Nora Volkow Explains (Not Really) Why People Don’t Become Addicted

Editor’s note: Points is happy today to republish our friend Stanton Peele’s recent commentary on the new Cambridge study of sibling pairs and addiction.  Not many of us here at Points are real hardcore quants, but even we were scratching our heads at these findings.  In brief: researchers looked at sibling pairs in which one sibling was an addict and the other was not, and claimed that the disparate responses prove that addiction is an inherited brain dysfunction.  50% addicts + 50% not addicts = 100% brain diseased?  But don’t take our word for it; let Stanton Peele to do the math.

You have heard about the earth-shaking new study proving that addicts inherit a brain dysfunction that causes them to have poor impulse control?

The Cambridge Brains

Published in the most prestigious fundamental research journal in the world, Science, investigators at Cambridge found that siblings, half of whom were drug-abusers/addicts and half of whom were not, shared this trait.  This proved to the researchers that the brain anomaly preceded the drug abuse, and was not a result of it.

Here, let’s turn to Nora Volkow (as Science itself did) for an explanation:

“The inferior frontal gyrus is really one of the main ‘brakes’ of our brain,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse, who wrote a commentary accompanying the study in Science. “[Drug users and their siblings] have less [sic] connections that are linking the rest of brain with the inferior frontal gyrus [and other key regions] that form a network that allows you to inhibit responses.”

Run that by me again.  A study showing a brain dysfunction that somehow causes addiction led in half of siblings to drug abuse and in the other half didn’t?  Doesn’t that make us want to learn what accounted for the siblings with the brain anomaly not becoming addicted?The most casual reading of these results points to a fundamental problem with the conclusion that brain function causes addiction.  Let’s grant that we can reduce impulsivity to a single brain structure (which isn’t itself true*).  Instead of saying this study provides proof that addiction is inbred, it is equally true—truer—to say that it proves that impulsivity and brain structure have no impact on addiction.  After all, only a coin flip could tell you the chances of two people who share these traits becoming addicted or not.

The Alcoholism Gene

Really, the study—since it measured no natural populations—tells us nothing about whether this brain condition is any more prevalent in addicts at large than it is in non-addicts. (Do you remember the ballyhooed 1990 study in the Journal of the American Medical Association which found the gene for alcoholism and addiction in one group of alcoholic cadavers?  It was never replicated among any general alcoholic-addict population.)

Nothing daunted, Volkow (as described by addiction reporter Maia Szalavitz for Healthland) builds a whole edifice on such nothingness:

But the big question, as Volkow points out, is why the siblings in the current study ended up following such different paths when they shared the same vulnerabilities to addiction. Why did one become addicted, but not the other?

Additional results from the brain scans may provide intriguing hints at an explanation. For instance, people with addiction—but not their siblings—showed decreased activity in their medial orbitofrontal cortex (OFC). “That area is crucial in terms of enabling you to have flexibility and to shift your behavior as a function of changes in [the] environment,” says Volkow.

Well, that explains it—doesn’t it?  “Brain-disease” Volkow offers as the reason that some impulsive people abuse drugs and some don’t is their (hypothetical) deficient functioning in another area of their brain!  These poor souls are doubly diseased!

Ain’t science grand?  I’m being ironic, of course—this isn’t science.  It’s as though, having found something in the brain—but something not able to account for addiction—the writer doubles down on her brain-behavior bets.  Why, she has become addicted to seeking brain explanations!  This disease is known as reductionism: the ironclad belief that describing events in biological terms comprises a scientific advancement no matter how hypothetical the explanation is and how little it improves our understanding of—or ability to influence—outcomes.

And the disease is catchy. Forbes magazine’s coverage of the Science study purported to defy its results—”Your Brain May Be Wired for Addiction but You Don’t Have to Surrender.” But it actually reified them by fantasizing that the resiliency against addiction in half the subjects must have stemmed from some yet-to-be discovered “variations in the brains of the un-addicted siblings.”

Control for Childhood Dysfunction

Brains, brains, brains.  Nothing in the addicts’ and non-addicts’ lived experiences had any impact? The researchers carefully controlled for childhood experiences, and ensured that the siblings’ upbringing was similar (they found high levels of family dysfunction and abuse in the early lives of both the addicted and non-addicted siblings). Since abuse also causes addiction (we are told), then certainly abuse + genetic predisposition must equal addiction. Except, then, we still have the one addicted sibling and the one nonaddicted one, given the presence of both factors.  That’s because negative childhood experiences are just as nondeterminative as predictors of addiction when actually measured in general populations as is brain structure.

Isn’t there any other possible explanation for the differences in siblings’ addictiveness?  How about the role of purpose, social support, learned skills, etc.?  The reason to suggest these things is that another government agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), spent a year surveying leading behavioral mental health professionals in order to uncover the common current elements in people’s lives that lead to recovery from mental illness and addiction.   SAMSHA identified these psychological and environmental conditions that prevent and dispel addiction: Health, Home, Purpose, Community.

