Big Think Interview With Nora Volkow
Nora D. Volkow, M.D., became Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health in May 2003. NIDA supports most of the world's research on the health aspects of drug abuse and addiction.
Dr. Volkow's work has been instrumental in demonstrating that drug addiction is a disease of the human brain. As a research psychiatrist and scientist, Dr. Volkow pioneered the use of brain imaging to investigate the toxic effects of drugs and their addictive properties. Her studies have documented changes in the dopamine system affecting the actions of frontal brain regions involved with motivation, drive, and pleasure and the decline of brain dopamine function with age. She has also made important contributions to the neurobiology of obesity, ADHD, and the behavioral changes that occur with aging.
Question: What makes dopamine such a powerful chemical?
Nora Volkow: Dopamine is a chemical substance that serves to send messages between two cells in the brain, and that's, we call neurotransmitters. There are many neurotransmitters and dopamine plays a key role in the areas of the brain that enable a wide variety of functions, best known is movement and when your dopamine cells die, for example, you cannot initiate movement, and that's Parkinson's disease.
But the effects of dopamine go way beyond movement and one of actions, very relevant for drug abuse and addiction, is it modulates the areas of the brain involved with our ability to perceive reward reinforcement and to be motivated by that reward to do actions. So, for example, it's so important that if you can generate through trans-genetic, genetic technologies, you can generate in a mouse that does produce synthesized dopamine. These animals will die of starvation because they don't have the motivation to engage in the behaviors to go and eat the food. You can rescue this animal by injecting dopamine into the areas of the brain that control this. But if you don't to that, these animals will die of starvation. And that really epitomizes how extraordinary important dopamine is. It gives you that energy, that drive to do things.
Now, drugs of abuse, we know that for the past 50 years, all of them, whether it's legal or illegal, they don't make any distinctions over there in terms of the pharmacology, they increase dopamine in specific areas of the brain, of the limbic brain. And this ability to increase dopamine when a person takes a drug is associated directly with what we call rewarding or reinforcing effects. So if you can actually manipulate it in such a way that to interfere with the ability of a drug to increase dopamine, than that drug is no longer pleasurable.
And so that's why dopamine is so important. Understanding why certain drugs can produce addiction and others not. If a drug produces increases in dopamine in these limbic areas of the brain, then your brain is going to understand that signal as something that is very reinforcing. And will learn it very rapidly, and so that the next time you get exposed to that stimuli, your brain already has learned that that's reinforcing and you immediately what we call a type of memory that's conditioning, will desire that particular drug.
Now, these mechanisms are not developed in our brains to take drugs. These mechanisms of dopamine signal reinforcement and once you have experienced it, getting conditioned to it is extraordinary important way for nature to ensure that humans, as well as animals, will perform behaviors that are indispensable for survival. So therefore, it shouldn't surprise us that behaviors such as eating or sexual behavior are linked with increases in dopamine and in the same areas that drugs do it. There are differences though, because natural reinforcers increase dopamine as a function very much of the context. What do I mean by that? If you're hungry, for example, and you get exposed to food, that will increase dopamine much more than if you just finished eating. And so as you eat, the ability of food to increase dopamine goes down and eventually disappears. And because it disappears, you are no longer motivated to eat the food.
Question: How is dopamine related to drug addiction?
Nora Volkow: What happens with drugs though, on the other hand, is they do not decline the ability to increase dopamine. So a person may take a hit of cocaine, snort it, it increases dopamine, takes a second, it increases dopamine, third, fourth, fifth, sixth. So there's never that decrease that ultimately leads to the satiety. And this is believed that then these differences between the normal responses of the dopamine stimuli as it was developed through evolution to serve physiological functions, versus the ways that drugs do it, much more potently, longer duration of action. And it does not decline with repeated administration. It's believed to trigger the adaptations, the plastic changes in our brain, that eventually will lead, in those individuals that are vulnerable, to addiction. To the process of addiction, which is a condition whereupon the person, with repeated administration of drugs, no longer can control his or her ability to decide when they take or they don't take the drug. This is fundamentally a stage where that individual has lost control and has intense drive to compulsively take the drug.
