Volkow Speaks Up on Science, Stigma, Addiction

Last night NIDA director Nora Volkow, MD, gave a fascinating presentation on the science of drug abuse and addiction, followed by an informative question and answer session. Both sections of the program highlighted a core Speak Up for Kids goal: the use of scientific knowledge to address stigma and ensure everyone gets the mental health care they need.

Dr. Volkow began by making a comparison between two pairs of scans: a pair of the heart, and a pair of the brain. One heart was healthy, and the other was of someone who had suffered a myocardial infarction—a heart attack. She indicated how the images showed glucose consumption in the muscles of the organ, a sign of health and activity. Bright colors lit up the healthy heart; the damaged one looked pale in comparison.

The two images of the brain were of a “control”—someone who had not taken drugs—and of a cocaine abuser. The story was the same, if more nuanced: the control brain had bright lights indicating activity in the prefrontal cortex, the control center. The other was dim. Damage had occurred. “By using these technologies we can document that there is harm in the brain, and what areas in the brain, in people that are addicted,” she said. “Just like we have done in the past for cardiac disease or other types of medical illness.”

Lest her point be lost, she summed up. “Our ability to document the pathology in the organ has led us to recognize that drug addiction is indeed a disease of the brain just like myocardial infarct is a disease of the heart.”

This understanding for Dr. Volkow is a key to getting people with substance use disorders the help they need and deserve, a task made difficult by the enduring stigma surrounding addiction. In the litany of diseases that have emerged from the shadows—she mentions AIDS, epilepsy—she even counts “typical psychiatric disorders” as easier to accept and seek treatment for than addiction.

I recommend watching her entire presentation, which touches fascinatingly on the unique neurodevelopmental risk factors for addiction in adolescence and how they manifest in and are influenced by the social and psychological trials of young adulthood. And in the question and answer session, she provides real advice to teens and parents alike. What should a young person do if he is struggling with drugs? Talk to someone—preferably a parent, but anyone who will listen.

And on the other hand: Should a parent tell a child about his own past experiences with substance use? Everyone is different, Dr. Volkow says. But “it’s important to have your kid trust in you,” whether you are talking about the actual risks of drugs or your own experience. As she puts it, kids are smart, and they’ll lose faith in you if you say you’ve never smoked pot, or that one hit will doom you forever. If you can’t maintain “credibility,” if you aren’t “relevant,” than you lose the chance to teach them about the real risks.