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In 1997, a one page article was published in the journal Science, “Addiction is a Disease of The Brain, and It Matters.” Written, by Alan Leshner, Director, of the National Institute on Drug Abuse (NIDA), Leshner’s paper, was the first to make the case and bring forth the notion, that addiction was a disease of the brain. Leshner based his claim on recent advances in neuroscience, citing research that, “virtually all drugs of abuse (had) common effects, either directly or indirectly, on a single pathway deep within the brain.” Known as the reward pathway, “activation of this system appears to be a common element in what keeps drug users taking drugs.” Further, Leshner wrote, “prolonged drug use cause(d) pervasive changes in brain function that persist long after the individual stops taking the drug,” and cited significant effects of chronic use that had been identified, “molecular, cellular, structural, and functional. The addicted brain,” he wrote, “is distinctly different from the non-addicted brain in brain metabolic activity, receptor availability, gene expression, and responsiveness to environmental cues,” and summed up his argument, now and forever forward know as the brain disease model of addiction, stating, “that addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease.” Proclaiming addiction a medical problem in 1997, was like comparing alcoholism to diabetes, indeed that is exactly what it is, and does not conform to our common held beliefs and views— that drug addicts and alcoholics are weak, bad people, immoral, persons lacking an ability to control oneself, people who just can’t “say no.” Leshner confronted this issue in his landmark article, “The gulf in implications between the “bad person” view and the “chronic illness sufferer” view is tremendous. There are many people who believe that addicted individuals do not even deserve treatment.” Twenty years have passed since the brain disease model for addiction was introduced. It remains not widely known by the general public, nor is it fully known or accepted by the medical profession or those making public policy. The implications are indeed tremendous— we are in the midst of an Opiate Crisis in America, and its far more easy for a doctor to write a prescription opiate pain killers, yet far more difficult for a doctor to write one for.

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Methadone, an opiate that does not get addicts “high”, but is used as maintenance therapy, much like insulin for diabetics, to get addicts through the day, and get them off heroin. Addiction remains so poorly understood, last year, the newly elected president of the Philippines, Rodrigo Duterte, vowed to kill 3 million addicts (having already killed an estimated 3,000 in the first few months his presidency.) NIDA has focused their research not just on the brain, but on genetics — looking for a genetic link, they’ve not found one yet; and on the behavioral and social mechanisms involved. But their core research remains focused on the brain.  And addiction researcher has been focused on finding targets for treatment in the brain.  Baclofen, a generic medication used to treat muscle spasms, was accidentally found to treat cocaine addiction by a paralyzed cocaine addicted patient at the University of Pennsylvania in the late 1990s, and was found to cure alcoholism, by an alcoholic treating himself in Paris; the use of Transmagnetic Stimulation to treat cocaine addiction, was stumbled by chance by a researcher in Padua, Italy.  All three treatments work  by actions on the Dopamine Reward Pathway and related circuitry in the brain, but not all is understood,  and more work and much more continues to be done.  Another major area of focus is the Pre-Frontal Cortex. What researchers found in the Pre-Frontal Cortex the area of the brain involved in judgement and decision making— and these findings have been identified  across the broad range of substances of abuse and the behavioral addictions. There is a reason why addicts make poor decisions for themselves.  A crucial if not fundamental necessity of current addiction research is to eliminate the stigma of addiction and promote wider recognition of addiction as a chronic, relapsing brain disease.  When this happens, a new era of addiction treatment and how we view addicts and reatment will be upon us.

 

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