60 Minutes held its first-ever live Facebook chat last night, and we had a great turnout as people fired away questions for Dr. Nora Volkow, director of the National Institute on Drug Abuse, part of the NIH.
Dr. Volkow gave answers and guidance on issues of drug use, abuse, addiction and treatment, and the following is a transcript of those questions and answers.
Dr. Volkow was profiled by Morley Safer last Sunday in his story, "Hooked."
Please note that this chat provided general information on the science of addiction and didn't focus on individual cases. For people who want information on treatment, you can check with your doctor or go to: http://findtreatment.samhsa.gov/
For more information on drug abuse and treatment, go to NIDA's website: www.drugabuse.gov
The Q&A Begins:
60 Minutes: We're going to start off with a question sent to us a few days ago about military veterans with substance abuse problems. Jake writes: Dr Volkow: What do you suggest we do with the increasing amount of military vets who return from war with severe drug addictions, especially of pain killers? Someone in my family has been gravely affected and is now in rehab.
Dr. Volkow, NIDA: Jake, I am sorry to hear about your family's situation. There are effective treatments for painkiller addiction that veterans can take advantage of, which may include medications like suboxone (buprenorphine) or vivitrol (http://1.usa.gov/IFdzwt). NIDA is actively supporting research on how to make treatments more effective. You can find more information at http://1.usa.gov/JQrfqo. Good Luck.
Tom: Dr. Volkow, do you think the recent advances in controlling specific neural circuits with light (optogenetics) and chemicals (eg DREADDs) will ever be applied to human populations to correct for chronic drug induced alterations in function (eg hypofrontality)?
Dr. Volkow: Hi Tom. In theory it's a good idea, but the technology is not there yet, even in animals. Hopefully we will learn more and be able to think about this. / NV
60 Minutes: Jolene asked this question a few days ago: I have a question. Why after many years of recovery, 10+, do some recovering addicts relapse? What in our brain tells us to seek out our drug of choice after soooo many years of freedom? How long does it take for our brains to re-learn "normalcy". For me, I feel as though relapse becomes a choice for some people especially if the tools were used towards success after many years.
Dr. Volkow, NIDA: Jolene - You have hit on a key reason why addiction is such a difficult disease to recover from. Many people remain vulnerable to relapse for a very long time, and may need some level of treatment (or support group participation) for their entire lives. One reason for this is that the brain reacts to cues that were associated with drug use (peoples, places, things), which trigger intense cravings and are difficult, but not impossible, to overcome. This can happen even years after last use of the drug. The association in the brain is that strong.
Casey: In terms of food addiction, what are your thoughts on parents and teachers using food as a reward with children?
Dr. Volkow: Hi Casey - Good observation--making food a reward (especially high fat or sweet foods) for good behavior could have unintentional downsides. The brain pathways overlap for addiction to drugs and for other compulsive behaviors such as uncontrolled overeating, gambling, etc. So you don't even need to use food as a reward to make it "rewarding" in the brain; but I agree, we do not need to increase the salience of fatty and sweet foods in our young people who are already at greater risk of obesity now than in years past for many reasons. / NV
Phoenix House: Greetings from Phoenix House. Great to see Dr. Volkow increasing awareness about addiction
Dr. Volkow, NIDA: Phoenix House - Thanks for joining us and being a great supporter in the fight against addiction.
Dr. Volkow, NIDA: We've been getting a lot of questions about whether not it is possible that a person on drugs can function normally. By definition addiction means that a person's normal life is being interfered with, their thinking revolves around getting and using the drug, they are not able to stop, and their ability to make good decisions is compromised. However, there are exceptions. Someone who is addicted to nicotine can function normally--at least until it takes its toll on their health.
Martha : How can so many people be addicted to pain killers?
Dr. Volkow: Hi Martha - These medication are widely available and highly addictive. As a result they are relatively easy to get and particularly when used outside medical supervision can results in addiction. Moreover many people think that because they are prescribed by doctors they are not so dangerous as illicit drugs, but this is not the case. / NV
Marc: I have been smoking marijuana on a daily basis for over 40 years and I can stop and start whenever I need to. Why am I not addicted?
Dr. Volkow: Hi Marc - Not everyone becomes addicted to drugs and we are studying what determines the differences between people. One factor that is very important is your genes. But there may be other adverse consequences, including to both your physical and mental health. / NV
Colleen: Hi Dr Volkow. I'm a drug counselor with my MSW and I am very interested in the neuroscience of addiction. I'm curious what books or websites you recommend to someone who wants a deeper understanding of addiction but does not have an extensive science background.