And that's what we call addiction. Not everybody that takes drugs, actually, becomes addicted. We've come to recognize, for example, that approximately 50% of the vulnerability of a person to take, to become addicted is genetically determined. So that vulnerability has a very strong genetic component. It also has other processes that determine vulnerabilities. For example, if you get exposed to drugs when you're very young, very early adolescence, you're much more likely to become addicted than if you get exposed to the same drugs when you're an adult. And this has to do with the fact that the adolescent brain is much more neuroplastic than the adult brain. And as a result of that, a drug, which triggers this adaptation process, is likely to produce these changes faster in an adolescent and it's also the duration of those changes is likely to be much longer lasting in an adolescent than it is an adult. So these are two processes as it relates to addiction.
Question: What makes somebody become addicted to a drug?
Nora Volkow: Many surprising findings have come across the studies that have completely destroyed all of the hypotheses that we initiated with. For example, when we first started doing these studies, one of the things that I had postulated, not because it was my great idea, but because a lot of people had been postulating it and in animal models, there was evidence that that could be the case, that people that were addicted because drugs were more rewarding, more pleasurable. And thus, their brain will have a much greater release of dopamine in these limbic areas when they took it. And so, that was the idea. But we did the studies and consistently now in three independent investigations that we've done in our laboratory, and similar findings have been reported by others at Columbia University, we've shown exactly the opposite. Which is fascinating! What we're observing is that in cocaine addicted individuals, and individuals addicted to alcohol, that in these subjects, the ability of drugs to increase dopamine is actually markedly decreased and their subjective experience of the drug is also decreased. But what's fascinating is that this fact, almost in contradiction, in contrast to these decreased responses, when they take the drug, they immediately, it's almost like triggers the desire of more, of more, of more. Like, almost like you open the faucet and there's this intense drive to want more drug and this inability to get satiated.
And I always try to understand when someone is telling me this experiences, have I ever felt that way? And I've never been addicted to anything, but I am a very compulsive person, and I can get into stages, certainly for example, with food, certain foods, I generate, and you eat a chocolate chip cookie and it tastes so good that you immediately know that you want more and you do another bite, and you already in your brain are saying, "I'm going to want more." So when I think about it, this is the closest it gets. Or when you've been incredibly, incredibly thirsty. I actually, I just start to drink water, it seems like you need more and more and more water, right? Eventually, of course, you just get bloated and that's the end of the water. But in the person that's addicted, that's what seems to happen.
So the reward center itself is decreased, but it triggers a response that is abnormal, that you don't see in people that are not addicted. And our imaging studies, of course, we've been trying to understand then, what is driving this different response, even though you have less reward, why are they generating this response? And what we have shown and certainly other investigators have looked at that is, that you've shifted the response to the drug to add stimuli that is associated with the drug and this is done through memory and learning, condition. We all know about conditioning, because Pavlov taught us that if you show a dog, taught him hear a sound when they get meat, and you do that repeatedly and repeatedly and then one day you bring the dog and you just show the sound, that animal will salivate with the sound. There's no meat, they salivate. That's a transfer of the physiological response that initially was triggered by the meat into the sound. And that's what we call conditioning.
Now, you can look inside the brain and try to understand what happens, why is this dog salivating with the sound? It just makes no sense. Well, the learning, the brain has automatically linked the meat with the sound so in the moment that the brain inside listens to the sound, it's predicting that the pleasure will come, it's predicting the meat. So just automatic they've learned. The brain needs to learn in order to be prepared and that's exactly what happens when people become addicted to drugs, they get conditioned to a wide variety of stimuli.
So, for example, a person that is snorting cocaine with a $20 bill, when they see that $20 bill will do the equivalent of salivation, except inside their brain, and what's going on is, their brain, in expectation of getting cocaine, is releasing dopamine. So they've transferred what was a pharmacological response, a response to cocaine, an action of the drug affecting specific areas in the brain, is now triggered by observing a $20 bill. Now what happens when dopamine goes up, because they see that $20 bill, is that that activates the motivational circuit that drives you into action. So, the brain is saying, this is motivational salient, this is relevant, remember? All of the circuits were generated for us to survive, to do behavior crucial for survival, it, sex for procreation.
