Hungry for the next fix: Behind the relentless, misguided search for a medical cure for addiction.

Author:Peele, Stanton
 
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As DIRECTOR OF the National Institute on Drug Abuse (NIDA), Alan Leshner toured the country with a PowerPoint presentation featuring brain scans. The show was a slightly more sophisticated version of the Partnership for a DrugFree America's famous ad showing an egg frying in a pan. As he flashed magnetic resonance images (MRIs) on a screen, Leshner would say, in effect, "This is your brain on drugs."

Leshner's message was threefold. First, certain drugs are inherently addictive. Second, scientists have discovered the neurochemical processes through which these drugs cause addiction. Third, that understanding will make it possible to develop drugs that cure or prevent addiction. Leshner's traveling PowerPoint show epitomized NIDA's reductionist approach to drug abuse: Take a brain, add a chemical, and voila, you've got substance dependence.

Leshner left NIDA at the end of November. Coincidentally, Enoch Gordis, head of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) since 1986, retired around the same time. Like Leshner, Gordis sees addiction as a biological problem with a pharmaceutical solution. He believes scientists have "the ability based on new knowledge from neuroscience research to develop pharmacologic treatments that act on brain mechanisms involved in alcohol dependence."

The view of addiction espoused by Leshner and Gordis is at odds with what we know about the actual behavior of drug users and drinkers--including evidence from government-sponsored research. These studies indicate that treatment is neither necessary nor sufficient for overcoming addiction. The main factor in successful resolution of a drug or alcohol problem is the ability to find rewards in ordinary existence and to form caring relationships with people who are not addicts. By looking instead for a magical elixir just over the horizon, NIDA and the NIAAA give short shrift to the individual circumstances that are crucial to understanding why some people abuse drugs.

'A Medical Illness'

NIDA's official mission is, in its own words, "to lead the Nation in bringing the power of science to bear on drug abuse and addiction." Leshner, who has a Ph.D. in physiological psychology, took the agency's helm in 1994. During his tenure NIDA's budget doubled to $781 million, money devoted mainly to biological research that approaches addiction as a disease.

Although drug use "begins with a voluntary behavior," Leshner said in a 2001 interview with The Journal of the American Medical Association, it ceases to be voluntary after it repeatedly affects the "pathway deep within the brain" common to all drug addiction. "There's no question it's a medical illness," he said, "and once you have it, it mandates treatment. It's a myth that millions of people get better by themselves."

Leshner's model of addiction emphasizes the special power of drugs. After all, he did not travel around the country with MRI images showing how shopping, gambling, or eating potato chips affects the brain. Thus it was startling to see him concede that drug abuse may be fundamentally similar to excessive involvements with other activities that give pleasure or relieve stress. "Over the past 6 months," he said in the November 2 issue of Science, "more and more people have been thinking that, contrary to earlier views, there is a commonality between substance addicdons and other compulsions?" Some of us have been making this point for years, and it does not fit very well with the idea that drugs create addicts by transforming their brains....

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