Neuroscientists don’t believe in ghosts. She corrected him. “Ghosts in our brain,” she said.
Volkow is always talking about her brain, according to McLellan. “She will say, ‘My brain really wants chocolate now,’ ” he said. “I say, ‘Am I talking to Nora, or am I talking to her brain?’ . . . It’s how she understands the world.”
Her fascination has produced important insights into addiction. Sustained drug use alters what addicts find pleasurable and rewarding, making it less likely that addicts will resist the urge to get high. Volkow has shown that changes in the brain can last through many months of abstinence, forcing clinicians to think more carefully about helping recovering addicts stay clean in the long term.
Treatments for addicts generally involve therapy and counseling. Opiate and heroin addicts can take medications such as methadone, but for most addictions, effective pharmaceutical remedies are lacking.
“A cure would be fantastic, and that means you get a medication like an antibiotic, I cure you,” Volkow told “60 Minutes,” describing her hopes for the field. “We’re not there yet, but perhaps one day, we may be. In my brain,” she added, as though that organ embodied her entire worldview on scientific progress, “if you don’t dare to think very ambitious things, you’ll never be there.”
One promising area of research involves anti-drug vaccines. The idea is to train the immune system to neutralize a drug with the proteins known as antibodies, which the body uses during an infection to mark invaders for destruction. Attached to these large molecules, the drugs would be unable to slip out of the bloodstream and into the brain.
It could be a long time before such vaccines are ready for general use. They wouldn’t provide lifetime immunity, researchers said, nor would they cure addiction in the same way that an antibiotic cures conjunctivitis. Addicts would receive vaccines along with other medications and counseling.
Only 13 percent of NIDA’s research budget last year was allocated to pharmaceutical treatments such as vaccines. But for the institute’s critics, the emphasis on finding a cure reveals flaws in the approach of the institute, and of the broader medical establishment, to drug research.
NIDA officially defines drug addiction as a “chronic, relapsing brain disease.” Volkow didn’t formulate that definition, but she has been one of its most visible proponents. Although the definition is widely accepted, a small but vocal group argues that the definition is too narrow to describe such a complicated condition.
“If you’re a clinician or a policymaker, construing addiction as a brain disease is not necessarily the most useful way to understand it. It overlooks the social and psychological dimensions,” said Sally Satel, a psychiatrist affiliated with the American Enterprise Institute.