60 Minutes: Dr. Volkow, we have gotten a lot of Facebook questions about free will, about people using addiction as an excuse not to kick their habit. Give us your thoughts on this. How powerful is will power?
Dr. Volkow: Great question on free will. It's true that the first time someone tries a drug it's a willful choice, but over time the drugs change the brain and the ability to "choose" to stop is compromised.
Addiction is not so different from other diseases that also involve choices before the disease takes hold. Think about heart disease. It can be caused smoking, eating fatty foods, etc, but once the heart is diseased, we do whatever is necessary to help a person recover--that includes medication and healthy behaviors--which they are responsible for doing.
Addiction is the same, and one of the goals of treatment is to re-train the brain to restore a person's ability to make good choices. / NV
Karina: Could overeating and cravings be linked to liver malfunction?
Dr. Volkow: Hi Karina - Yes in fact consumption of diets rich in fat can produce liver damage. / NV
Two questions about genes and addiction:
Frankie: Dr. Volkow- Do you think there is any variation between substance- based addiction and behavioral based addictions? Do you think that all humans have the possibility of becoming addicted, or is it a genetic predisposition?
Jose: Is addiction linked in any way to a genetic predisposition?
Dr. Volkow: We've been getting a lot of questions about whether addiction is genetic. We know from research that genetics account for about half of an individual's vulnerability to addiction.
Neglected: In a scale 1 to 10, being 10 the most addictive (heroin?), where do you place marijuana? In a scale 1 to 10, being 10 the most dangerous for the body (meth?), where do you place marijuana?
Dr. Volkow: Chemically the most potent drug is methamphetamine, and it would get the ten on an addictiveness scale. Marijuana is harder to quantify since its potency depends on the relative content of THC as well as other components. Also there are people that are more sensitive to the addictive effects of one drug vs. another. For example, alcohol which is not very potent can be terribly addictive to those that have the genetic risk. / NV
Samantha : Still interested on your opinion of synthetic marijuana. I have seen my son's dad deteriorate off this stuff. He used to be a very nice guy until he began to do this. Now he has a bad temper and smokes this stuff very often. I would like to know your opinion of the stuff and any info u can offer me. This stuff is killing people all over and sending CHILDREN into hospitals
Dr. Volkow: Hi Samantha - Great question about K2. K2 or Spice abusers who have been taken to poison control centers report symptoms that include rapid heart rate, vomiting, agitation, confusion, and hallucinations. Spice can also raise blood pressure and cause reduced blood supply to the heart (myocardial ischemia), and in a few cases it has been associated with heart attacks. / NV
60 Minutes: Dr. Volkow, we've been getting a lot of comments and questions about marijuana and whether it's addictive, and the impact it has on the brain. Can you address that issue?
Dr. Volkow: Marijuana is not a benign drug. Research shows that 1 in 11 who try it will become addicted, a risk that increases to 25-50 percent among daily users. We also know that it can affect attention, learning and memory. Not to mention it's effects on coordination, which impair a person's ability to drive. / NV
Norman: Can you describe the difference between psychological and physical addiction?
Dr. Volkow: Hi Norman - That was a distinction made in the past that is no longer used. We now know that psychological processes are also the result of our brain, and addiction involves physical and functional changes to the brain that affects how we think and behave. / NV
Tim: How will the current debate over the FY 13 budget have an impact on NIH research budget?
Dr. Volkow: Tim--these are going to be challenging times and it will mean that we need to prioritize very carefully what we fund and work better to share data and costs across the NIH. This will be particularly difficult for very expensive, but crucial studies, including clinical trials. Nevertheless, we will continue to support the best science to help us accomplish our public health mission. / NV
60 Minutes A question from viewer Aaron: Why do you have one or several approaches to rehab when you have proven there are an infinite number of causation combinations? How do you plan on augmenting your suggested approach to psychotherapy as a result?
Dr. Volkow: Matching treatment--settings, programs, and services--to a person's unique problems and needs is key to its success. Things to take into account include a person's age, gender, ethnicity, culture, addiction severity, co-occurring disorders, and previous efforts to stop drug use. The best programs offer a combination of therapies and other services tailored to the patient, who may also need medicine, family therapy, parenting support, job training, and social and legal services. For more info, see http://1.usa.gov/K50jEo. / NV
Seth: Dr. Volkow, I enjoyed your findings as you stated substance abuse was a disease, specifically in reference to decreased dopamine receptors in the brain. Drug policy reformers have strenuously argued for sentencing policy that favors treatment identifying motivating factors for drug-related crime, instead of punitive incarceration. Do you think your findings will give aid to theories supporting treatment programs for low-level offenders in non-correctional facitilities, or do you feel implementation of treatment in these facilities is a more effective treatment model?