So these are hard wired across evolution. So your brain is immediately, automatically responding and it becomes an automatic response. So in that moment, the person desires and takes action to take the drug. They have all of these learning responses and memory that actually just automatically triggers a behavior that becomes compulsive and repetitive.
And they cannot stop it. It's basically, when the brain engages in such a state, and the normal mechanisms by which we sort of control our desires and our behaviors, all of us, all of us. I think that if we are honest, on a daily basis have things that tell us, "I want that! But I shouldn't do it, it's a bad idea. I just can think of a million reasons why it's a bad idea." And so we have to relinquish things that we want on a daily basis. How can we do that? Well, we judge, we analyze, and it's always a balance about how much we want this and how bad it is to go and do this.
So dopamine actually there plays a very important role because it regulates the brain areas that are making the analysis, that are judging. Is this worth the effort? Is this worth the punishment? And in base of that, that judgment, you then stop. Stop the behavior. No matter how much you want it, if your judgment is not worth the risk, you'll stop it. And that's also regulated by the pathways. So when you've been taking the drug repeatedly, you basically disrupted all of these normal mechanisms that allow you to exert judgment and to decide, no, it's not worth the risks. Or basically you decide, "No, I don't think it's a good idea. If I take cocaine, I'll end up, my probation officer will put me in jail." You cannot stop it.
Question: Does nurture play a role in addiction?
Nora Volkow: Absolutely. Oh, absolutely. There's an enormous amount of evidence about how important nurture is in terms of either protecting or making a kid more vulnerable for taking drugs. We are in the area of genetics, so everybody tries to polarize things: it's either nature or nurture. Well, it's not either/or, it's both. And as we understand more and more how genes are marking the vulnerability of people, many instances, the way that they are marking that vulnerability, is by affecting your sensitivity and the way that you respond to the environment. So you may have a genetic vulnerability in such a way, for example, that it makes you much more sensitive to stressors. So if you have that genetic vulnerability and that you're exposed to a very stressful environment as a child, your parents are not there, they don't care about you, you are physically abused, then that combination of the sensitivity to these stressors makes you more vulnerable to taking drugs.
But on the other hand, if you have accepted that same genetic vulnerability, but you grow up in a family that is very caring, very protective, then you will not develop the vulnerability because it's that interaction of the high sensitivity to the social stressor and exposure to the social stressor that then triggers the vulnerability for taking drugs.
Now, this is, of course, very important because it shifts the paradigm from, "If I'm born with these genetics, what is it that I can do?" Well, there are many things that you can do, because it means that prevention, prevention interventions, even in those that have the genetic vulnerability, can actually have an effect in preventing the disease of substance abuse and addiction.
An area of extraordinary interest right now in research is exactly how to understand how environment, why is it that an environment that's stressful can trigger that vulnerability of a person to take drugs? What does it do to the way that the brain works? How the brain works? We're going one step even more basic, how do certain environments influence the expression of genes in the cells in the brain? I mean, just amazing the sorts of things that we can now, through science, investigate. And for example, now there's been studies shown, these are studies done in Canada by an investigator, Michael Meeney, who led this effort, showing that if in little rats, the mother is not there during the first few days, they don't have that physical touch. That silences a gene, silences a gene that is important to have activated because it will enable to regulate a response to stress. So if you don't have, during those very first few days when you are born, that physical contact, that gene is silenced, and that of course will affect all your adult life.
So here you have, it's not that you inherited the gene, it's that the environment, the nurturing question you asked me, was not there, and that directly affects the gene, that will affect your sensitivity to the environment. These are the type of questions that now through science and technologies we can start to ask and this is giving us understanding about why is it that some people, no matter what environments they are born, seem to do all right, whereas others are much more vulnerable and become addicted. And we can see one day when we will be able to tailor an intervention on the basis of someone's vulnerability. And again, I just was going to say, vulnerability not just in terms of your genetics, which you don't choose. I don't choose my genes, but you also don't choose your nurturing environment. You’re born into an environment. And unfortunately, some environments are very stressful, some kids are very, very stressful growing up, that makes them vulnerable for addiction and other behavioral disorders, where others are brought up in environments that are very, have a lot of nurturing. And that's very protective.
