Addiction-an HBO documentary

i-fd5c0431079bb645dae965f156e73f00-3-8-7 addiction.jpg

I was recently invited to the screening of a new HBO documentary series called "Addiction". I had the pleasure of meeting the filmmakers as well as some of the medical experts, like Nora D. Volkow M.D. and Mark Willenbring M.D., who helped shed light on this phenomenon. I was quite amazed at what I learned about the science of addiction, its new perception as a 'chronic but treatable brain disease' and the many misconceptions surrounding it.

If addiction is a brain disease, I wondered: how does one 'get' the disease and why are some people more prone to 'get' it than others?

According to Mark Willenbring, M.D., Director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism/National Institutes of Health and one of the main experts involved in the documentary series, the risk factors for addiction include genetics, environment, availability of drugs or alcohol and a person's developmental age. The earlier a person starts to abuse drugs or alcohol, the greater their chance of becoming addicted.

One documentary that particularly moved me was entitled "A Mother's Desperation". Here a mother tries to rescue her 23-year old daughter from heroin addiction and a life on the streets by resorting to have her arrested.

Other documentaries in the series explained that many addicts also suffer from mental disorders such as depression or ADHD. This led me to pose another question: what comes first-the addiction or the depression/ADHD?

Apparently, there is no easy answer to this question. Robert Swift, M.D., Ph.D., Professor of Psychiatry and Human Behavior at Brown University Medical School Center for Alcohol and Addiction Studies explained that there are several possibilities:

1) Addictive disorders may be caused or worsened by substance use; 2) substance use may cause or worsen mental disorders; or 3) substance use disorders and mental disorders may have a common etiology.

The reason, he explains, is that the risk for both substance use disorders and mental disorders is affected by both genetics and environment. Some genetic factors can promote risk for one or both disorders and some may protect against one or both disorders. The same situation occurs with environmental factors. Some environmental factors may increase risk and others may decrease risk.

The good news is there are treatments for addiction.

While no single treatment is appropriate for all individuals, there are certain combinations of treatment that are scientifically proven to be most effective such as integrating treatments for coexisting mental and drug disorders. New FDA-approved medications are also available that may help reduce the risk of relapse. Finally, scientists are now using brain imaging to see how drugs and alcohol physically alter the brain and are using this information to develop targeted therapies.

If it does nothing else, this documentary series will hopefully open up conversation about addiction and get people talking about it as a brain disease and a treatable illness rather than a moral failure of sorts.

Image from Volkow ND et. al., 2001 Journal of Neuroscience 21(23):9414-9418

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How interesting Karen,
I would love to see this, but I don't get HBO. Hopefully it will filter down to regular channels. It seems pretty important to me. It would be good if addiction could be treated in everyone and understanding the risk factors could be a big help


I have been following this new science of Addiction for about a year. In fact I decided to write a book on it called, "Preventing Addiction: What Parents Must Know To Immunize Their Kids Against Drug and Alcohol Addiction." It agrees with and complements the HBO documentary.

However, it does differ in one way----it applies this information to the PREVENTION of addiction. You can find out more at

Regarding the PET scan: Is there any significance to the more widespread dark areas (areas where the ligand used didn't bind, I assume) in the 24 month detox image? Or, is this either an artifact of some sort or simply natural variability. Obviously, the real story is that there is stronger ligand binding in the area of interest after longer detox.

I found viewing the first episode of "Addiction" very interesting. I have enabled a daughter for over 30 years and am raising her 13 year old son. I decided on August 20, 2006 to put her out forever. Amazing, an addict will and does survive. I am convinced part of the problem is just plain bad behavior and laziness on the part of the addict. I am sure addicts hide behind the word "disease". I certainly hope this series enlightens me.

It's all well and good that professionals investigate the 'how'. The 'why' is totally different story. I recall Nora D. Volkow M.D,mentioning genetics as playing a role in the 'why'. I'm no medical professional but this seems nonsensical. Addiction doesn't occur in quantum steps, it's a continuous degeneration. If someone who doesn't have any mental illness to begin with allows him/herself to get to that point, while recognising that it's slowly destroying themselves and everything they touch, then they are just selfish.

