again. We believe that’s because that stress is causing perhaps the same release of dopamine” that substance abuse causes.
Volkow points out that there is an overlap in the circuits and brain areas that are affected by drugs and stress. And what ties those areas together? What commonality do they have? It all boils down to dopamine. “Dopamine is there not only to signal pleasure but actually to signal saliency, and as you recognize, of course, pleasurable events are very salient.” We need to learn from them. “But a stress is also very salient, because if we do not learn from it, when we are exposed to it again we may not avoid it.
“So anything that has importance, in terms of the survival of the species, that connotes a need to learn an experience, so you can change your behavior accordingly, will involve dopamine. When you are exposed to a stress, you are going to be releasing dopamine. And that’s going to drive a similar circuitry to that that we see in drug addiction.”
In individuals who are addicted, the increase in dopamine by itselfis a conditioned response. “It’s a learned memory response that’s associated with the drug. And this is probably one of the reasons why, when a person that’s going through recovery is stressed, and then they relapse, it’s in a way similar to the way they relapse when they get exposed to a stimulant that, in the past, they had associated with the use of drugs.”
STIGMA: ROADBLOCK TO RESEARCH
Is there any way, medically, to reverse the addictive wiring in the brain, perhaps through new medications? Volkow says it’s a “very challenging question indeed.” The federal government is trying to encourage researchers using laboratory animals “to do exactly that. Can you strengthen certain pathways that have been damaged by the chronic use of drugs? There are some very interesting compounds that, for example, are targeting the disruptions that exist in the memory circuit. We’re also looking to strengthening the ability of your brain, through cognitive operations, to regulate your emotions and your desires. And this is, of course, a pathway that is badly eroded by the usage of drugs. Those compounds are currently being investigated in animal studies, some with actually fascinating positive results. But it’s very difficult to get these compounds into the clinic.”
Why can’t we move toward testing these drugs in humans? First, says Volkow, because the process is very, very expensive, and as is the norm in developing new drugs, that burden falls on the pharmaceutical industry, “and here in the pharmaceutical industry, it’s not one of their primary interests.” It’s not just the expense that turns them away. Drug companies routinely spend hundreds of millions of dollars developing a new drug. In this case, Volkow believes the reason is quite different. Drug companies fear “that drug addiction is stigmatized.” And drug companies don’t want to be associated with unpopular illnesses. “That certainly doesn’t help the translation of potentially promising medications into the practice. We cannot get them into the clinics. We cannot get that translation from the animal experiments into the humans as fast as we could, because of restriction and budgets. The government has to carry the costs that are associated with these medication developments.”
What may change this attitude is the profit motive. Drug companies understand profits. Drug addicts may not constitute a large enough market to be profitable, especially if many of them are not covered by health insurance. But what is slowly dawning on researchers and the drug industry—with the prodding of Volkow and researchers like her—is the potential for much larger profits from a much larger pool of customers. “You don’t necessarily need to address it as a medication for cocaine addiction but rather a medication for addiction in general. And then you can start to recognize that, indeed, the
Volkow points out that there is an overlap in the circuits and brain areas that are affected by drugs and stress. And what ties those areas together? What commonality do they have? It all boils down to dopamine. “Dopamine is there not only to signal pleasure but actually to signal saliency, and as you recognize, of course, pleasurable events are very salient.” We need to learn from them. “But a stress is also very salient, because if we do not learn from it, when we are exposed to it again we may not avoid it.
“So anything that has importance, in terms of the survival of the species, that connotes a need to learn an experience, so you can change your behavior accordingly, will involve dopamine. When you are exposed to a stress, you are going to be releasing dopamine. And that’s going to drive a similar circuitry to that that we see in drug addiction.”
In individuals who are addicted, the increase in dopamine by itselfis a conditioned response. “It’s a learned memory response that’s associated with the drug. And this is probably one of the reasons why, when a person that’s going through recovery is stressed, and then they relapse, it’s in a way similar to the way they relapse when they get exposed to a stimulant that, in the past, they had associated with the use of drugs.”
STIGMA: ROADBLOCK TO RESEARCH
Is there any way, medically, to reverse the addictive wiring in the brain, perhaps through new medications? Volkow says it’s a “very challenging question indeed.” The federal government is trying to encourage researchers using laboratory animals “to do exactly that. Can you strengthen certain pathways that have been damaged by the chronic use of drugs? There are some very interesting compounds that, for example, are targeting the disruptions that exist in the memory circuit. We’re also looking to strengthening the ability of your brain, through cognitive operations, to regulate your emotions and your desires. And this is, of course, a pathway that is badly eroded by the usage of drugs. Those compounds are currently being investigated in animal studies, some with actually fascinating positive results. But it’s very difficult to get these compounds into the clinic.”
Why can’t we move toward testing these drugs in humans? First, says Volkow, because the process is very, very expensive, and as is the norm in developing new drugs, that burden falls on the pharmaceutical industry, “and here in the pharmaceutical industry, it’s not one of their primary interests.” It’s not just the expense that turns them away. Drug companies routinely spend hundreds of millions of dollars developing a new drug. In this case, Volkow believes the reason is quite different. Drug companies fear “that drug addiction is stigmatized.” And drug companies don’t want to be associated with unpopular illnesses. “That certainly doesn’t help the translation of potentially promising medications into the practice. We cannot get them into the clinics. We cannot get that translation from the animal experiments into the humans as fast as we could, because of restriction and budgets. The government has to carry the costs that are associated with these medication developments.”
What may change this attitude is the profit motive. Drug companies understand profits. Drug addicts may not constitute a large enough market to be profitable, especially if many of them are not covered by health insurance. But what is slowly dawning on researchers and the drug industry—with the prodding of Volkow and researchers like her—is the potential for much larger profits from a much larger pool of customers. “You don’t necessarily need to address it as a medication for cocaine addiction but rather a medication for addiction in general. And then you can start to recognize that, indeed, the
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