Question: Are there certain patterns of food consumption that lead to addiction?
Nora Volkow: Oh, yeah, and I do love chocolate. I just actually have found very few people that don't like chocolate. There are certain instances, of course, where you see people that are morbidly obese, where the notion of control of food is basically almost impossible. Where they don't want to be obese, I've never encountered anybody that wants to be obese, so I've been intrigued. That was the first question in my brain when I was saying, we are seeing these changes in the conditioning responses, in the ability to control in people that are addicted, but the behavior is similar to that, that you see in people that are morbidly obese. And so I've started to actually, systematically, that's how I started to use imaging to understand the brain. And again, dopamine is very important. Dopamine drives the motivation to it. In animals you can actually predict how much an animal is willing to press a lever in order to get the food on the basis of how much that stimuli is releasing dopamine. So the more it releases dopamine, the more the drive to get the food.
Now, why is it that some people are more sensitive to food versus something else or more sensitive to chocolate versus french fries? Well, again, food is more complicated than drugs. Because in drugs, where abuse start with is the rewarding responses. With food, what drives eating behavior is chemical signaling that are aiming at maintaining a balance of calories of energy requirements that responds to chemical signals that are just all throughout the body. That's one. And then the other one, pleasure and reward. Food can be very, very rewarding and reinforcing. And I would put the concept forward that most people that overeat, and we all overeat here or there, do it because food is pleasurable. And also, because food can decrease anxiety. So in a stressful situation, you can eat and that will decrease stress responses in your body. So food has the function of maintaining energy to activate reward and to also decrease stress. So it's not absurd that we have coined these term of comfort food, because it does decrease stress responses.
Now, when we are associated, normally and where glucose signals are saying you have enough energy, you can overcome the normal satiety response by putting food that you remember and you know tastes very, very good. So it's again, I don't think that it's satiety, that you have desert, and desert, one of the deserts is chocolate, right? Because you may be satiated, and there's no more dopamine that's going to be triggered by seeing a piece of chicken at that point. But may be triggered by a conditioned response that you have with that particular chocolate.
So just like we were discussing with drugs, where you've got condition, even if you are satiated, if you bring a stimuli that's salient enough, because you've had it in the past and it tastes very, very good, that will trigger the release of dopamine that will drive you to eat it.
Why do some of us fall into compulsive patterns and others do not? Many factors are going to be playing roles here. Again, aspects of vulnerability. But also, conditions. Look around yourself when you're in an airport and they cancel the flights. You'll immediately see people going in there and start to eat. So when you are stressed, you are much more likely to fall into one of these patterns of compulsively eating more food than you wanted to do. And this again has to do with some of the conditioned responses.
Our brains did not evolve at all for us to take drugs. What happened was that by just randomness of nature, certain chemicals, which we call drugs, are able to activate the same circuits that develop there in our brain to ensure that we will engage in a particular behavior. So therefore, it's not surprising that there's such a tremendous overlap. And the question that emerges is, why is then though, that if this is such an important process for survival, could it be that it goes wrong in such a way that people compulsively overeat and become obese at the expense of their own well being? Well, of course, this is of great interest because we are facing a massive obesity epidemic that is affecting the health of our society, and this is not just a problem in the United States, it's a problem everywhere. And this has to do with the social factors of easy access to food, food availability, diversity of food. Food that is extraordinarily appealing, that creates these conditioned responses.
