Response to Huff Post Article: The Likely Cause of Addiction has Been Discovered, and It’s Not what You Think

http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html

So my goal today was to post an introduction to the neuron but then I read the above article and felt it my duty as a neuroscientist that actually studies addiction to respond to the many glaring problems with this piece.

This is my response (also read it on the Huffington Post Blog directly):

This article makes many false claims that ignores the scientific basis of addiction. I’m a neuroscientist studying the neurobiological basis of drug addiction at the Rockefeller University (NY, NY) and many of the views presented in this article are, in my professional opinion, harmful to the decades of scientific progress made in understanding this devastating disease.

Addiction is a very complicated disease with genetic, environmental, and drug-specific causes and effects. The disease/medical model of addiction is not a “liberal” view but the scientific view (which has no left/right bias). This article makes no mention of the vast amount of concrete basic research that has identified real molecular changes that occur to brain as result of drug use and the subsequent effects on behavior that these molecular changes have. There is no mention of neurons, or dopamine, or neurotransmitters, or neurotransmission, or receptors, or gene expression changes, or neuroplasticity, or mesolimbic reward pathway, or many other of basic concepts in the neuroscience of addiction.

And of course, being in a harmful/stressful environment can induce or exacerbate drug-taking behavior. This has been known for years and the drug/stress interaction is a huge area of study within the addiction field. Stress induces chemical changes within the brain, and many of these chemical changes are similar to the ones that drugs cause. In fact, everything that the brain does and everything that happens to brain ultimately has a chemical basis. And yes, that means there is of course an enormous chemical basis for addiction and the effects of drugs themselves. To say anything otherwise is blatantly not true. The synergy of drug-taking and stressful situations also has a concrete molecular basis and there is an enormous body of published, peer-reviewed scientific studies that support this.

However, I do agree that 12-step programs (on the whole) are successful and that addicts should be treated with compassion and love. Treatment of addiction is just as complicated as the disease itself and multiple approaches are likely required. But to ignore the science, and claiming a political bias of the science, and cherry-picking a handful of studies that support a false overall conclusion, is inexcusably irresponsible. My newly-minted website is attempting to counter harmful information, such as this article, regarding addiction (drsimonsaysscience.org). Thank you.

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Drug Addiction is a Medical Disease-a Disease of the Brain

brain1 med symbol good

Let me say that again, Drug Addiction is a medical disease-a disease of the brain.

To some people, this may sound controversial but throughout my posts I hope to provide the scientific explanation for why this is and how we know that this is true. Drug addiction is a very complex disease and a great deal of knowledge is required to understand it.

But what is addiction? The textbook definition of addiction (according to Wikipedia) is “a state characterized by compulsive engagement in rewarding stimuli, despite adverse consequences”. “Rewarding stimuli” can be food, sex, gambling, the Internet, or in our case, drugs of abuse. And as we’ll learn later, all these “rewarding stimuli” hijack the brain in very similar (yet distinct) ways. “Adverse consequences” can be anything from losing your job to deterioration of your health to committing a crime.

Historically, a drug addict was considered someone that was weak, lacked a strong will, or was morally inferior. This is not true.

(From http://www.dependency.net)

Drugs of abuse (nicotine, cocaine, marijuana, alcohol, heroin, oxycodone, etc.) are not magic: they are physical substances that have a physical effect, specifically on the brain. The function of an addict’s brain has been changed as a result of the drug use; their behaviors and motivations—even what you might call their “will—have changed (more on this later). An addict is not “morally weak” but suffering from an illness of the brain and, in many instances, in need of compassion and help.

A quick note:

I must point out that a person cannot even become a drug addict unless they try the drug in the first place. But the reasons behind this first use are complicated with numerous contributing factors to consider: sociology, public policy, genetic predisposition, environment, and many other issues. Ridiculous simplifications such as “just say no” or absurd taglines like “the war on drugs” don’t even begin to address the problem. More on this in future posts.

Another quick note: This post is a bit long but I will try to keep future ones a more reasonable length.

Now, back to the neuroscience:

By now, some of the questions you should be asking are: how do we know that addiction is a medical disease/brain disease? How do drugs act on the brain and what do we even mean that brain function is “changed”? And even if drugs do change the brain, how does this translate into changed behavior, such as uncontrollable drug craving, or bad behavior/“adverse consequences”?

So we all know that our body is made up of organs: heart, lungs, intestines, etc. and those organs are responsible for carrying out different jobs that keep us alive (blood circulation, breathing, food digestion and absorption, etc.). The brain is an organ just like any other with specific jobs to do.

We were taught since we were young that the brain is the control center of the body, which is  one of those phrases that is technically true but doesn’t really offer much real insight. By control center, we mean that the brain controls, regulates, and coordinates how our organs function (breathing, heart rate, muscle movement, etc.). Less well understood is that the brain also controls our behaviors, actions, thoughts, and emotions—our minds.

Let me phrase that in a different way, the result of the brain’s functions IS the mind!Brain-=-Mind

This may be controversial to some and at the neuroscientific level, is remarkably complex and not very intuitive. The brain vs mind topic will be a primary theme this blog will cover.

But let’s just assume for a moment that I’m correct and our thoughts and behaviors come from the biological functions of the brain. Then if something changes how the brain operates (like an illegal drug, for example), then it stands to reason our thoughts and behaviors would also be changed. If this change is harmful and results in negative behaviors or thoughts, you could think of the brain as suffering from a disease.