Of course there will come a point when the brain doesn't function normally and they can't control what they're doing. Drugs are know to have that effect, and we've known it for more than 100 years. Nothing new there.
To absolve these addicts from responsibility by calling it a 'brain disease' sends a message saying that these people are just unfortunate victims. This is ridiculous.

They are selfish people to begin with. Treatment can't change an attitude that's already ingrained. They have to do that for themselves,if they can recognise their self-destructive personality.

David Horton
PhD student

By David Horton (not verified) on 19 Mar 2007 #permalink

my life was untouched by addiction until a week or so ago when a drug addict who was doing work in my home broke in to my home and stole a friend's laptop. i believe my home was robbed by crack cocaine, and not by the man who did it. i am trying to be compassionate and to understand him and his pain. i hate drug dealers and i hate drugs and i hate what this is doing to a family of my neighbors. god bless hbo for producing this program and helping others understand the tragedy that is drug addiction. i hope many people watch it (hbo was free in my area this weekend) and learn and try to help.

i am a "recovering" addict. i have been out of rehab for almost 4 years. i am one of the strongest willed you can get. i love life and strive to find peace, but know this, i still use often, i find ways and cant no matter what or how much time goes by stop. i seek info and try antidepressants, sobriety, religion, na, nothing makes my cravings go away, i want to stop and can actually go months without using, but its always there, like being hungry, but dieting and limiting yourself. i hate it now it is as much a part of me as my hands. i hold down a job pay my bills raise my son, function just like all, only i am always starving for that peace that only comes from opiates. some say self disipline is needed, well i have mastered that and still want my food.this show gives me hope that maybe it is in my brain and there is hope. p.s. both my parents are addicts.

"what comes first-the addiction or the depression/ADHD?"

As I see it?

ADD in preteens and teens (Untreated)
Turns to depression (Untreated)
Teens turn to self-medication because of the depression
(drugs and alcohol)

Self questioning - Why can't I learn? / Why can't I fit in? etc...
No one person or place to turn to.
The broken find others who are also broken.

All leading to further despair and addiction.
All the while the ADD has gained strength and has never left.
The brain and nervous system is damaged even more so.

You may treat with pharmaceuticals but in the end there must be a never-ending supply of supported treatment like A.A. or N.A. to have no one looking down on them even in the slightest.

Relapse will always be one moment away at any given time.

Ego and the super ego also play a part in the way some manage their addiction and become the fully functioning addict with a bipolar disorder associated in some.

Found item some years ago outside a middle school, no name.
My hope is this child who wrote it found help.

My life tho? tragic
No promised magic

Life sucks with a wanting to die

so in tears I drown
I scornfully frown.

Screaming to the devil - why oh why?! - is so insane
I know some will understand this refrain...

I know things will stay the same?
I just feel like numbing this torturous pain

To walk deep into a lake of amber ale?
or breathe deep the vapors of nature.

To be Alice late of time? a running rabbit with a habit.

My pain offends me to point of despair
Wishing to drown the sorrow, that is so unfair

I have read the above posts with great interests, people who have come in contact with addicts and one who is an addict. Your observations are correct. Addiction is the following:

1. Caused by exposure to addicting substances at a young age, not genetics---anybody can become an addict if they start young enough.

2. A disease. No matter what, most addicts can't stop using, even with treatment. The addicts brain is altered forever.


4. Though addiction is a disease, addicts must remain accountable for their behavior just like anybody else.

Thanks,Dr.Fleming for dispelling the 'genetic' theory of addiction. That trend of thought/idea is extremely dangerous. Even more dangerous than addictive substances. I'm sure you'll agree.
Thanks for also mentioning the addict's direct accountability. (Even though pairing it in the context of a disease seems a bit shakey to me, but that's just a personal opinion.)
Overall,I think the series was very good in that it de-glamorized drug use and showed it as the dark,sickening reality it actually is by interviewing real people.
Until rotten teeth and uncontrolled bowel movement become attractive, some measure of sanity would prevent embarking on such a journey.

