HEAD OF DRUG ABUSE AGENCY GIVES PERSPECTIVES ON 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 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, 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.

Dr. Volkow 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 has become a museum.

Now, as the first woman to lead the drug abuse agency, Dr. Volkow directs
the spending of government money on drug addiction research. Here she
discusses her new challenge.

Question: What got you interested in drug abuse? Answer: 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.

Question: How can a drug change a person's motivation? Answer: 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.

Question: How does drug abuse affect free will? Answer: 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.

Question: What kind of environment is likely to protect people from
addiction? Answer: 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.

Question: Do you consider drug addiction to be, in part, a biological
problem? Answer: 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. ... 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. Question: Drug abuse usually begins in
adolescence. Do adolescents have a kind of predisposition to drug addiction?

Answer: 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.

Question: Is there any priority among the various drugs of abuse that needs
special attention?

Answer: 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. Question:
Is marijuana as dangerous as other drugs?

Answer: 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.

Question: How do you try to prevent drug abuse? Answer: 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. Question: As the great-granddaughter of Leon Trotsky, did you grow
up in a political household?

Answer: No. My father was so traumatized by what had happened to his family,
he wanted to protect us from anything political. ... 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.