Leading researcher explains how viewing addiction as a brain disorder improves treatments

Geoff Bennett:

This week, we have been reporting on some promising treatments for two of the deadliest drugs in America, opioids and alcohol.

William Brangham is back now with a conversation with one of the nation's leading researchers who is studying America's addictions and how we can better address them.

William Brangham:

My next guest is one of the researchers who helped establish that addiction is in fact a brain disorder, that taking certain drugs over time can change how our brains actually work.

Dr. Nora Volkow is the head of the National Institute on Drug Abuse, which is part of the NIH and is one of the world's biggest funders of research into drug abuse and addiction.

Dr. Volkow, so good to have you on the program.

We have been reporting on a few of the medications that show effectiveness for treating opioids and alcohol abuse disorders, and I wonder that, from your long research on this topic, what role do you see medications playing in helping people address their addictions?

Dr. Nora Volkow, Director, National Institute on Drug Abuse: In the case of opioid use disorders, they are — they have been crucial and they have been lifesaving. And, again, it's one of the drivers that is now reducing the number of people that are dying.

So, in the case of opioid addiction, we have very effective medications. The problems are, number one, that only a small percentage of people that would benefit from them, approximately 25 percent, will get prescribed this medication.

Second problem is, they start taking them and that protects them from overdosing. But at six months, 50 percent of them will stop taking their medications. So — and we only have three, buprenorphine, methadone, and naltrexone.

So we need a wider variety of medications and we need alternatives so that people that don't respond to one medication can have options that go beyond two — those three medications and, importantly, combinations of medications that may make it easier for patients to stay in treatment, because that's crucial for someone to have the long-lasting preventing effects of the medication treatments.

William Brangham:

Why do we have so few medications? I mean, when you think about other disorders, we have a million blood pressure drugs and hypertension drugs, but so few for such a huge public health crisis.

Dr. Nora Volkow:

This is not for the lack of not understanding and scientific developments. It is due to the level of interest, the lack of interest that the pharmaceutical industry has had overall, typically, on the development of these medications.

What are the issues why there has been limited interest? Number one, stigma. Addiction is a stigmatized disorder. How do we see it? In general, people feel comfortable with people that are addicted. But it's also stigmatized in that, when you come to reimbursement, as a physician, you are paid less if you take care of someone with an addiction than if you take care of someone with a depression.

So there is discrimination on the way that we actually incentivize the willingness of a provider to participate in the process. So, these are two extreme, big barriers that have made it very difficult for industry to say, OK, I'm going to go after that.

And then the third element, it is very difficult to get these medications if they show a signal, get approved by overall, because what is required for a medication to be approved by the FDA for addiction is that you achieve abstinence.

And abstinence is an incredibly difficult goal to achieve. It's like say, OK, I'm not going to approve you a medication unless you show that the pain is completely gone or that depression is completely gone. But for these diseases, we approve medications if they reduce the magnitude.

William Brangham:

As you know, there is a strong sentiment also in the recovery community that drugs are not the right use for drug addictions, that they believe this is what got us into the problem, let's not use them to get out of the problem. They argue abstinence is the only approach.

What do you say to that argument?

Dr. Nora Volkow:

Well, it's another factor that has made it much harder for certain individuals to get the treatment that could have saved their lives. We can be very categorical in the field of addiction. It's either this or that.

And my perspective is, many of these help groups that actually have done a lot of good, but are very intolerant of the use of medications, actually are curtailing the ability to actually have someone that can benefit from the medication and from the treatment support that these groups offer.

We are — the way that we think about addiction is very different from the way that we think about other disorders, because we account the person responsible for their acts, and, as a result of that, we tend to be much more demanding of what they should do in order to actually achieve recovery.

William Brangham:

On a different note, you have done some of the initial investigations into these widely popular drugs to treat obesity and diabetes, the Ozempics and Wegovys, the GLP-1 drugs, as they are called.

Those are also showing some promise in treating people's drug and alcohol use. How promising do you think those drugs really are?

Dr. Nora Volkow:

Well, the data looks like they could potentially be quite transformative.

So, whether you are looking at the data from experiments in laboratory animals — for example, in grad, we have been funding research and they have actually shown consistently across different types of drugs they prevent the animals from escalating into compulsive drug-taking. They prevent them from relapsing.

And we're seeing the anecdotal reports from people saying, I don't have the same desire of drinking or smoking or taking cocaine. So it looks very promising. There are now ongoing randomized clinical trials, which are the gold standards for determining, in fact, what is the level of efficacy and to bring them to the next level, which is to ultimately get the data that will result in an approval by the FDA of these as an indication for the treatment of addiction.

That work is ongoing. But the preliminary findings overall look very promising.

William Brangham:

All right, Dr. Nora Volkow of the National Institute on Drug Abuse, thank you so much for your time.

Dr. Nora Volkow:

Thanks for having me.