Nora Volkow

Only the weak become addicted. If that's what you think, Dr. Nora Volkow is determined to change your mind. The director of the National Institute of Drug Abuse (NIDA, part of the National Institutes of Health) and one of the country's leading addiction researchers, Volkow says brain science is proving that we all have the potential to become addicted to something: drugs, alcohol, tobacco, sex, gambling, even food. And while we may think that being addicted to food is not as bad as being addicted to heroin, researchers are learning that all addictions are more alike than was previously thought. Becoming an addict is more a matter of chance than we ever realized; mix the right combination of genetics and life experience, and anyone could find himself addicted to something.

Many people might consider that idea unsettling. Volkow finds it fascinating and encouraging, because it means everything we learn about one type of addiction has the potential to teach us something about the others. "Just imagine," she says, "if all the private money being spent to understand and treat obesity could help us understand and treat alcoholics and drug addicts." Millions of people could be pulled back from the abyss.

Volkow, the great-granddaughter of Leon Trotsky, grew up in Mexico, in the home where the Russian revolutionary was assassinated in 1940. As a young scientist, she became intrigued with the loss of free will that characterizes addictions, including the alcoholism that bedeviled her uncle. "We all think we can control our actions," she said. "But why does one person have such intense cravings that they experience a loss of control, while another person can overpower those desires? I wanted to understand the brain mechanism that makes people lose control."

Over the course of the past three decades, Volkow, 50, has published more than 420 papers, many of them on different aspects of addiction. She brings an intense, passionate advocacy for addicts to her role as head of NIDA. She is steering her agency to use breakthroughs in one area to advance research in others. In the next year, she predicts, we'll see progress in new treatments, such as drugs designed to disrupt and weaken an individual's memory of how good an addictive substance feels. "If we could interfere with that conditioned response, we might be able to weaken the addiction," she said. In effect, she says, this research is like trying to get Pavlov's dog to stop salivating when it hears the bell.

Using biofeedback as a way to control cravings is showing promise, she said, as are clinical trials now underway for a cocaine vaccine. (Antibodies would be created to protect against the effects of cocaine, similar to the way an antibiotic fights off bacteria.)

Much of the research into addiction revolves around dopamine, the neurotransmitter associated with pleasure. New research by Volkow and others indicates that high levels of dopamine receptors (which are like docking stations in the brain for dopamine) seem to protect against addiction, while low levels increase vulnerability. High levels of dopamine receptors also seem to protect against obesity and drug abuse.