biopharmaceuticals in Florida has also developed a nicotine vaccine).
The vaccines, which the institute on drug abuse and others are testing,
work by producing antibodies to a specific drug, binding to the drug
when it enters the bloodstream and keeping it from entering the brain.
An effective vaccine won't stop craving or treat any underlying
pathology (making it an inadequate solution, some say), but it will make
it nearly impossible for an addict to get high on that particular
substance.

And if it is combined with medications that could blunt craving, some
addiction specialists believe that we'll stop using the word "treat" and
start using the word "cure." Matthew Torrington, an addiction-medicine
doctor in Los Angeles who works with Smith at his Prometa center,
attended the society's conference and told me that he believes we can
essentially eliminate addiction in America.

"With the scientific advances we're making in understanding how the
human brain works," he says, "there's no reason we can't eradicate
addiction in the next 20 or 30 years. We can do it by fixing the part of
the brain that turns on you during drug addiction and encourages you to
kill yourself against your will. I think addiction is the most beatable
of all the major problems we face. And I think we will."

The Stress Culture

It's not the first time a doctor has predicted the end of addiction. In
his book "Slaying the Dragon: The History of Addiction Treatment and
Recovery in America," William L. White recounts how in the 1800's,
countless "medications" like Knights' Tonics for Inebriates promised to
remove "the craving for a stimulant that those who have been addicted to
the use of ardent spirits know so well." In the 1905 Sears, Roebuck &
Company catalog, a person struggling with opium or morphine addiction
could buy a bottled "cure" for 69 cents.

Most of these miracle potions were promoted as a result of important
scientific and medical breakthroughs. Science, it seems, has always been
just about to save us from addiction. "But it has never lived up to its
promise," says Bruce Alexander, emeritus professor of psychology at
Simon Fraser University in British Columbia, "and I don't believe the
science will live up to its promise now, either. Addiction doesn't
demand a scientific solution."

Alexander is among a vocal group of addiction researchers who argue that
focusing on a pill to treat addicts fails to address the primary cause
of becoming and staying hooked: our unhappy, disconnected lives.
Beginning in the late 1970's, Alexander and his team of researchers at
Simon Fraser set out to study the role of our environment on addictive
behavior. Until that point, most scientists studying addiction put rats
in small, individual cages and watched as they eagerly guzzled
drug-laced solutions and ignored water and food, sometimes dying in the
process. This phenomenon was noted - first by researchers, then drug
czars, then parents trying to keep their children off drugs - as proof
of the inherently addictive quality of drugs and of the inevitable
addiction of any human who used them. This was false, of course. Most
people who use drugs don't become addicted.

So what made all those lab rats lose their minds? Bruce Alexander and
his research team had a rather simple hypothesis: The rats had awful
lives. They were stressed, lonely, bored and looking to self-medicate.
To prove it, Alexander created a lab-rat heaven he called Rat Park. The
200-square-foot residence featured bright balls and tin cans to play
with, painted creeks and trees to look at and plenty of room for mating
and socializing.

Alexander took 16 lucky rats and plopped them into Rat Park, where they
were offered water or a sweet, morphine-based cocktail (rats love
sweets).
Alexander offered the same two drinks to the control group of rats he
left isolated in cages. The results? The rat-parkers were apparently
having too much fun to bother with artificial highs, because they hardly
touched the morphine solution, no matter how sweet Alexander and his
colleagues made it.
The isolated and arguably depressed rats, on the other hand, eagerly got
high, drinking more than a dozen times the amount of the morphine
solution as the rats in paradise. 

When I spoke with Alexander recently, he predicted that unless we
undergo a "cultural renaissance" and all start living in a human version
of his rat park (which he conceded isn't likely), we won't be
eradicating addiction anytime soon. While Volkow of the institute on
drug abuse doesn't agree with Alexander that developing addiction
medications is a fruitless enterprise, she does say that a positive and
nurturing environment, particularly during childhood and adolescence, is
a strong protector against addiction. Volkow says that addicts are more
likely to have been unnecessarily stressed during childhood (from
neglect; emotional, physical or sexual abuse; or poverty) and that
they're less able to deal with stress as adults. 

Studies show that animals who are stressed during early development are
more likely to self-administer drugs later in life and that living in an
enriched environment - one with a minimal amount of strain and anxiety,
like Rat Park
- appears to protect animals from developing addictive behavior.

And remember the dopamine D2 receptors that some hypothesize may protect
us from abusing drugs? There is evidence that our environment can affect
those, too. In 2003, researchers at the Wake Forest School of Medicine
measured the levels of dopamine D2 receptors of 20 macaque monkeys while
they were housed in isolation. They then assigned the monkeys to social
groups of four monkeys each, letting natural social hierarchies develop.
Three months later, they tested the levels of D2 receptors again.

The dominant monkeys - who, the theory goes, were much less stressed and
anxious than the subordinate ones - had 20 percent higher D2 receptor
function, while the submissive ones were unchanged. The monkeys were
then taught how to self-administer cocaine by pressing a lever, with
researchers finding that the dominant monkeys took significantly less
cocaine than the subordinate ones.

