&: Addiction and the brain

St. Paul Pioneer Press Posted on Wed, Oct. 09, 2002
Addiction prescription
BY KITTA MACPHERSON
Newhouse News Service

Joy, love, success AC/a,!aEU the magic that makes life worthwhile AC/a,!aEU are not bewitching enough for some people. They trade happiness for cocaine, heroin, painkillers, alcohol, cigarettes or food.
These people are addicts, and they're all around us.

Now, science is on the brink of developing breakthrough medications to treat addiction. The work is bringing the country to the verge of a new era in medicine in which addiction will be treated as a disease, not a personality defect.
The change is based on an insight gleaned from the work of hundreds of brain researchers: that addiction rewires the brain, dooming its owners to a downward spiral of self-defeating behavior.
"What's coming are medications and behavioral treatments that are going to be both subtle and effective," said Francis Vocciof the National Institute of Drug Abuse in Bethesda, Md.

"There's just an explosion of things going on."

A slew of medications AC/a,!aEU drugs that could break the death grip of illicit and prescription drugs, alcohol, cigarettes, even food and other substances AC/a,!aEU are being studied. Many are available now for other purposes.

For instance, buprenorphine, under review by the Food and Drug Administration as a treatment for heroin addiction, is a painkiller used to counter postoperative pain. Selegilene, a promising treatment being studied to fight cocaine addiction, currently is used to treat Parkinson's disease.

While interest in such approaches is steadily growing, change in treatment is not endorsed unanimously within the medical establishment. Some say willpower still plays a key role in behavior. Others question whether it is appropriate to give addicts more drugs, furthering the cycle of dependence.

"I don't buy the whole biological model of addiction," said Stanton Peele, a psychologist and attorney. "People become addicted to substances or things because there is something missing from their lives. Taking a pill is not going to address the problem."

Those in law enforcement who see drug-related murders, rapes and robberies daily would love to see the problem go away. But they are watching and waiting.

"I'm all for trying new things," said Essex County (N.J.) Sheriff Armando Fontoura, whose narcotics bureau makes thousands of drug arrests every year. "But I also know that heroin was introduced in the U.S. a century ago to fight morphine addiction. That didn't work out very well, did it?"

Scientists developing new drugs for addiction dismiss such qualms. Drug addiction needs to be viewed in a new light, they say: as a chronic health issue that requires prevention and long-term treatment.

Addiction, generally defined as an overwhelming compulsion to perform certain acts knowing they are self-destructive, is Western society's most serious public health concern. More than 14 million Americans suffer from chronic alcohol and drug abuse, a figure far surpassing the estimated 8 million who have cancer.
Government studies show that alcoholism costs American society about $90 billion a year and drug addiction an additional $67 billion a year. The majority of the costs are productivity losses, particularly those related to incarceration, careers in crime, medical bills and premature death.

If cigarettes and food are included in the damage assessment, the figures are believed to be much larger.

BRAIN FUNCTION

The coming changes in treatment are based on the combined efforts of hundreds of researchers working over the past decade to explore the complexities of the human brain. Armed with powerful imaging technologies, scientists now know more about the effects of addictive drugs on the brain than about almost any other aspect of brain function.
People in the field are betting on a miracle AC/a,!aEU that addiction will lose its stigma. Once that happens, addiction will be just another in a long list of brain diseases, like bipolar disorder, depression and schizophrenia, scientists say.
"The search for an effective treatment for addiction has been hampered by social strictures," said Walter Ling, a professor of psychiatry at the University of California. "For so long, society has thought of drug addicts as sinners, making them jump through hoops, hoping that the treatment doesn't make them feel so well. As people begin to understand that this all comes from the brain, my hope is that attitudes, and treatment, will change."
But some basics are slow to change.

"People take drugs for two reasons AC/a,!aEU to feel good and to feel better," said Herbert Kleber, a former White House drug adviser and now a physician-researcher at Columbia University in New York.

If a person tries a drug once, what is the likelihood he will become dependent on it? "Surprisingly high," said Kleber, who has studied the syndrome.