But you can’t find those things in a laboratory.  And that is why the revolutionary SAMHSA initiative has received virtually no media attention from the likes of Time Healthand.  I guess it depends on how you define science—is it the result of work by people wearing white lab coats or is it identifying the things that make a difference in comprehending and dealing with the world?  The factors identified by SAMHSA seem so prosaic.  Their only advantage is —that they are prosaic.  Because these are the fiber of human lives, the things parents and people themselves can strive to attain, the things society and social agencies can encourage.

Oh, and these factors actually account for which people resist addiction, and tell us how and why they are able to do so.  If that isn’t science, then nothing is.

Recovery: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. -- SAMHSA

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4 thoughts on “Nora Volkow Explains (Not Really) Why People Don’t Become Addicted

  1. I think I agree with the general aim of this piece, but it seems to misrepresent the article in Science a bit. (Caveat: I’m an historian and have no background in statistics or science, so I’m speaking as an interested amateur.) Peele writes:

    “Really, the study—since it measured no natural populations—tells us nothing about whether this brain condition is any more prevalent in addicts at large than it is in non-addicts.”

    Yet according to the summary of the study he links to, the 50 sibling pairs with abnormalities in their fronto-striatial systems “were compared with those of 50 unrelated healthy volunteers who had no personal or family history of drug addiction.” I take this to mean that the abnormality was shown to be just that – something more prevalent in the sibling pairs than in the (presumably) non-addicted control group.

    I’d also note that the person he keeps quoting here, Volkow, doesn’t seem to actually be involved in the study itself, just the author of a commentary on it. I doubt the authors of this article would be so silly as to claim that their finding “explains” all instances of addiction in every context (although I have little doubt that the popular press could misrepresent it in this way). My personal take is that I welcome brain scientists working on topics like this — even if their outlook can at times be overly mechanistic or reliant on lab analysis rather than real life experience, surely its better to have multiple perspectives, no?

    • Ah, what I mean is that this anomaly has not been examined in general populations as an indication that it is associated with addiction within the broader population. This would occur by conducting a population study, finding those with substance abuse patterns, and finding this anomaly predominantly, even significantly more, present in this group. This would tell us (a) that it is any kind of marker, (b) how strong of an abuse/addiction marker it is. The JAMA study I referred to found a claimed genetic marker in a specific group of cadavers (which I believe were largely African-American). But no such marker for addiction/alcoholism was ever found in a general population — the finding is pooh-poohed today (actually, it is now simply ignored and forgotten), as this one will eventually be
      * * * *
      I was critiquing Science’s overall handling of this article, by employing Nora Volkow to comment on it, which produced the predictable Volkow-world response: “YES, we’re on the verge of a genetic-neuro explanation for addiction” — actually, since Volkow’s own work is strictly based on exposure models (they took the drug and became dependent on it due to its pharmacological properties), it’s not actually clear how such findings relate to her dopamine-based models posited to account for addiction.
      * * * *
      All of this is actually academic — on the grounds that epidemiological studies CONSISTENTLY find that people outgrow addiction and alcoholism, which of course subverts all “they were born to be addict” models, which simply don’t conform with the repeatedly established reality of the way addiction actually works.
      * * * *
      As to these two comments, I have two reactions. I welcome any careful and thoughtful readings, and so I am glad to see them. On the other hand, that these fake models (which obviously fail to make sense of the most fundamental data on addiction) are so popular and take in even careful socially-oriented investigators, affirms for me how seductive — even as they are dysfunctional and harmful — these models have become.

      • Volkow’s remarks were obviously premature and incorrect, but the scientists themselves are not to blame! What they are doing is worthy, even if how it is used by politicians is messed up. The scientists say so themselves that what they are doing is observing correlations, not arguing causations. We shouldn’t punish the science for for how it comes out in the politicians mouth.

        I don’t think people are born addicts. But I do think there is a genetic/biochemical component that makes people prone to it. In sociological studies, addiction is shown to run in families, across all socio/cultural/economical classes. There is reason for this science to occur.

  2. I agree with Ben. Even in the articles you site, they make clear that the siblings were compared with a healthy population.

    Also, this is irrational: “Instead of saying this study provides proof that addiction is inbred, it is equally true—truer—to say that it proves that impulsivity and brain structure have no impact on addiction. After all, only a coin flip could tell you the chances of two people who share these traits becoming addicted or not.” This argument would only be rational if 50% of the population were addicts. But when less than 10% of the population are addicts, a coin toss is pretty good statistical analysis!

    Doctors use statistics all the time to let patients know their proneness to disease. For instance, I know I have a 30% greater chance of getting blood clots than the general population due to a genetic blood abnormality. For that reason, I take precautions such as not taking certain medicines that increase the chance of blood clots. For you to say that such science is unworthy and useless when it comes to understanding addiction is kind of absurd and unfair.

    All that said, I do worry about the future. I worry that in the future we will be able to screen people for addictive tendencies, and force them to live a guarded life or stigmatize them in other ways. It’s important scientific advances don’t prevent future generations from free choice and opportunities to determine one’s fate. There is also a lot to be said about so-called “addicts” being highly functional and offering a lot to society, regardless of their status as “diseased”.

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