So we got into the art of managed the most powerful food reinforcer, that for me, I would sort of say is chocolate, but for someone else it may be something else, but it's not just one chocolate. I can go there and there's all this diversity of chocolates. So I'm conditioned and if I take these chocolates and I get satiated by the taste, I can turn around to the left and there's all of these other variety that's it's now all intriguing. So we generated a system where many times, actually I ask myself, no wonder we have a problem of obesity in this country, I am surprised we don't have even a more serious one, because we are conditioned to the diversity of food. Food stimuli are everywhere. I walk, and now I'm in New York City, and oh, my God, I walk and they are all of these stores showing the most appealing food. And I'm conditioned to it, I mean, everybody's conditioned to it. I was commenting to you the story where you see that drug in a person that's addicted to drugs and you get that condition stimuli, we've done exactly the same study with food, people that are not obese, we just show them the food when they are food deprived, and you have exactly the same response. Dopamine system gets activated, you see the food, the dopamine system gets activated and that engages the motivational drive. So that's why when you go and see Godiva's chocolate on the glass, you want them, you want them! Of course you want them. And what you have to do is say to your brain, your frontal cortex, "No, I'm not going to eat it! No!" So you have to inhibit.
So we're constantly inhibiting. So that's what's happened to us when we get exposed to all of this food stimuli all over the place. We have to inhibit responses to want to eat it. It's just the way that our brain is hard wired. And that's modulated reaction.
Question: Why do diets fail?
Nora Volkow: Well, again, it's very difficult to diet. A person wants to stop smoking, right? They are addicted to smoking and it's not so hard to stop one, two, three days. But most people will relapse after two or three days. The same thing with diets and food. For once, these changes that occur, these conditioned responses, number one, are long lasting. So you are going to be constantly inhibiting these pre-potent need to actually want to eat.
Now, imagine your day 24 hours, sort of imagine my day 24 hours. In the morning, I go run, exercise, I'm all wired up, so I have perfect control, nothing bad has happened to me. But then I basically lose my key and I have to make this huge line and then the secretary insults me and I have to say, "No, no, no, no, I'm not going today," so you start to get frustrated, and frustrated, and frustrated, and angry and angry. And your ability to then regulate this urge to eat the food starts to be undermined. So as we get frustrated, as we get stressed, our ability to exert control gets diminished.
So, you go on a diet, and this is one of the reasons, it's not the only reason, and I'll come back to it in a second. The ability to exert control, to control our emotions and our behaviors, gets eroded when we're stressed, when we're tired. Or actually, when we feel deprived. And that's why people become irritable. Because it's actually a response where your brain, your body, is sensing that you are in a state of deprivation and under a state of deprivation, your mental state changes to go and want to do that behavior that will get you out of that state. So you have, again, that balance of an intense drive to get out of that very unpleasant state, and on the other one, your cognition says, "I want to lose weight, I want to lose weight." And there is a point that you lose this battle. And so you give in, you get a stressor comes up, the flight has been cancelled, I've been dealing with all of these, I had a bad day, and my flight, on top of everything gets canceled, and at that moment, you lose the ability to control.
So that's one of the things, and it's exactly the same thing with drugs or with smoking behavior. A person is doing fine and all of a sudden their spouse says, you know, "I want a divorce." And they have been stopped smoking and then they relapse. Something very, very stressful, they lose that ability. They're other things that are being shown by animal studies that may also be very, very provocative, and again, this is at the research level, in animals, it hasn't been shown in humans. But in my view, the moment that I start to see results in animals, I want to question, is this happening to humans?
There's been a series of studies now by Dr. Hovel, for many years, and when I read this, I said, "Wow!" Where he takes rats and he gives them a diet high in sugar. Well, we all eat in this society a lot of sugar. Well, he takes these little rats and gives them high amounts of sugar. And then he takes these animals and gives them a drug that we call an opiate antagonist. Now, what is an opiate antagonist? An opiate antagonist is some medication that when you give to a rat, only when you give it to a rat that has been repeatedly exposed to opiates, like heroin, morphine, oxycontin, repeated exposure, only when it's repeated, you gave the trigger withdrawal, like a heroin withdrawal. The animal starts to shudder, it gets to shake, and it's very, very unpleasant for the animal. This opiate antagonist in an animal that has been exposed to a high content of sugar, it triggers an opiate withdrawal. This is incredibly unpleasant.