Let’s consider this in slightly more detail by thinking about disease more generally.

You may or may not have thought about this in this way, but the entire modern medical profession is based on a standard way of treating illness: the medical model of disease. The model is simple to understand: illness occurs because something (bacteria, virus, a genetic mutation, a poison, etc.) affects a particular organ, causing it to not work properly and resulting in the symptoms of the disease. Therefore, if you eliminate the cause of, or reverse, the damage to the organ,  you ameliorate the symptoms and cure the disease.

The figure below compares three different diseases in the context of the disease model: cystic fibrosis, hepatitis, and drug addiction.

Disease-Model

For cystic fibrosis, the cause of the disease is a genetic mutation that you inherit from your parents. The organ the mutation affects is the lung. The mutation causes the lungs to produce more mucous which makes breathing more difficult (the symptoms).

For hepatitis, a virus, the hepatitis virus, causes the disease. The virus specifically infects the liver (the affected organ), which it damages and causes a loss of appetite and malaise, can lead to yellow discoloration of the skin, or more severe liver damage (the symptoms).

For drug addiction, the cause of the disease is drug abuse. The drugs act on brain cells (neurons) which changes how they work. The change in brain function results in the drug-specific effects that you experience right away, while repeated use results in cravings, drug-seeking behavior, and even withdrawals (all of these are symptoms).

However, unlike the other diseases, the symptoms of cystic fibrosis or hepatitis do not feedback onto the organ to worsen the effects of the initial cause. But for drug addiction, this is exactly what happens. Drug addiction operates in a cycle in which the symptoms promote the cause (more on this in the future).

And one more significant caveat, not everyone that tries a drug will become an addict. This is just another layer of complexity that will be discussed in more detail later.

But so far, I haven’t discussed any concrete neuroscience. I’ve kept things very vague with phrases like “changes in brain function” but what changes am I talking about? Specifically, drugs change how brain cells, called neurons, talk to one another.

OK, that’s plenty for a little introduction…

Next Post

Introduction to Neuroscience: the Neuron.

Welcome to Dr. Simon Says Science!

(Image from http://mashable.com/2013/04/02/obama-brain/)
(Image from http://mashable.com/2013/04/02/obama-brain/)

Something I noticed about science/neuroscience blogs, and science writing in general…it’s not done by scientists! That doesn’t mean that quality of the writing or the reporting is of a poor quality—in some instances, they can be phenomenal (Carl Zimmer’s articles come to mind). However, journalists (even the best) are not scientists and their writing is not a scientists’ perspective.

It was this realization, in concert with my passion for science communication and love of writing and thinking about science, that lead me to this little project: a science blog by a scientist.

Above all, I want the public to understand science because I’m an early career scientist that cares about making life better for as many people as possible. And I strongly believe that science, more than nearly any other human endeavor, has consistently improved the lives of people in numerous ways: from health to lifestyle to industry.

A little bit about me first. My name is Derek Simon and I completed by PhD in Cellular and Molecular Biology in August 2012 from the University of Michigan. I have been working in academic research labs for over a decade, since my second semester (January 2004) as an undergraduate at the University of Wisconsin-Madison. My research interests and projects have ranged from Huntington’s disease to the endocrinology of prostate cancer to cancer biology and biology of the adrenal glands. I am currently a Postdoctoral Fellow at the Rockefeller University (http://rockefeller.edu/) working in the Laboratory of the Neurobiology of Addictive Diseases.

My current scientific passions are neuroscience (brain biology) and specifically, the neuroscience of drug addiction. This blog will largely focus on topics related to drug addiction but since this is a remarkably complex disease (the same as nearly all topics related to the brain) a great deal of basic neuroscience knowledge is needed.

Science is Fun! But there's more to it than fancy glassware. (Image © Derek Simon 2015)
Science is Fun! But there’s more to it than fancy glassware. (Image © Derek Simon 2015)

However, my scientific passions are eclectic so here’s an overly ambitious list of topics I hope to discuss:

  • Drug addiction
    • Basic neuroscience knowledge
    • Important research about the actions of drugs of abuse
    • Experimental techniques in neuroscience and drug addiction research
    • Drug policy and criminal justice issues related to drug abuse in the United States
  • General discussion of science
    • The scientific method and “how do we know what we know?” in science
    • Science policy in the United States
    • Discussion of limitation, flaws, and improvements to be made in the scientific research world
  • Other fun topics in science
    • Hot Topics in science and exciting new research
    • The science of music
    • Consciousness and free will
    • The science of sexuality

Just a quick disclaimer: the views and opinions posted here are mine and mine alone. My writings here do not represent the views or opinions of the Rockefeller University, my boss, or my colleagues.

And I do not claim to be an expert, merely what I would call “a source with professional experience”. An important quality for a scientist to possess is to know what you know. That may seem like a strange statement but is the core of all scientific research. As scientists, we strive to learn as much as we can about how the world works (new discoveries are made all the time) but there are limits to our knowledge. I am simply being honest about my own limitations as a scientist.

I’m also a classically trained pianist, composer, and amateur photographer. The other sections of this  site will be dedicated to these other passions.

Thank you so much and hopefully this will be an educational and enlightening experience for my readers and myself!