PhD student

By David Horton (not verified) on 20 Mar 2007 #permalink

In response to smidscot's comment (March17):
Dr. Volkow's paper explains that the dopamine transporters appear to be adaptive. According to the paper the methamphetamine-induced DA transporter loss reflects temporary adaptive changes (i.e., downregulation). The increased binding of ligand after prolonged abstinence may be because the terminals can recover, or because the remaining viable terminals increase functionality.

It's interesting to see the variance of opinions.I suspect this is partially related to whether you've ever had direct experience with an addicted family member.I find the HBO special to be a ray of hope in a sea of despair.While the addict is no doubt responsible for that initial choice, believe me they and their families pay a huge price for many months and years after that first hit.I think that the evidence is building that addicts are not simply bad people who selfishly won't quit their habit, but rather tortured souls who can't quit easily despite gruesome consequences.The stories do show that addiction can be overcome and that medication clearly has a role to play in helping the addict heal themselves.

This post is in response to D. Horton, PhD. who questions how we can think of addiction in terms of a disease and yet still hold addicts responsible for their behavior. This is, indeed, a perplexing question and let me try to answer it.

Sal in an above post articulates how he has always had strong will in his life until drugs took control. This is the essence of addiction in that the brain becomes permanently reprogrammed, truly re-hardwired, to work daily toward achieving relief of anxiety caused by periodic withdrawal from drugs and to satisfy a very strong urge to achieve euphoria. The brain becomes HIGHLY reward driven through its reward axis mediated by dopamine, a neurotransmitter.

There is no doubt that this permanently distorted reward system has a major control over the addict's behavior. Having said this, the need to avoid punishment remains in play in the addict's brain as well. The extent that this system is still functioning depends on how severe is the addiction.

For instance, a "skid row" heroin addict who is homeless and has no job and no family has almost no punishment avoidance in effect. If he did, he would have made life changes before falling that far. By contrast, a highly functional executive who has an intact family unit and who is in the early stages of alcohol addiction (alcohol being a lower potency addicting substance than most), has a lot to fear in terms of punishment---loss of job, family or even prision. Consequently, the latter example is far more likely to submit to treatment and remain sober. Why? Because he has a lot to lose.

In summary, the need to hold addicts accountable for their behavior has two functions:

a. It tends to counter-balance the effect of an out of control reward system by making addicts weigh the risks and benefits of dangerous or criminal behavior.

b. It forces those addicts who can't control their addiction to be placed in a controlled enviornment (prison) so they cannot harm others, therefore protect society.

Consequently, the apparent duality of the arguement that addiction is a disease yet offenders must be punished begins to become logical. Another disease that could be compared to this is epilepsy. If a person is subject to seizures to an unpredictable level, his or her driving privleges are removed. This seems like punishment, and to the patient it really is to an extent. However, public safety is always an overiding concern even though the source of the problem is a disease---epilepsy in this case.

What is a truly an illogical argument is the one that goes like this. Why shouldn't we legalize drugs, much like we see in Europe, because it is victimless crime. My answer is this. Please ask the families of those killed in alcohol related car crashes or the children brought up in homes where the entire budget goes to drugs instead of food, clothing and shelter or parents who have lost their kids to drugs or the victims of crimes small and large committed by addicts to feed their habit whether it is a victimless crime. I think you will change your view on addiction being a "victimless" crime.

I have had several people in my family son,sister,
Grandchildren and cousins addtions to crack, cocain, alcohol, and prescription pain pills etc. maybe some things I don't even know about. Why all of them Why????
I would like to help them all but I would not even know where to start. Is there something out there that can save there lives? Get them back to living everyday lives or at least what I see as everyday as a somewhat normal life.