Now, one of the things that we haven't studied in humans is could there be something similar, that there is a withdrawal, just like it's been shown in animals, occurring when a person is stops in a diet and then they basically are cutting the intake of sugar, which liberates indigenous opiates. So no longer those indigenous opiates are being liberated and you are creating a mild state of withdrawal. That is not, of course, so powerful that you recognize it, but that may be creating a state of dysphoria and discomfort. This is what happens when you put someone withdrawal, mild withdrawal from opiates is not like they're going to start shaking. There's a sense of discomfort, which you are not feeling well under your skin, you're like that. And it's very unpleasant.
And so the extent to which a similar process, for example, may be happening, is something that should be investigated. That could also, if proven correct, help to understand why so very difficult to go on a diet. And will also, if it's, again, documented in humans, because this is documented in animals, could provide strategies to help persons so that they don't have this, these very disagreeable states of discomfort.
Question: Can drugs change someone’s personality?
Nora Volkow: Yes, indeed. Unfortunately, drugs—again, it depends on the drug, obviously. Not all of the drugs are the same. In terms of how addictive they are, some drugs are more addictive than others. For example, methamphetamine is considered among the most addictive drugs of abuse. Not all of the drugs are the same in terms of their damaging certain circuits of the brain. Some drugs are more harmful. And for example, some interfere with cognitive processes more than others. One of the drugs that has been shown to be particularly damaging for cognitive processes for regulating mood, for example, is ecstasy. On the other hand, you have, for example, like nicotine, that does not damage cognitive processes. So when you are, again, addressing the extent to which a drug is going to produce changes in personality, you have to consider the type of drug.
So nicotine addiction does not, per se, change your personality. On the other hand, if you have drugs like alcohol that will change your personality and will trigger these cyclical shifts in the pattern of a person's behavior that are driven in part by the shifts between intoxication, withdrawal, and recovery. And the same thing happens with opiates. If you maintain someone on, a heroin abuser, when they are taking heroin, their personality may be very expansive. But when the heroin is leaving their body, they can become very irritable and aggressive. So you'll see that.
With repeated use, these drugs can, in some individuals, produce decreasing function of frontal cortex. And frontal cortex is what enables you to really understand a wide variety of environmental stimuli, including social, social communications, which are very, very important. Very important, on a one to one basis, but also in group, in group dynamics. And these can interfere with an ability of a person to properly engage on behaviors and social systems and this could explain why, also a person that has become addicted become more and more and more alienated with their own social networks. Which again, puts them at greater and greater risk of relying more and more on drugs as a means to try to get some sort of reinforcer, because they no longer get even the reinforces that we get with social interaction, which are very powerful.
So yes, indeed, and this is in fact one of the issues that when we are helping someone in a therapeutic set up recover and get back into their social system, recover from drug addiction, we need to very much help them into that transition, so that they regain the knowledge about how to navigate the social systems and they also regain the sensitivity to the social stimuli as enforcers. So that they can also be driven by them.
Question: Can we trick our brains to crave healthy things?
Nora Volkow: I actually am addicted to exercise. I am a compulsive person and again, I think that when one addresses the issue of vulnerabilities, we know that there's an important genetic component into addictions. And so if these genes have survived all these hundreds of years of evolution, an addiction still prevails, does it have, is there something positive about these genetics that make you vulnerable to addiction?
I think one of the things is that may, first of all, facilitate these compulsive behaviors. And compulsive behaviors are not necessarily bad at all, in fact, if you want to excel professionally, I mean, you really do require to do sometimes very compulsive work, just to maintain on task, no matter what, no matter when, you just actually, and that's a way, certainly, for example, I get with data. I stop, I basically filter everything out and I become compulsive until I understand it. And I cannot stop it. When I go running, I'm a compulsive person and I run, and I run, and I run, and I run, and I run and I have to sort of say, "Stop it, this is pathological."