In the case of nicotine, 32 percent of those who smoke will get hooked, according to a federal study. For heroin, the study shows, it's 23 percent; for cocaine, between 17 and 23 percent; for alcohol, 15 percent; and for marijuana, 9 percent.

Addiction now is treated with a combination of psychotherapy and a handful of drugs. Patients learn coping and training skills. Twelve-step programs, like those offered by Alcoholics Anonymous, are designed to address the underlying reasons for the patient's substance abuse.

But between 40 percent and 60 percent of patients treated for addictions return to active substance abuse within a year after being discharged from treatment.

The basic research of today, scientists say, will lead to far better, more customized therapies a decade from now. As scientists learn how abused substances affect brain chemistry, they are hoping to design highly targeted drugs that eventually will treat addiction on a chemical and even a genetic level.

Understanding what parts of the brain are affected will aid in the development of targeted medicines. Much of the search centers on the hope that there's a common "pathway" for addiction AC/a,!aEU a route through brain circuitry shared by heroin, cocaine, nicotine, alcohol and food AC/a,!aEU so that a "magic bullet" drug can be developed to address any form of compulsive, self-destructive behavior.
In the long term, scientists are working to develop medications that keep abusive substances out of the brain. This will be done by finding drugs that zero in on the addictive processes, targeting neurotransmitters that block the abusive substance's action or reverse the biochemical changes that cause compulsion, craving and loss of control.

Researchers expect to combine medication with therapy for optimal treatment. For now, that's seen as the ideal approach, tackling both biological and social problems that keep addicts from getting better

Edited by: lizwool at: 10/13/02 1:10:12 pm

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St. Paul Pioneer Press Posted on Wed, Oct. 09, 2002

What researchers learn from rats
BY KITTA MACPHERSON
Newhouse News Service

UPTON, N.Y. AC/a,!aEU Panayotis Thanos gave 12 rats a choice: take a nip now and then or stay sober.

For three to four hours each day, for eight weeks, the 33-year-old neuroscientist observed the behavior of white Sprague Dawley lab rats, each brought daily to its own plexiglass cage, lined with soft cotton bedding.

Thanos, working at Brookhaven National Laboratory, wanted to know which of the rats would become addicts. To find out, he gave them alcohol and let their behavior speak for what was going on inside their brains. Then, he tried to cure them.
His addiction trial, which he is currently repeating with cocaine, is at the forefront of neuroscience and modern research.

"Once you understand how the brain mechanisms controlling this behavior work and what the components are, you can introduce effective treatments. And cures," Thanos said.
Some of Thanos' rats grew to prefer the ethyl alcohol they found in one bottle over the water in the other. The booze was slightly sweetened at first, like a wine cooler. Eventually, some rats binged, sipping the alcohol compulsively AC/a,!aEU even when it was no longer sweet AC/a,!aEU until they fell into a stupor.

By allowing the animals to choose what to drink, tracking their behavior over time, then scanning their brains with imaging equipment, Thanos discovered which rats got addicted to alcohol and began to work on why they did so.

Scientists know that addictive drugs like alcohol feel good for a reason. They mimic brain chemicals that signal "reward" in the mind.
The delicately regulated reward system has evolved over thousands of years to ensure human survival. In it, naturally occurring neurochemicals signal "good" when food is spotted, when sex is possible and when a threatening situation dissolves. Addictive drugs hijack this reward pathway and disturb the normal mechanisms that keep people on an even keel.

The use of addictive substances could be seen as a reckless attempt to sabotage one's brain, perhaps the most finely tuned machine on Earth.

Researchers have found major differences between the brains of addicts and nonaddicts. And they have found some common brain elements of addiction, regardless of the substance involved. Genetic studies also have been useful in identifying inherited traits that are strongly linked to substance abuse.
The horror of addiction, according to scientists, is not just that some people may be predisposed to abusing drugs. It is what happens to the brain as the addict develops a taste for the poison AC/a,!aEU changes that may force the behavior to continue.

Thanos has his rats to prove it.

Edited by: lizwool at: 10/13/02 9:01:36 am