2013 Science, Technology and Environment

Nora D. Volkow

Demonstrated that drug addiction is a disease that changes brain function and created new strategies for treating patients with substance abuse issues.

Dr. Nora Volkow conducted groundbreaking research that has moved drug addiction science into mainstream medicine, demonstrating that addiction alters brain function and is a disease, not simply the result of poor judgment or personal weaknesses.

As director of the National Institute on Drug Abuse (NIDA) for the past decade, Volkow has used findings from cutting-edge research to promote the study and development of more effective intervention strategies to prevent and treat drug abuse and addiction. She has made significant strides to curb the intertwined epidemic of HIV/AIDS and drug addiction, worked to stem the high rates of prescription opioid abuse and explored innovative medication strategies to treat drug abuse and addiction.

“She’s taken the National Institute on Drug Abuse and made it a neuroscience institute,” said Dr. Larry Tabak, principal deputy director at the National Institutes of Health (NIH). “She was an early proponent of the concept that addiction is a disease of the brain. This has had profound implications for our ability to identify people who are most at risk and develop evidence based interventions that work.”

Dr. David Shurtleff, NIDA’s acting deputy director, said Volkow’s early work with imaging showed that the “addictive brain is different than the non-addicted brain,” and that a deeper understanding of the multiple circuits that become disrupted in addiction is the key to developing medically-based treatments.

In addition, Volkow has shown that the part of the brain called the orbital frontal cortex, which allows people to anticipate consequences, does not have the same metabolism rate in an addicted person, leaving that individual unable to put the brakes on addictive behavior, according to Joanna Fowler, senior chemist at the Brookhaven National Laboratory, a Department of Energy funded research institution. Volkow’s research also has shown that addiction can impact all levels of society, from the most affluent to the most destitute.

Using this and other research as a springboard, Volkow has employed the resources of NIDA to impact drug addiction treatment in several ways.

With one million people in the United States living with HIV, and about 50,000 new cases occurring each year, Volkow has led a major initiative to identify the best strategies to implement the “Seek, Test, Treat and Retain” approach that identifies high-risk populations, including substance abusers and those in the criminal justice system, tests them for HIV, begins highly active antiretroviral therapy for those who test positive and provides the necessary support to help these individuals remain in treatment.

A 2010 Canadian study supported by NIDA showed that aggressive use of antiretroviral therapy was associated with a 50 percent decrease in new yearly HIV infections among injection drug users.

Volkow also led the support of research to provide greater access to evidence-based drug abuse treatments, including medications, and to encourage the integration of HIV and substance abuse treatment in primary care.

In another initiative aimed at addressing the growing abuse of prescription pain killers, Volkow helped create 12 Centers of Excellence for Pain Education at the NIH to develop, evaluate and distribute pain management curriculum resources for medical, dental, nursing and pharmacy schools. Under her leadership, NIDA is coordinating an NIH-wide effort to reach out to health care professionals and teach them about pain and its treatment. In addition, NIDA and the Food and Drug Administration are working together to develop an over-the-counter medication to prevent overdoses by rapidly reversing the reduced breathing that results from misuse of opioid drugs.

A third effort spearheaded by Volkow involves exploring new vaccines to aid addiction treatments. This immune-based strategy, actively being pursued through preclinical research and clinical trials, has already produced promising results that soon could translate into more effective medications to decrease drug use among patients who produce high levels of antibodies against cocaine or nicotine.

Thomas McLellan, president and CEO of the Treatment Research Institute, said Volkow has been “really influential in changing the public and governmental perceptions of the substance abuse problems from a character and pathology issue to an acquired, heritable disease that is preventable and treatable.” He said she has been pursuing a science-based strategy that emphasizes “fact over ideology,” and focuses on new ways to attack the problems.

Volkow was born in Mexico and received her medical degree from the National University of Mexico. Her father was a pharmaceutical chemist who had come to Mexico with his grandfather, Leon Trotsky, the Marxist revolutionary who was expelled from Russia by Josef Stalin in 1929 and exiled to Mexico where he was later murdered.

“In my family, I grew up immersed in a culture that taught us the importance of doing something that will improve the lives of others, and I have devoted myself to research, specifically around drug addiction,” she said.

“The issue for me was whether I could play the important role of transforming addiction from a criminal behavior to a disease of the brain. It was my studies that first documented that the brains of people addicted to drugs were different from those of the non-addicted,” she said. “That gave me a unique opportunity to use that knowledge to try and change the culture.”