point enough. “If you follow along on that model and continue to think about it—for someone who’s being treated for diabetes or heart disease or hypertension, what you hope you would do is you would help them in the acute first illness that they had, and then you enter them into treatment. And you want them to be monitored over the long term to keep them healthy and hopefully to prevent any more acute episodes.
“This is very similar to substance abuse treatment. People come in with an acute problem, you treat them, and then what you’d really like to do is enter them into care where they’re followed to keep them as healthy as possible. If people are connected to care, if there is a stressful life event or something else that comes up, they’re already hooked into care and they can usually continue how they’re doing or circumvent any exacerbation in their condition, hopefully avoiding, if possible, another major episode.
“This is truly a model of keeping people well over time, one that it’s really important we begin to implement for people with substance use disorders. We have many models in chronic disease care that work. We know that this is a kind of model that will work for substance abuse as well, over the long term.”
LOOKING AHEAD
Researchers are always looking for new questions to answer. What would we like to know about the brain that we don’t know now, and how could we get to know it? Where should the limited dollars for research be invested?
“I would put more money into really defining both the molecular changes in the brain that happen in response to substances of abuse or during addiction, but really beef up the imaging approaches so we can really understand, because the devil is always in the details,” says Dr. Malenka. “Which specific brain areas, which specific connections, which circuits in the brain are really being modified in a semipermanent way during addiction?”
Malenka also thinks we should invest in trying to identify both genetically and through other approaches those people who’re going to be most vulnerable to developing addiction, especially kids. “I believe people really start developing their problems mostly during adolescence, late adolescence to early adulthood, and I think it would be wonderful if we could identify those specific individuals that are going to be particularly susceptible and vulnerable to addictions.”
As for Volkow? “I’d like to be able, with the money, to create the knowledge that would allow us to have devoutness for substance abuse—the knowledge that would drive and motivate and intensify the pharmaceutical industry to be able to fund medications into clinical practice. And finally, to use that knowledge to create more targeted prevention, such that less people get exposed to drugs.”
CHAPTER FIVE
SLEEP AND LEARNING: CAFFEINE IN YOUR BEER
Laugh and the world laughs with you, snore and you sleep alone.
—ANTHONY BURGESS
Birds do it. Bees don’t. We do it more than elephants but less than bats or opossums. Of course, I’m talking about sleep—something you can’t do without, yet few of us, it appears, get enough of it.
Writers, poets, and scientists have pondered this mysterious state of consciousness for centuries, asking questions such as: Why do we even need to sleep? Why would evolution favor sleep? Think about it. When you’re asleep you’re in your most vulnerable position. You’re unable to defend yourself from an enemy. So what’s the payoff here? Are there crucial biological functions that can take place only when we sleep? And if so, what happens when you don’t get enough sleep? Does memory suffer? Are there deep psychological things that are going on when we sleep that we don’t even know about?
Yet millions of people are not getting enough sleep. Whether it’sbecause of snoring, restless leg syndrome, or sleepwalking with a pint of ice cream, a staggering number of people don’t sleep well at
“This is very similar to substance abuse treatment. People come in with an acute problem, you treat them, and then what you’d really like to do is enter them into care where they’re followed to keep them as healthy as possible. If people are connected to care, if there is a stressful life event or something else that comes up, they’re already hooked into care and they can usually continue how they’re doing or circumvent any exacerbation in their condition, hopefully avoiding, if possible, another major episode.
“This is truly a model of keeping people well over time, one that it’s really important we begin to implement for people with substance use disorders. We have many models in chronic disease care that work. We know that this is a kind of model that will work for substance abuse as well, over the long term.”
LOOKING AHEAD
Researchers are always looking for new questions to answer. What would we like to know about the brain that we don’t know now, and how could we get to know it? Where should the limited dollars for research be invested?
“I would put more money into really defining both the molecular changes in the brain that happen in response to substances of abuse or during addiction, but really beef up the imaging approaches so we can really understand, because the devil is always in the details,” says Dr. Malenka. “Which specific brain areas, which specific connections, which circuits in the brain are really being modified in a semipermanent way during addiction?”
Malenka also thinks we should invest in trying to identify both genetically and through other approaches those people who’re going to be most vulnerable to developing addiction, especially kids. “I believe people really start developing their problems mostly during adolescence, late adolescence to early adulthood, and I think it would be wonderful if we could identify those specific individuals that are going to be particularly susceptible and vulnerable to addictions.”
As for Volkow? “I’d like to be able, with the money, to create the knowledge that would allow us to have devoutness for substance abuse—the knowledge that would drive and motivate and intensify the pharmaceutical industry to be able to fund medications into clinical practice. And finally, to use that knowledge to create more targeted prevention, such that less people get exposed to drugs.”
CHAPTER FIVE
SLEEP AND LEARNING: CAFFEINE IN YOUR BEER
Laugh and the world laughs with you, snore and you sleep alone.
—ANTHONY BURGESS
Birds do it. Bees don’t. We do it more than elephants but less than bats or opossums. Of course, I’m talking about sleep—something you can’t do without, yet few of us, it appears, get enough of it.
Writers, poets, and scientists have pondered this mysterious state of consciousness for centuries, asking questions such as: Why do we even need to sleep? Why would evolution favor sleep? Think about it. When you’re asleep you’re in your most vulnerable position. You’re unable to defend yourself from an enemy. So what’s the payoff here? Are there crucial biological functions that can take place only when we sleep? And if so, what happens when you don’t get enough sleep? Does memory suffer? Are there deep psychological things that are going on when we sleep that we don’t even know about?
Yet millions of people are not getting enough sleep. Whether it’sbecause of snoring, restless leg syndrome, or sleepwalking with a pint of ice cream, a staggering number of people don’t sleep well at
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