Now, whether it's pathological or not, I do not know, it makes me feel good, and it doesn't have any adverse consequences. Not now, I mean, maybe when my joints start to hurt me, but not now. So my view on these things is that actually as a strategy for therapeutics so people that are addicted to drugs and have a propensity for these compulsive patterns of behavior, a healthy behavior that is compulsive, can actually substitute for a compulsive behavior that is pathological. And indeed, is one of the strategies that works in some people, not on all people that are addicted, this would work. Or on some people that are compulsive eaters, if you can get them to get compulsive about exercising, then you may have solved their problem. And there's two groups of individuals that are addicted that get into this marathon, ultra marathon behavior. And they actually stop the drug and just become compulsive exercisers.
So the answer is yes. Can you get compulsive about eating salads without dressing? Just a piece of lettuce? I have never seen that. But I have seen getting compulsive about eating a salad that has very nice things in it that go beyond just a piece of lettuce.
Question: How should drug addicts be treated in society?
Nora Volkow: Drug addiction is a disease of the brain. It's a disease of the brain. We don't put people that have diseases in the jail or in prison because they actually, that's what we decide, right? I don't even dare myself to the concept of putting someone in jail because they have a disease. My brain doesn't even allow me to think that way.
And yet we do that with addicted people and I've thought a lot, why is our society criminalizing the person that's addicted to drugs? And I think it's because it has been very hard for people to recognize that our behaviors and our ability to control our desires is basically the product of very complex systems in the brain that enable us to perceive these desires, to control them, to make the right choices. This is very difficult for people that have all of their faculties intact, to understand that not everybody can do it. And so I sort of easier to say, "Well, if I can do it, that person is not doing it because they are choosing to just have a good time." And so we've taken that approach and I guess the other element that happens with drugs, the drive to take these drugs can be so overpowering, so, so overpowering, because it's hard wiring of the brain, the signaling is this is something that is necessary for survival. That's what drugs have done in a person that's addicted. They've generated the message as the same intense as if you haven't eaten. And it's a signal, you have to eat or you'll die, you have to drink water or you'll die, very, very powerful signals. Very difficult to control. You haven't eaten for one week and you have food in front of you, just try to say no to that food. It's the same drive.
So they can, when they are in those situations, this intense drive, they can do behaviors that are criminal, they can go and steal, in order to be able to get the drug. Like someone who has not eaten for one week, if they have nothing but to steal the food, they may steal the food. So that leads to the criminal behavior that then leads the person and the system to react very negatively, you should not steal. Of course you should not steal. But people should not be hungry, people should not be in the situation that they have to steal in order to eat. That should not happen. Like a person should not be, not given treatment that is in a situation where their body's experiencing the drug as if it were a survival need. They should be provided with treatment.
So yes, we should deal with drug addiction as a disease, like we deal with any of the other medical diseases. We should not be criminalizing it. When we criminalize a drug addict, nobody wins. Certainly you're not going to improve the behavior of that person that is thrown into jail. When they get out of the jail, the first thing they'll do is relapse. Unless you treat them in jail. If you treat them in jail and you maintain the treatment when they leave jail, then you're giving them a chance. If you're throwing them in jail and not providing any treatment or treating them in jail and then throwing them out, they will relapse.
So, and that costs an enormous amount of money, to put people in jail because they are addicted to drugs is very, very costly. It doesn't make any sense. Your tax dollar goes into the criminal justice system, it's much less expensive to treat. And if you treat the person, you're giving that person a chance. And you're giving the family of that person a chance. So it's a win-win. You're basically decrease your cost on criminal behavior, you decrease reincarceration and the person can go back and become an active member of society at all levels.
Recorded on November 6, 2009
A conversation with the Director of the National Institute on Drug Abuse.
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- Realists believe that there is an exactly understandable way the world is — one that describes processes independent of our intervention. Anti-realists, however, believe realism is too ambitious — too hard. They believe we pragmatically describe our interactions with nature — not truths that are independent of us.
- In nature, properties of Particle B may be depend on what we choose to measure or manipulate with Particle A, even at great distances.
- In quantum mechanics, there is no explanation for this. "It just comes out that way," says Smolin. Realists struggle with this because it would imply certain things can travel faster than light, which still seems improbable.