Addiction and Free Will

37f48-6a01156f9c01e7970c017eeae51f50970d-piIn an article recently published by the Huffington Post, the director of the National Institute on Drug Abuse (NIDA) shares an intimate anecdote about her grandfather’s harrowing battle with alcoholism, an addiction that was kept secret from her until long after his death.

Nora Volkow, M.D., has served as NIDA’s director for the last twelve years and has contributed to the institution’s mission with her own work as a research psychiatrist and scientist. Also a member of the Dana Alliance, Volkow’s research focuses on neuroimaging to investigate the effects and properties of abusable drugs.

According to Volkow, drugs of abuse not only cause large flows of dopamine in the reward regions of the brain, they also affect the “prefrontal regions that control our higher functions like judgement, decision making, and self-control over our actions.” She writes, “To explain the devastating changes in behavior of a person who is addicted…where they are willing to give up everything they care for in order to take a drug—it is not enough to say that addiction is a chronic brain disease.”

The article aims to challenge this current definition of addiction as a “chronic brain disease.” Instead, Volkow attributes the distressing behavior of addicts to their lack of free will. When it comes to drug usage—whether it is legal or illegal—the brain circuits crucial for motivating our behavior become desensitized to the dopamine “surges” that the drugs cause (a process called “receptor downregulation”), says Volkow. “The result is that ordinary healthy things in our lives…no longer are enough to motivate a person; the person needs the big surge of dopamine from the drug just to feel temporarily okay…and they must continually repeat this, in an endless vicious cycle.”

Just last month, Volkow spoke at a Capitol Hill briefing to address the need for a thorough understanding of legislation that permits the use of marijuana, whether medical or recreational. In 2013, she was nominated for a Samuel J. Heyman Service to America Medal in recognition of her work on addiction.

While illicit drug use among teens seems to be declining, according to a survey conducted by the University of Michigan late last year, there is still much work to be done regarding the stigma that society ties to drug addiction. Volkow notes:

If we embrace the concept of addiction as a chronic disease in which drugs have disrupted the most fundamental brain circuits that enable us to do something that we take for granted—make a decision and follow it through—we will be able to decrease the stigma, not just in families and workplaces but also in the healthcare system, among providers and insurers.

– Seimi Rurup

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