Gambling. Cocaine. Sex. Alcohol. Work.
The roots of addiction span a vast landscape of need and run deep
in the human brain. Craving rises from the amygdala, one of the
most ancient parts of the brain. And in all of human history, only
the native people of Alaska have not developed a psychoactive substance
integral to their culture. That, some say, is only because so little
grew in their cold climate.
As participants in an Emory faculty seminar discovered last year,
however, addiction is as social as it is biological. How else could
we become addicted to activities, like gambling, as well as substances,
like cocaine? Each week, clinicians, bench scientists, and scholars
in this group of about twenty faculty gathered to discuss such questions.
School of Public Health dean Jim Curran; Center for Health, Culture,
and Society director Randall Packard; and Science and Society director
Arri Eisen collaborated to form the seminar. Howard Kushner, Nat
Robertson Professor of Science and Society, organized readings and
led discussion. Whether talking about rats, people, or culture,
seminar participants repeatedly questioned their own understanding
of the term addiction."
The laboratory of addiction
One seminar participant, Michael Kuhar, neuroscience division chief
at Yerkes Regional Primate Center, is leading a team that investigates
addiction at the molecular level. Pinpointing the molecular site
in the brain where cocaine takes effect has allowed Kuhar and his
collaborators to develop cocaine analoguesdrugs that behave
like cocaine but lack many of its negative effects.
Both like cocaine and significantly different, these analogues may
one day be used to treat cocaine addicts, just as methadone helps
some people dependent on heroin. While the analogues reduce craving
by acting on the same molecular site in the brain as cocaine, the
effect is less toxic and longer-lasting. Kuhar works with a biotechnology
company, Addiction Therapies, Inc., that plans to test the cocaine
analogues in humans as early as next year. Studies in other labs
with animal models suggest that a vaccination to prevent drug use
is on the horizon.
One day, Kuhar says, treatment may go something like this: Someone
comes in and receives our medication to help him stop his out-of-control,
often illegal behaviors. Relying on this medication binds him to
the treatment program and all it offers. The next step may be to
vaccinate him against the drug, so that if he relapses, the drug
just wont have the same effect.
The addictive drug would be stopped in its tracks by antibodies
in the addicts own blood. Labs at Yale and Columbia have developed
a vaccine that stimulates antibodies that bind to the tiny cocaine
molecule, preventing it from reaching the brain and causing a high.
Since the vaccine does not stop the cocaine analogue from reaching
the brain, the two treatments could be used in tandem.
Even if such a medicine for cocaine
addiction proves safe and reliable, experts predict many other approaches
will be needed to address addiction fully. Since dependence has
complicated physiological effects and roots in genetic and social
circumstances, says Kuhar, theres not going to be a
single, magic bullet.
search for supernormals
Growing numbers of experts say
effective treatment demands a better understanding of the interaction
of the biological and social aspects of addiction. National Institute
on Drug Abuse chief Alan Leshner, who spoke to the faculty seminar
last fall, has crusaded to make addiction understood as a brain
disease that manifests in compulsive behavior. Yet researchers find
that dependent behaviors defy easy categorization.
Addiction may be more like a syndrome than a distinct disease,
says seminar moderator Kushner. It could be a label for a
group of behaviors that all have different
The tendency of addiction and other diseases to travel in packs
also bedevils attempts to define the nature of dependency. Researchers
call this synchronicity among illnessessuch as depressions
tendency to accompany alcoholism or heroins link to hiv/aidsco-morbidity.
The faculty seminar confronted a complex chicken-and-egg question:
Does the drug change the addicts brain chemistry, or does
the drug do something for the addict because of an underlying condition?
According to Kushner, Thats where the jury is still
Co-morbidities offer important clues to the workings of many diseases.
Discovering, for instance, why schizophrenics and people with attention
deficit hyperactivity disorder seem frequently to self-medicate
with cigarettes may lead to a better understanding of the neurobiology
of those diseases.
Untangling the knot of co-morbidities, though, really reveals
the gap between the medical or laboratory researchers and the social
scientists, says Claire Sterk, chair of the Department of
Behavioral Sciences and Health Education in the School of Public
Health. In the lab, you isolate a substance to test its effects.
That makes taking co-morbidities into consideration very difficult,
says Sterk, who has studied addicted populations for twenty years.
Just to get a control group for a neuroimaging study of cocaines
effects on emotion, for example, the research group of Karen Drexler,
assistant professor of psychiatry and behavioral sciences, had the
daunting task of finding human supernormals. These are
people free of cocaine addiction and other dependent behavior or
psychiatric conditionseven minor neuroses. Though they found
a few such rarefied creatures, Drexler admits that co-morbidities
represent an important challenge to clinical research.
For social scientists too, analyzing the impact of co-morbidities
is anything but straightforward. The social context of drug use
makes life and death differences, but the logic of addictive behavior
is often surprising, says anthropology professor Peter Brown. For
example, using heroin in a group would seem to increase the deadliness
of the activity through exposure to illnesses like hiv/aids. But
studies show that addicts who shoot up alone actually die more often.
Theres simply no one to pick up the phone and call 911
when someone overdoses, Brown explains.
Though the social context of drug use is key, social education programs
eventually hit a brick wall in reducing usage. Organizations
like the American Cancer Society are set up on the principle of
education as a solution. When that doesnt work,
theyre stuck, says Arri Eisen.
Cigarettes, still the most deadly addiction in America, according
to Drexler, illustrate the limits of education and the promise of
interdisciplinary research. In the last three decades, the American
Lung Association reports that the number of Americans who smoke
dropped by 40 percent, largely because of massive educational campaigns
and shifts in social attitudes. A team of Emory researchers including
Drexler, Sterk, Kushner, and psychology professors Darryl Neill
and Irwin Waldman hopes to discover why a quarter of smokers remain
Like addiction specialists across the nation, these diverse researchers
have been energized by the concurrence of social losses and scientific
gains. Some speculate that the blatant failure of Americas
War on Drugs will open doors to new approaches in drug
treatment and policy. At the same time, technological advances and
interdisciplinary efforts promise to pin down a disorder that has
been as nebulous as clouds and as common as dirt. A.B.B.