- Open Access
Can Neuroscience Improve Addiction Treatment and Policies?
Public Health Reviewsvolume 35, Article number: 5 (2013)
The main target of alcohol and other drug self-administration is the brain. For this reason understanding of brain mechanisms (i.e., neuroscience research) may offer important insights for creating effective prevention and treatment interventions, as well as fair and appropriate drug policies. Fair and appropriate drug policies (public laws and regulations) are expected to reduce the harms of drugs to the user and to society in general, while minimizing unintended but related policy “side effects.”
In this paper we explore how more informed understanding of neuroscience may help to improve the effectiveness and reduce the unintended side effects of contemporary drug policies. The article goes on to suggest some rational ways neuroscience may better inform and assist in policy decisions. We cover currently illegal drugs plus others such as alcohol and tobacco and touch on the new and emerging substances—legal highs.
Volkow ND, Fowler JS, Wang GJ, Baler R, Telang F. Imaging dopamine’s role in drug abuse and addiction. Neuropharmacology. 2009;56:3–8.
Di Chiara G, Imperato A. Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Proc Natl Acad Sci U S A. 1988;85:5274–78.
Nestler EJ. Is there a common molecular pathway for addiction? Nat Neurosci. 2005;8:1445–9.
Laruelle M. Imaging synaptic neurotransmission with in vivo binding competition techniques: a critical review. J Cereb Blood Flow Metab. 2000;20:423–51.
Watson BJ, Taylor LG, Reid AG, Wilson SJ, Stokes PR, et al. Investigating expectation and reward in human opioid addiction with [11C]raclopride PET. Addict Biol. 5 July 2013; epub ahead of print.
Nutt DJ, Lingford-Hughes A. Addiction: the clinical interface. Br J Pharmacol. 2008;154:397–405.
Thanos PK, Volkow ND, Freimuth P, Umegaki H, Ikari H, Roth G, et al. Overexpression of dopamine D2 receptors reduces alcohol self-administration. J Neurochem. 2001;78:1094–103. doi:10.
Volkow ND, Wang GJ, Fowler JS, Tomasi D, Telang F. Addiction: beyond dopamine reward circuitry. Proc Natl Acad Sci U S A. 2011;108:15037–42.
Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2009;35:217–38.
Dalley JW, Fryer TD, Brichard L, Robinson ES, Theobald DE, et al. Nucleus accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement. Science. 2007;315:1267–70.
Volkow ND, Wang G-J, Fowler JS, Logan J, Gatley SJ, et al. Prediction of reinforcing responses to psychostimulants in humans by brain dopamine D2 receptor levels. Am J Psychiatry. 1999;156:1440–43.
Martinez D, Saccone PA, Liu F, Slifstein M, Orlowska D, et al. Deficits in dopamine D(2) receptors and presynaptic dopamine in heroin dependence: commonalities and differences with other types of addiction. Biol Psychiatry. 2012;71:192–8.
Volkow ND, Wang GJ, Begleiter H, Porjesz B, Fowler JS, et al. High levels of dopamine D2 receptors in unaffected members of alcoholic families: possible protective factors. Arch Gen Psychiatry. 2006;63:999–1008.
Reid AG, Daglish MR, Kempton MJ, Williams TM, Watson B, et al. Reduced thalamic grey matter volume in opioid dependence is influenced by degree of alcohol use: a voxel-based morphometry study. J Psychopharmacol. 2008;22: 7–10.
Volkow ND, Wang GJ, Fowler JS, Logan J, Gatley SJ, et al. Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature. 1997;386:830–3.
Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010;376:1558–65.
Weissenborn R, Nutt DJ. Popular intoxicants: what lessons can be learned from the last 40 years of alcohol and cannabis regulation? J Psychopharmacol. 2012;26:213–20.
Carter LP, Stitzer ML, Henningfield JE, O’Connor RJ, Cummings KM, Hatsukami DK. Abuse liability assessment of tobacco products including potential reduced exposure products. Cancer Epidemiol Biomarkers Prev. 2009;18:3241–62.
Krebs TS. Johansen PØ. Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. J Psychopharmacol. 2012;26: 994–1002.
Moreno FA, Wiegand CB, Taitano EK, Delgado PL. Safety, tolerability and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder. J Clin. Psychiatry. 2006;67:1735–40.
Mithoefer MC, Wagner MT, Mithoefer AT, Jerome L, Doblin R. The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J Psychopharmacol. 2010;25:439–52.
Nutt DJ, King LA, Nichols DE Effects of Schedule1 drug laws on neuroscience research and treatment innovation. Nature Rev Neurosci. 2013;14:577–85.
Carhart-Harris RL, Murphy K, Leech R, Erritzoe D, Wall MB, et al. The effects of acutely administered 3, 4-methylenedioxymethamphetamine on spontaneous brain function in healthy volunteers measured with arterial spin labelling and blood oxygen level-dependent resting-state functional connectivity. Biol Psychiatry. 2014; epub ahead of print.
Carhart-Harris RL, Leech R, Hellyer PJ, Shanahan M, Feilding A, et al. The entropic brain: A theory of conscious states informed by neuroimaging research with psychedelic drugs. Front Hum Neurosci. 2014;8:20.
McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness. JAMA. 2000;284:1689–95.
McLellan AT, McKay JR, Forman R, Cacciola J, Kemp J. Reconsidering the evaluation of addiction treatment: from retrospective follow-up to concurrent recovery monitoring. Addiction. 2005;100:447–58.
McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:a2038.
Mann K, Bladströam A, Torup L, Gual A, van den Brink W. Extending the treatment options in alcohol dependence: a randomized controlled study of as-needed nalmefene. Biol Psychiatry. 2013;73:706–13.
Volkow ND, Wang GJ, Fowler JS, Tomasi, D. Addiction circuitry in the human brain. Annu Rev Pharmacol Toxicol. 2012;52:321–36.