PICKING JUNKIES' BRAINS FOR RESEARCH

Penn Psychologist Hopes That Learning About Craving Can Help

By Alfred Lubrano, Inquirer Staff Writer

Drug addicts from the street stumble into the welllighted labs of the
University of Pennsylvania to watch movies about junkies getting high.
"Good stuff," one celluloid "crackhead" tells another in the film, as his
head snaps back with a smoking hit from a hotburning pipe.

"Yeah, feels all right," his buddy responds, the rush of headringing
molecules seemingly grabbing hold.

For the nonaddict, the crack film with men only pretending to smoke dope
is a thumbsdown effort with decent acting but no story line, and just
one, interminable scene of two guys at a makebelieve good time. But for
the hooked user, it's "Citizen Kane Goes To Jurassic Park On Independence
Day," an alltime boxoffice event.

When addicts see people abusing drugs, it kicks off craving a profound
state of desire stronger than sexual arousal, says psychologist Anna Rose
Childress, who studies the brain basis of addiction craving.

On hiatus from their wrecked lives, the ragged corps of strungout people
who troop to the Penn cinema provide scientists such as Childress entree
into their heads. Crack and heroin addicts are shown the films while they
are in a PET (positronemission tomography) scanner, which pinpoints brain
activity. In exchange for their help, Childress and her colleagues treat
the addicts. Childress can peer into brains and literally see the seat of
desire, the wantingplace inside addicts that orders them to abandon jobs,
children and spouses to hunt for mindspiraling product.

The hope is that from these unusual teamings of addicts and doctors will
come a heightened understanding of drug craving, and perhaps development of
anticraving medication to end relapses.

It's all cuttingedge stuff, and Childress, a 45yearold softspoken,
athletic Ph.D. from Appalachia with a weakness for chocolate, explains the
science by referring to a drawing of the brain that her daughter Amelia did
when she was 6.

Not content to be a mere lab rat, stuck in an ivory tower, Childress will
go anywhere for her work, with sometimes unforeseen outcomes.

Not long ago, she and some former heroin addicts were driving around West
Philadelphia in her white Volvo, making a movie about shooting up. They
were so convincing, the police stopped them and demanded to know what was
happening. "Dr. Childress is like nobody else," says a former heroin addict
who was successfully treated by Childress, and who helped her make the
copinterrupted heroin film. He asked that his name not be used. "She
really wants to help people, and when she asked me to do the film, it made
me feel like I was doing something to keep others from this drug life that
no one should have to live."

The addictscientist alliance works, the former addict and others say,
because Childress is so affable. Intellectually rigorous in her research,
Childress is also a warm and empathetic ally for addicts. One recent day
she showed up to work with a backpack full of brain scans, notes for an
academic article she's writing and a waffle iron to make pear waffles for
her colleagues and any patients who happened by.

Her work is generating enough buzz to have landed her on Nightline and
20/20 several times. She will also be the focus of a Bill Moyers PBS
program on addiction scheduled to air April 8.

"Addiction is one of the very toughest things in the world," Childress
says. "The patients see we want to treat and help them, and not just use
them in research."

Craving is insidious.

The smell of burned matches, the sight of a $10 bill (the price for a dime
bag of drugs), even those "Just Say No" posters with a crossedout needle,
all act as potent cues that could bring even longclean addicts to their
knees, screaming for dope. Childress has long known that telling people who
relapse that they have no willpower is feeble counsel.

For years, the definition of addiction was physical dependence followed by
observable withdrawal. Heroin always has had a colorful withdrawal state
that included flulike illness. And, without intervention, alcohol
withdrawal could kill a person. People kept taking these drugs to quell the
sick feelings they had when they stopped dosing.

But cocaine didn't seem to come with the same kind of withdrawal; you don't
get ill when you're not high. So scientists dismissed cocaine addiction as
being merely psychological, not physiological.

But Childress has learned that drugs like cocaine have an incredible draw
to them. Cocaine addicts are pulled by the anticipation, or craving, rather
than pushed by withdrawal, she says.

Cocaine addicts seeing Childress' movie report tasting cocaine in the backs
of their throats. "Their hearts pittypat, they get lightheaded, some even
experience a minor euphoria," she says.

"We're stuck with a wonderful brain that's wired to pursue things that are
pleasurable, because those are the things that allow us to survive as a
species," Childress says. "And that system encourages you to repeat what
activates you. We're prisoners to it."

When addicts see the films, the pleasure centers in their brains light up.
The PET scan detects where the brain is working hardest where it's
active. That's proof of a physiological not merely psychological
component to craving. "There's a physical, brain basis to it all,"
Childress explains, pointing to Amelia's drawing.

Greg Scirotto's brain sits gray and still, like the first pictures from a
dead planet. PET photos of his head have helped Childress understand how
cocaine can tear apart a life, cell by cell.

Somewhere among the abused neurons of Scirotto's brain is his former life.
Friends and family chased by the crack and outrageous behavior exist as
neurochemical flickers in the part of Scirotto's brain where memories and
regrets get warehoused.

A former senior account executive with WWDB radio, Scirotto, 45, of
Ardmore, smoked up his car and his savings and alienated his family. "I was
out of chips when I went to Anna Rose," Scirotto says. "I was a guy on a
raft, drifting from land."

In exchange for drug treatment, Scirotto allowed Childress to look inside
his head. She popped him in the PET scanner, and showed him a series of
movies. First, hummingbirds, waterfalls, horses and other nature films. His
brain scan never lit up. Then, Childress ran the movie of the guys smoking
crack.

Red lights. "It makes your heart race," Scirotto says. "It stimulates you.
It's not a Hollywood movie. It was like watching the real thing. It's a
very accurate film."

Now he's clean, and the blues don't push him to smoke crack anymore. He's
got his life back including his 16yearold daughter.

Because so many addicts compare drug craving to sexual desire, Childress
asked her young colleagues to put together a sex film from various adult
movies. She wanted to see whether the same parts of the brain that get lit
up in the PET machine during drug movies are activated during sex films.
Childress got volunteers to lie in the PET scan for 86 minutes, watching
people have sex.

It looks as if she was right sex and drug craving are seated in the same
part of the brain.

Though she shot and edited the drug films, Childress was shy about the sex
film and has never seen it. She'll tell you that there are limits, even for
dedicated brain scientists.

Still, her work will continue. She explains it simply: "I am obsessed with
craving."