Interestingly, though, when the animals that seemed to be protected from
addiction were given cocaine repeatedly, the number of their D2
receptors eventually went down, and they then became addicted. The moral
of the monkey story, Volkow says, is that environment - if good or bad
enough - can sometimes trump genetics
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics
/geneticsandheredity/index.html?inline=nyt-classifier>  and biology.

"Some people may be naturally better protected against addiction than
others," Volkow says, "but that's not enough to keep someone from
becoming addicted. The same thing is true for those who are genetically
predisposed.
We know from twin and family studies that about 50 percent of a person's
vulnerability to addiction is genetic. But if you're never exposed to
illegal drugs, or if you grow up and live in an environment without
trauma and too many stressors, you probably won't become addicted."

If It's Not One Addiction, It's Another

What Volkow and other researchers can't yet explain is why we choose one
particular manifestation of addiction over another. Why do some of us
become addicted to cocaine, while others are hooked on alcohol or
cigarettes?
Researchers hypothesize that environmental availability and genetic
predisposition both play a part, but they don't know for sure.

Further complicating the question is that many people are addicted to
more than one thing. Howard Shaffer, director of the division on
addictions at the Cambridge Health Alliance, an affiliate of Harvard
Medical School, suggests a "syndrome model" of addiction: each outwardly
unique manifestation of addiction is actually part of the same
underlying disorder.
Shaffer's syndrome model argues that behavioral addictions (like
gambling, sex and eating) can be just as powerful as an addiction to
heroin or crystal meth, and his belief is gaining acceptance among
neuroscientists and addiction researchers, many of whom used to dismiss
this idea as a product of an American culture that's addicted to calling
everything an addiction.

But by studying the brain's reward and pleasure systems, researchers are
discovering that drugs and powerfully rewarding behaviors like gambling
and sex affect it in similar ways. Neurologists at the University
Medical Center Hamburg-Eppendorf in Germany, for example, found that
pathological gamblers, like drug addicts, have a sluggish reward system
that doesn't react normally to pleasing stimuli. The scientists used an
M.R.I. scanner to compare the brain responses of 12 gambling addicts and
12 nonaddicted people to a card-guessing game. Subjects were told to
pick a playing card, and if the card turned out to be red, they won a
euro. 

The game activated the ventral striatum, an important part of the
brain's reward system. Those nonaddicts who picked a winning card had
increased blood flow to the striatum, but the gambling addicts who
picked the right card had much less of it (their reward system was less
active). It was as if their brains, which were accustomed to powerful
rewards, were saying, "You call this silly prize a reward?" The same
kind of indifference to basic rewards has been seen in the ventral
striatum of cocaine addicts.

"People addicted to gambling and drugs look a lot alike," Shaffer told
me when I visited him in his office in March. "Gamblers have to increase
their bets to get the same level of excitement, just like someone
addicted to drugs who has to keep using more to get an effect. When
addicted gamblers cut back, they experience withdrawal symptoms that
look like stimulant withdrawal. They get depressed, they're irritable
and they have trouble sleeping. And if they gamble again, they can make
the symptoms go away for the short run."

While Shaffer focuses much of his recent behavioral addiction research
on gamblers, Volkow studies overeaters and also finds many similarities
to drug addicts and alcoholics - including the fact that obese subjects
have lower levels of dopamine D2 receptors than those who eat normally.
"Because we know that many people are addicted to more than one thing
and that many people switch addictions," she told me at the M.I.T.
conference, "in my own research I'm mostly interested in developing
medications that could work across a variety of addictions."

An Addict's Perspective

What do addicts think about all this focus on their brains? William C.
Moyers, a recovery advocate (and the son of the journalist Bill Moyers
<http://topics.nytimes.com/top/reference/timestopics/people/m/bill_moyer
s/in
dex.html?inline=nyt-per> ) who for 12 years has been free of crack and
alcohol, was invited to speak at the M.I.T. conference. In a room full
of scientists and addiction researchers obsessed with the intricacies of
the human brain, Moyers read a lecture that reminded them that treating
addiction might be even more complicated than they thought.

"I have an illness with origins in the brain. . .but I also suffered
with the other component of this illness," he told the gathered
researchers and scientists, some of whom dutifully took notes. "I was
born with what I like to call a hole in my soul.. . .A pain that came
from the reality that I just wasn't good enough. That I wasn't deserving
enough. That you weren't paying attention to me all the time. That maybe
you didn't like me enough."

The conference room was as quiet as it had been all day. "For us
addicts,"
he continued, "recovery is more than just taking a pill or maybe getting
a shot.. . .Recovery is also about the spirit, about dealing with that
hole in the soul."

Benoit Denizet-Lewis is a contributing writer for the magazine. He is
working on a book about addiction in America.

Article forwarded by:
 
David T. Courtwright
John A. Delaney Presidential Professor
Dept. of History
University of North Florida
Jacksonville, FL 32224-2645
Home office: (904) 745 0530
University office: (904) 620-1872
Fax: (904) 620-1018
Email: [log in to unmask]