Dr. Volkow: Hi Seth - Overall I favor the model of treatment programs, but if an individual is going to be incarcerated, then a treatment program should be given while in jail or prison and there should also be a plan for follow up after release. For more info, see http://1.usa.gov/InCczS. / NV
Frankie: I come from a long lineage of addictive personalities, which helped me to realize that even though I hadn't been arrested, had DUI's, had severe health issues, and wasn't prostituting for my addiction, I was heading that way. I got into recovery at 21 years old and currently have 8 years, 5 months clean and sober. But in recent years, my addiction has shape-shifted to behavioral addictions, things that society doesn't consider as severe, thus it gets swept under the rug.
Dr. Volkow: Hi Frankie - I do think that all humans have the potential of becoming addicted, but there are large differences between people on how easily they can become addicted. This is due to genetics, but adverse environments also play a role and situations of intense stress can increase the risk for a person to become addicted
There are also behaviors, such as gambling and compulsive overeating that vulnerable individuals can engage in compulsively--meaning they are unable to stop despite adverse consequences. / NV
Patty: Is the disease of addiction the same as the disease of alcoholism and, if so, why have there never been maintenance drugs created for alcoholism? Can you explain why, of all drug addictions, narcotic addiction is the one that harm reduction is geared toward?
Dr. Volkow: Hi Patty - Yes alcoholism is an addiction just like that for other drugs. We have very few medications available for the various addictive substances, currently only for alcohol, nicotine and heroin. The use of methadone as a maintenance drug has to do with the fact that most people relapse once it's discontinued, but it would be desirable if we could have a medication that would allow the person to be able to stop their meds and remain abstinent. This is possible for certain individuals addicted to alcohol and also nicotine. / NV
60 Minutes: Pine asked this question on Facebook a few days ago: My cousin was in prison for many years for drug related charges. Why do crack addicts go right back on drugs? Is it that they don't want to quit, even after being off of drugs for such a long time?
Dr. Volkow: Anyone who has been addicted can be easily triggered to crave their substance of choice, sometimes before they're even aware of it--from stress or something they see, hear, or smell. This can even happen years after their last use of the drug, especially if they've never had treatment. The association in the brain is that strong--and forced abstinence by being in prison does not equal treatment. / NV
NIDA: A few people have asked about how they can quit smoking. There are medications available to treat tobacco addiction including nicotine replacement (e.g., patch, gum), bupropion and varenicline. You can also go to smokefree.gov or call 1-800-quit-now for more resources.
Colleen: Dr. Volkow, I have a rare type of muscular dystrophy and I find that medical marijuana/hash work so much better on my pain then pain meds, and my body doesn't go through withdrawls. I would like to know how you feel about the medical benefits of medical marijuana?
Dr. Volkow: Hi Murphy - Marijuana is a combination of chemicals that interact with your body's cannabinoid system. This system modulates pain among other things, which is the reason why marijuana can relieve pain. In fact, scientists are trying to develop medications that are based on cannabinoids, which have fewer side effects and are not smoked, that may help in the treatment of pain and other conditions. / NV
Larry: I have thought for the last year or so that my food addiction has to do with depression. I have long been an addict -- before it was with substance abuse, then I switched. Will power does nothing for me to stop the eating badly routine.
Dr. Volkow: Hi Larry - Being depressed makes you more vulnerable to addictive behaviors initially in an attempt to feel better. However the addictive behaviors can occur with or without depression. Stress will always make it harder to stop, but creating new routines (e.g., exercising) can help break bad habits. For more info see http://1.usa.gov/KtJnGO. NV
Rosemary: If a drug/etho [ethyl alcohol] addict gets and stays clean, does the brain recover? In other words, are the receptors restored? My son has used and a used drugs and etho since he was a teen. He has been through rehab twice. He is now on methadone. Any chance his brain cells can recover from the abuse? Thank you, Dr. Nora.
Dr. Volkow: Hi Rosemary - We know that the human brain can recover significantly. However the degree of recovery varies from person to person and is dependent, among other things, on how long the exposure to the drugs has been, as well as doses and drug combinations. In general young people have a greater likelihood of recovering from insults to their brains. Thanks for your question. / NV
Katherine: Dr. Volkow spoke of her frustration during med school concerning a lack of knowledge and expertise with addiction. How do we add more in the med ed curriculum as well as training for mental health and health professionals?
