No Pill Can Cure Addiction
No pill for addiction.
Posted Apr 29, 2008
A remarkable article by Marilynn Marchione in last week's (April 23) Washington Post announced the death knell for an addictive fantasy - that we will find a chemical cure for addiction. The article summarized negative clinical outcomes--including frequent cases of depression and even some suicides--from drugs prescribed for smoking and obesity.
At first blush, the NIDA seems focused on the chemical rewards produced in the brain by specific drugs, notably cocaine. But, as I announced in Psychology Today 35 years ago, this model is illusory. Addiction is not the result of a drug molecule binding with specific receptors. For one thing, too many drugs with widely varying chemical structures can be addictive.
Actually, Nora Volkow and other NIDA theorists have moved beyond that model to identify general reward paths in the brain which many different substances impact. Of course, this immediately calls into question the NIDA's mandate - if we're mucking about among general reward mechanisms in the brain, why are they limiting their research to illicit substances? The answer is, of course, the government hates these drugs and wants to label them addictive to alarm Congresspeople and scare school children and their parents.
Thus, the obesity and nicotine drugs the Post discussed were not strictly in the NIDA's realm (although several have been touted for alcoholism and drug addiction). But the therapies rely on the same approach of blocking pleasure signals that underlies NIDA strategizing. The only problem is, since the mechanisms involved are so global, pleasurable experience is defused in general--walla, people become depressed.
Some key players have been struck by this lesson, including the man (Mark Egli) in charge of chemical cures at the NIDA's sister agency, the National Institute on Alcohol Abuse and Alcoholism. His chastened conclusion: "It certainly diminishes my enthusiasm."
This is actually reminiscent of the reactions of key genetic researchers when simple-minded hopes of finding a single gene for schizophrenia and bipolar disorder were no sooner announced than they were immediately dashed, as I described in Psychology Today. (We won't go into Ken Blum's "discovery" of the gene for alcoholism, which he then claimed explained all of addiction.)
As is now occurring for serious students of addiction, real geneticists announced they were recasting their entire model of how human behavior and mental illness arises. It cannot be the result of a single inheritance, or solely of genetics altogether. Nor, we now see, can addiction be resolved and dealt with as one uniform biochemical process.
Follow Stanton on Twitter