Taking a Picture of Cocaine Craving

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One of the most interesting brain studies ever published used PET scans of the brain to take a snapshot of addiction cues in action. The 2006 study, in the Journal of Neuroscience is available here. To cut to the chase, this landmark paper described what happens in the brains of addicts when they think about using.

That’s an important distinction. Not actually using, but just thinking about it. Addicts were shown either neutral pictures (usually nature scenes) or images of drug using or drug paraphernalia. While they viewed the two types of pictures, their brains were scanned. The images showed that the same areas of the brain that were affected by actually using cocaine were lit up when thinking about taking the drug.

Here, finally, was direct evidence of why cravings and cues lead to relapse. One way of looking at it is to think of addiction not only being tied to a drug, but also tied to a behavior and a lifestyle. Addicted to being addicted. This is a huge problem.

A side note: Dr. Nora Volkow, one of the lead authors on the study appeared in TIME magazine’s top 100 for 2007. She’s currently head of the National Institute on Drug Addiction. Her work finally showed that cravings mimic addiction and that the more strongly someone was addicted, the more intense these craving were.

Something less than five years ago, what we suspected about addiction was shown to be true. It isn’t a lack of will power or a flawed character – here were the scans to show actual changes in brain chemistry. Addressing the cycle of craving and relapse then began to be seen as a struggle to change the way an addict thinks. It became critical to not only stop active addiction and remove access to cocaine, but then to work on retraining how the brain responds to cues. Addiction treatment shifted from a simple strategy of detox and release to a more complicated, longer term, behavioral training regimen.

This also explains why effective treatments can take months. There are actual, physical changes that have to take place in the brain – new tissue growth and cellular repair. And the deeper the addiction, the longer this process takes. Six months or more is a better rule of thumb than six weeks.

At 51, Dr. Volkow still has a decade or more to work on understanding addiction enough to help find better treatments. For now, we should be thankful there are people like her attacking the problem.

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