From heroin and cocaine to sex and lies, Tetris and the ponies, the spectrum of human addictions is vast. But for Dr. Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse, they all boil down to pretty much the same thing.
Profiles in Science
Nora D. Volkow
This is the first in an occasional series of articles and videos about leaders in science.
Jessica Kourkounis for The New York Times
She must say it a dozen times a day: Addiction is all about the dopamine. The pleasure, pain and devilish problem of control are simply the detritus left by waves of this little molecule surging and retreating deep in the brain.
A driven worker with a colorful family history and a bad chocolate problem of her own, Dr. Volkow (pronounced VOHL-kuv), 55, has devoted her career to studying this chemical tide. And now, eight years into her tenure at the institute, the pace of addiction research is accelerating, propelled by a nationwide emergency that has sent her agency, with a $1.09 billion budget, into crisis mode.
The toll from soaring rates of prescription drug abuse, including both psychiatric medications and drugs for pain, has begun to dwarf that of the usual illegal culprits. Hospitalizations related to prescription drugs are up fivefold in the last decade, and overdose deaths up fourfold. More high school seniors report recreational use of tranquilizers or prescription narcotics, like OxyContin and Vicodin, than heroin and cocaine combined.
The numbers have alarmed drug policy experts, their foreboding heightened by the realization that the usual regulatory tools may be relatively unhelpful in this new crisis.
As Dr. Volkow said to a group of drug experts convened by the surgeon general last month to discuss the problem, “In the past, when we have addressed the issue of controlled substances, illicit or licit, we have been addressing drugs that we could remove from the earth and no one would suffer.”
But prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances. “The challenges we face are much more complex,” Dr. Volkow said, “because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders.”
In other words, these drugs must be somehow legal and illegal, encouraged yet discouraged, tightly regulated yet easily available.
The experts are looking to the institute for scientific tools that might help by loosening the tight bonds between pain relief and addiction in the brain.
And that, Dr. Volkow told her audience with a small smile, is all about the dopamine.
She knows a little about dopamine firsthand: She is a dedicated runner and a helpless pawn in face of dark chocolate. Her most significant long-term addiction, though, has been to the science of scanning the brain with techniques that expose its workings like a map, a passion she has pursued like a guided missile since medical school.
That was in Mexico, where Europe’s 20th-century upheavals had tossed both her parents: Her mother fled Franco’s Spain, while her father, the son of Leon Trotsky’s elder daughter, joined his grandfather in exile as an orphaned teenager. Dr. Volkow and her three sisters grew up in the house in Mexico City where Trotsky was murdered in 1940, giving tours of the premises on weekends.
In medical school she read an article in Scientific American about one of the first American positron emission tomography scanners, able to photograph not only the brain’s structures but also its invisible processes. She never looked back.
“It blew my mind,” she said. After a residency in psychiatry at New York University, chosen because it owned that PET scanner, she took a job in Houston, then transplanted her research to Brookhaven National Labs on Long Island, home of groundbreaking research into dopamine and PET scanning. She and her husband, Stephen Adler, a physicist with the National Cancer Institute, now live in Bethesda, Md.
Dr. Volkow’s research career, still based at Brookhaven, has been notable for its “brilliant science,” said Don C. Des Jarlais, an expert in drug addiction who directs the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center in New York. Dr. Des Jarlais cited her recent widely reported study showing that cellphones alter brain metabolism as a typical example of her unusually creative scientific thinking.
A Merging of Missions
Her days now veer from reviewing raw laboratory data with her research colleagues to leading the back-to-back meetings of a government functionary, but the two roles are joined by the mantra of her time at the institute: Policy should be grounded in valid science.One recent decision in the upper echelons of the National Institutes of Health reflects a similar conclusion: The drug abuse institute and the National Institute on Alcohol Abuse and Alcoholism are on track to be merged into a joint institute on addiction still in the planning stages.
National Institutes of Health watchers have already started a body count. “It will be a big loss that Nora Volkow, current N.I.D.A. director, cannot possibly be selected to head a new institute,” wrote one anonymous blogger on the Scientopia Web site. “This would be too much like N.I.D.A. ‘winning.’ ”…More at An Addiction Expert Faces a Formidable Foe: Prescription Drugs