Pubdate: Tue, 19 Aug 2003
Source: New York Times (NY)
Copyright: 2003 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Mary Duenwald

A SCIENTIST'S LIFETIME OF STUDY INTO THE MYSTERIES OF ADDICTION

BETHESDA, Md. - The road from Dr. Nora Volkow's childhood home in Mexico to
the director's office at the National Institute on Drug Abuse here was
surprisingly short and straight.

From the time she entered medical school, at 18, Dr. Volkow devoted herself
to the study of addiction.

A research psychiatrist known for her brain-imaging studies, she has
published hundreds of papers, including many that demonstrate how dopamine,
a brain chemical linked to pleasure and motivation, plays a major role in
addictions of all kinds: to drugs, to alcohol and even, some say, to food.

Two oversize computer screens, perfect for viewing PET scan images, stand on
the desk in her office; even with her new leadership role, she intends to
continue her own research.

Dr. Volkow (pronounced VOHL-kahf), 47, grew up in Mexico City, the daughter
of a fashion designer and a pharmaceutical chemist. Her father, the chemist,
had come to Mexico as a boy with his grandfather Leon Trotsky, the Bolshevik
leader expelled from the Soviet Union by Stalin.

She never met her famous great-grandfather, but she was raised in the house
where he lived and died, assassinated in 1940 by a Stalinist agent. On
weekends as a teenager, Nora Volkow and her three sisters led visitors on
tours of the house, which is now a museum.

Now, as the first woman to lead the drug abuse agency, Dr. Volkow will
direct the spending of government money on drug addiction research. On a
rainy morning in June, she discussed her new challenge.

Q. What got you interested in drug abuse?

A. It always fascinated me, the ability of a drug to take over the process
of what we call free will. I don't know of any other situation where an
individual will give up their family, their profession, their money because
of an addiction they cannot control. I wanted to know what drugs do to the
brain.

Q. How can a drug change a person's motivation?

A. People say that addicts take drugs because the drug is pleasurable. And
that is where the whole stigmatization of the drug-addicted person as being
morally weak comes across.

I don't like the whole concept of pleasure because it gets oversimplified.
It's motivation and drive. Drug addiction actually becomes a need. There's
tremendous variability in predisposition for addiction. We know that
genetics are a key element. Why? Because you can genetically engineer
animals that will not become addicted no matter how much of a drug you give
them. We also know that environment can be protective or can favor
vulnerabilities.

Q. How does drug abuse affect free will?

A. People say the addict loses control. But that is not complete.

A drug-addicted person is motivated by the procurement of a drug. They may
care for their family very much. It's just that the motivation to procure
the drug becomes much more powerful than the motivation to be responsive to
their family.

Q. What kind of environment is likely to protect people from addiction?

A. Parenting plays a key role. If you take nonhuman primates and rear them
with peers they are much more likely to abuse alcohol than those that were
reared by parents.

Having parents creates in them a sense of self-security. Whereas those that
are reared by peers become very timid. And then they are much more likely to
engage in aggressive acts and taking drugs. Parenting has very subtle
effects that you couldn't have predicted.

Q. Do you consider drug addiction to be, in part, a biological problem?

A. People say if you consider drug addiction a disease, you are taking the
responsibility away from the drug addict. But that's wrong. If we say a
person has heart disease, are we eliminating their responsibility? No. We're
having them exercise. We want them to eat less, stop smoking. The fact that
we have a disease recognizes that there are changes, in this case, in the
brain.

Drug addiction also has an impact on a wide variety of illnesses. Smoking
and alcohol are linked with a higher incidence and prevalence of certain
cancers. Marijuana too. The co-morbidity of depression and smoking is close
to 90 percent. Do you know what percentage of schizophrenic patients take
cigarettes or take drugs? Eighty-five. Look at heart disease, the No. 1
killer. What is one of the highest risk factors? Smoking.

Q. Drug abuse usually begins in adolescence. Do adolescents have a kind of
predisposition to drug addiction?

A. We don't know. Our studies have been very much targeted in adults. We
know certainly that the brain dopamine system changes dramatically during
childhood and adolescence. But what is unique about the brain of adolescents
that makes them particularly vulnerable to drugs? People have said, Well,
maybe it's just a stage in their lives where they want to try everything.
But why would they want to try everything? Obviously, it reflects something
in the way that the brain is working.

Q. Is there any priority among the various drugs of abuse that need special
attention?

A. If you look at it in sheer numbers, of course, cigarette smoking is an
overwhelming priority. Cigarette smoking may also facilitate consumption of
other drugs. Still nicotine is not like other drugs. For example, when
animals have free availability of cocaine, the animals stop eating, they
stop sleeping, and 100 percent of them die. If they have free availability
of nicotine or, for the same matter, heroin, the animals survive.

Q. Is marijuana as dangerous as other drugs?

A. There's data that shows it's damaging to learning and memory, but then
there's data that shows it's not. I've used imaging, and clearly we have
shown that marijuana abusers have changes in certain areas of the brain
involved with memory and motor coordination. So the idea that it is a benign
drug, I don't think that it is so straightforward.

We all know marijuana users that are so apathetic. But nobody has done the
studies to document the amotivational syndrome. If people are smoking
marijuana, they should know what marijuana is doing to their brain. We need
to do the work.

Q. How do you try to prevent drug abuse?

A. Providing access to knowledge definitely helps. A lot of people, and
certainly adolescents, do not realize the consequences of being addicted to
other things. People who are addicted are at the higher risk for suicide.
They are at the higher risk for depressive disorders. Many of these drugs
are toxic.

Take methamphetamine. When we look at the brains of young methamphetamine
abusers, they look like the brains of people 40 to 50 years older. So what
drugs are inducing in your brain is aging. Do you want to be a 20-year-old
with the brain of a 70-year-old? I think that message is very, very
powerful.

Q. As the great-granddaughter of Leon Trotsky, did you grow up in a
political household?

A. No. My father was so traumatized by what had happened to his family, he
wanted to protect us from anything political. When I left Mexico to go to
Paris - I did one year in Paris as a medical student - I was exposed to it
because there's a lot of Trotsky's group in France. It was a very
interesting experience.

But I've never become politically involved. If you want to be a scientist,
you cannot allow politics to get in the way of your objectivity.
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