After decades of research have helped to explain the neurological changes that underlie the severe behavioral and social problems associated with substance abuse, leaders in the field argue that it is time to put that evidence to use for developing better policies for addressing these conditions in the United States.
In an editorial in the February 24 theme issue of Neuron highlighting this evidence base, National Institute on Drug Abuse Director Nora D. Volkow, MD, and colleagues provide a detailed overview of how chronic drug use hijacks the reward circuitry of the brain, impairing the drug user’s ability to seek the things needed for his or her well-being and to avoid negative consequences (Volkow ND et al. Neuron. 2011;69:599-602). Review articles published alongside the editorial provide more comprehensive information about the mechanisms behind these neural changes and genetic vulnerabilities that may underlie them, as well as evidence-based therapies targeting these changes.
Other pieces in the issue tackle the challenges of balancing the risks and benefits of using opioids to treat chronic pain, and how similar changes in the brain’s reward system may be involved in obesity.
Addiction-related changes lead individuals to inappropriately value immediate gains over greater long-term benefits, explain Volkow and her colleagues. “This knowledge helps explain why the prevailing social system that dangles some future threat of imprisonment over an addict’s head does not work well in deterring immediate substance abuse–related behaviors in addicted subjects,” they note.
Additionally, incarceration itself may interfere with recovery.
“The recognition that social stressors such as stigma and isolation can further impair the function of neuronal systems necessary for an addicted person’s recovery highlights the need to treat addiction as a disease rather than as a criminal behavior,” the authors said.