In a cover story on addiction, Newsweek says the “emerging paradigm” sees it as a chronic, relapsing brain disorder to be managed with all the tools at medicine’s disposal. “We are making unprecedented advances in understanding the biology of addiction,” says public health Prof. David Rosenblum of Boston University. “And that is finally starting to push the thinking from ‘moral failing’ to ‘legitimate illness’.” In laboratories run and funded by the National Institute on Drug Abuse (NIDA), fMRI and PET scans are forcing the addicted brain, to yield its secrets. Geneticists have found the first few gene variants that predispose people to addiction, helping explain why only one person in 10 who tries an addictive drug becomes hooked on it. Neuroscientists are mapping the network of triggers and feedback loops that are set in motion by the taste, sight, or thought of a beer or a cigarette; they have learned to identify the signal that an alcoholic is about to pour a drink even before he’s aware of it himself, and trace the impulse back to its origins in the primitive midbrain.
Experts are learning to interrupt and control these processes at points along the way. Among 200 compounds being developed or tested by NIDA are ones that block the intoxicating effects of drugs, including vaccines that train the body’s immune system to bar them from the brain. Other compounds have the ability to intervene in the cortex in the last milliseconds before the impulse to reach for a glass translates into action. To the extent that “willpower” is a meaningful concept, the era of willpower-in-a-pill may be just over the horizon. “The future is clear,” says NIDA director Nora Volkow. “In 10 years we will be treating addiction as a disease, and that means with medicine.”