Expert talks about addiction and mental illness
U.S. expert Nora Volkow to speak in Montreal
The human brain is hardwired to respond to reward or pleasure, and if it weren’t so, no one would eat or have sex.
But that same “pleasure circuit” is also the underpinning of addiction, explained researcher and psychiatrist Nora Volkow, head of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, and world leader in the neurobiology of diseases of reward and self-control.
Volkow’s research comparing brain scans of those who are addicted to those who are not, show addiction can physically change the frontal areas of the brain that are involved with motivation and pleasure. Volkow has often said she never met an addict who wanted to be an addict, and that addiction is like driving a car without brakes.
It has become a critical health issue, as deaths from fentanyl, an opioid drug that is 50-100 times more potent than morphine, have more than tripled in the United States from 3,105 in 2013 to 9,580 in 2015, “and those numbers are likely underestimates,” Volkow said. In Canada, prescription painkillers and illicit fentanyl are together fuelling a national epidemic of opioid-related overdoses, killing more than 2,800 people last year.
Volkow will be speaking in Montreal on Thursday at the Low-Beer Memorial Lecture on mental illness and addiction, hosted by AMI-Quebec, a group founded 40 years ago to help families manage the effects of mental illness through support, education, guidance, and advocacy.
Volkow spoke to the Montreal Gazette in advance of her lecture.
Q Addiction is often misunderstood as a moral failure. What is the responsibility of the addict?
A Well, in a way, it’s similar to someone suffering from epilepsy. If you have a disease, it’s your responsibility to take care of it because if you don’t your outcome will be negative, and in the process you can also hurt someone else. So there is a clearcut responsibility for engaging in treatment.
Q They are responsible for their treatment but not for the illness?
A No, they are not responsible for the illness. You don’t choose an inheritable vulnerability for addiction. About 98 per cent of the population is going to be exposed in one way or another to alcohol, right? Yet most don’t become addicted and 10 per cent do. I can go to the restaurant and drink a glass of wine and I don’t have a problem with it. But I’m lucky. What about someone who when exposed to that substance, it modifies their brain much more rapidly than someone who doesn’t have that vulnerability? That leads them to become conditioned to it and to crave it and to desire it, and with time to actually lose control.
Q What would be a good strategy to help those who are most vulnerable?
A First, I would start with universal prevention interventions, then tailored to those who are most vulnerable. And who is most vulnerable? If you have a family history of addictions, it is likely you have a genetic vulnerability even though we don’t know exactly what genes. But risk of addiction runs in families. Also, the younger you are in getting exposed to drugs the greater the likelihood that you will be vulnerable. If you’ve had a very difficult childhood experience — physically abused or neglected, or sexually abused, no emotional support — all of those factors have been increasingly recognized as risks for addictions. And finally, a mental illness as a child or adolescent. If you have an emerging mood disorder but it’s not clear, the symptoms are not full blown but you don’t feel right, then you’re at much greater risk of starting to use drugs to self-medicate, and since drugs temporarily make you feel better, you may repeatedly take them and that puts you at greater risk of becoming addicted. These are the populations we can identify as at greater risk and where we can tailor interventions.
Q What is the connection between addiction and mental health?
A Addiction is a mental illness in and of itself and it influences the course of other mental illnesses. This is important to understand because (addiction) is highly, highly concurrent with other mental illnesses. And if you don’t address the addiction, the outcome of the mental illness is going to be much worse. For example, individuals with mood disorders are at particular high risk of opioid use and then they are at particular high risk of suicidal behaviour, and that combination increases that risk further. This is an example of how these two conditions collide. Another that is recognized is that cigarette smoking is predominantly driven in patients
with schizophrenia and other mood disorders.
Q Would people who are addicted to cigarettes be considered mentally ill, then?
A No, no, no. This is an issue of how we use interchangeable terms without really defining them. Addiction is one mental illness, but when people speak of it they think of schizophrenia, depression or post-traumatic stress disorders. You can have an addiction to nicotine and that drives your behaviour so that you cannot completely control it. … There are changes that happened in the brains of people smoking cigarettes — depending on the severity, they can be mild to severe. Because of strong (smoking) prevention efforts in U.S., there has been a dramatic reduction in smoking — except in individuals with other mental illnesses. In these people, we haven’t been able to reduce the prevalence of smoking because they are more vulnerable.
Q Are people who are overdosing on fentanyl seeking it out, or is it accidental?
A Both. You have individuals who are heroin addicts and they don’t know they are taking fentanyllaced drugs. Treatment providers say the older heroin users are afraid because they don’t know if a given batch is going to contain fentanyl or not and they fear they will overdose. On the other hand, I was speaking with people at the safe injection site in Vancouver … there are heroin abusers who are interested in seeking heroin laced with fentanyl. So you have a gamut. This is why it’s so important to create an education campaign — so that those who don’t know can realize and understand what fentanyl does and why it’s so dangerous.