Dr. Volkow: Hi Katherine - That's a great question. We've actually been working with medical schools to develop substance abuse curricula. We also have other resources to help physicians address substance abuse in their practices. We know they can be the first line of defense against substance abuse and addiction. See http://1.usa.gov/GD6IS1. / NV
Lori: Dr. Volkow, thanks for helping to educate about this insidious disease. Is there research being done using the neuroplasticity of the brain to address / enhance addiction treatment? Do you know what percentage of addicts have co-occuring issues?
Dr. Volkow: Hi Brandon - Yes we are funding several researchers to help develop interventions that can reverse neuroplastic changes triggered by drugs and help strengthen circuits that may not be functioning well. The idea is for medications to be used in combination with behavioral interventions to help recovery.
To your other question, we don't know the exact numbers, but the majority of individuals suffering from an addiction have co-morbidity at some time in their life (commonly: depression, anxiety, and other mood and attention disorders). / NV
Eric: I've been an addict for the last 8 years of my life started with pot and I've done just about everything from nutmeg to Dramamine, but then I found something that really grabbed ahold of my life and hasn't let go and that would be opiates. Is it true that if you abuse opiates long enough, your endorphin system will not ever function normally again? And does dopamine ever come back? I take L-tyrosine because it's a precursor to L-DOPA, which supposedly increases the amount of dopamine in your brain. Does L-tyrosine work for restoring dopamine receptors?
Dr. Volkow: Hi Eric - When you take heroin you decrease the production of your own opiates, which is why when you stop the drug you feel so bad. We believe that upon stopping your brain will slowly recover, though we don't know if you recover completely or how long it will take.
The dopamine receptors recover in some people, but we do not know if this occurs in all of those who stop taking drugs. For more info on the science of addiction see http://1.usa.gov/yCE2Sh. NV
Ando : What can you do to stop your addiction or prevent an addiction?
Dr. Volkow:. Hi Ando - The best way to prevent an addiction is to never start using drugs. But if you are using, there are effective treatments to help you stop, including both medications and behavioral therapies. For more information see http://1.usa.gov/K50jEo. NV
Colleen : I personally think doctors try to push Suboxone/methadone down people's throats. Instead of getting to the problem, there are just masking it
Dr. Volkow: Hi Colleen - Some individuals cannot just stop taking heroin, and as much as the doctors and the family try to help, they relapse. For them, methadone or buprenorphine can help then recover and lead normal lives.
Heroin is a very addictive and dangerous drug and without treatment the mortality rate is very, very high. For more information on medication-assisted treatment see http://1.usa.gov/IFdzwt. / NV
Sarah: Hello Dr. Volkow I believe my friend is addicted to prescription pills, Vicodin and Percocet to be exact. He does not take them as prescribed, and he takes them even when he's not in pain, but instead he likes the feeling he gets when he takes these pills. My friend does not believe taking these pills is a serious problem. How can I help him recognize this is a problem before it's too late?
Dr. Volkow: Hi Sarah - I would encourage you to convince him to see a doctor so he or she can discuss with him the dangers of using these medications. Not only are they addictive, but they also can result in overdose. These are powerful medications that should not be used without a careful oversight by a physician. For more information see http://1.usa.gov/xAJry2. / NV
Davissa: I have an addition to Sarah's question -- how do you help the people who are unknowingly supporting and/or condoning the drug addict's problem to make the unsuspecting party realize there is a problem?
Dr. Volkow: Hi Davissa - Make sure the people who are unknowingly supporting/condoning the problem know that the dangers of prescription drug abuse as well. In addition to the website above, we have one on prescription drugs for teens - http://1.usa.gov/cjP6ZN. Thanks / NV
Maggie: I would like to find out about shopping addiction, especially with the internet and the targeting of products to the consumer. As a sober alcoholic who's moved from one addiction to another, when I finally quit drinking -- and have had no problems with relapsing at all, not even a thought in my mind to drink -- I somehow found myself addicted to online shopping and the entire process of shopping online and then receiving the packages, it was almost euphoric. Is it possible that the same areas of the brain "light up" when something that seems as simple as shopping can trigger this addictive response? Will this cycle ever end of a sort of non-stop replacement of one addiction with another?
Dr. Volkow: Hi Maggie - What you are experiencing is indeed the activation of the reward brain regions that are driving you to do the behaviors. Avoiding being in a situation where you can engage in internet shopping may help you stay away from it. Learn how to recognize the urges and force yourself into new routines that can protect you against engaging in compulsive behaviors. / NV