Addiction Is a Chronic Disease | Vivek Kumar | TEDxDirigo
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Addiction Is a Chronic Disease | Vivek Kumar | TEDxDirigo

Translator: Marta Quirós Alarcón
Reviewer: Denise RQ Coleen Singer died of a heroin overdose
on Christmas Day, 2014. This is from her obituary that was
published in the Bangor Daily News, “She was a victim of herself, of politics, of our society’s continuing ignorance
and indifference to mental illness, and of our society’s asinine
approach to drug addiction. Beset by affective instability due to a marked reactivity of mood,
unstable sense of self, impulsivity, a pattern of intense
but unstable interpersonal relations, Coleen flashed amazing smiles,
but lived an inner life where she often felt emptiness,
loneliness, and depression. Coleen wanted to get back
into a methadone clinic, but the legislature said no
to the Medicaid expansion. It is no stretch to say that but for the veto
of the Medicaid expansion, Coleen probably would not have shot
the heroin that ended her life, and probably would not have had
the serious recurring infections that ravaged her limbs
the last couple years.” When I read this, I felt angry and sad. I’m a researcher who studies the genetics
and neuroscience of addiction, but it was clear that much of basic addiction knowledge
is not making its way back to our society, and certainly not making
its way back to our policy makers. I took it as a challenge to go out there
and talk about the science of addiction. Many of us are going to consume a drug with some abuse liability
for most of our lives, but only a few of us
are going to be addicts. Much of the addiction neuroscience
focuses on what mediates this transition from a casual drug user
to chronic drug users, and why certain people
are more vulnerable. Addiction is the result of our genes
interacting with our environment to produce this diseased state; so, genes plus environment. An addiction is a chronic brain disease. It is a long-lasting disease that we can manage,
but we cannot cure. It’s a chronic disease,
much like diabetes or hypertension. We can, in fact, even specifically compare addiction with diabetes
and hypertension in three ways. First, the prevalence of addiction. In the United States, the prevalence
of addiction is roughly 20%. This is very similar to the prevalence
of diabetes or hypertension. Secondly, relapse rate. For addicts and for diabetics,
the relapse rate is roughly 50%, but how we view the relapse
is very, very different. Let’s say we have two individuals:
an addict and a diabetic. They both have their disease
under control for ten years, and then they finally relapse. The diabetic goes to the doctor,
and the doctor says, “Well, we’ve successfully controlled
your blood sugar for ten years. It’s time to readjust your medication, and we’ll get this thing
back under control. We’ve successfully
controlled it for ten years.” An addict who re-initiates the drug use
is said to have “fallen off the wagon.” That’s a failure of treatment. They may go to the doctor,
start abstinence, reset the cycle, but one is a success of treatment,
the second one is a failure of treatment, even though, medically speaking,
they’re both the same thing. Finally, in terms of genetics, how much genetics influences
addiction, or diabetes, or hypertension is roughly the same amount; somewhere between 20 and 80%,
depending on the drug of abuse. These are obviously different genes, but what it shows is that the impact
of genetics towards this disease is similar in all three cases. Since I am a geneticist, I thought I would give you
an example of my own work, and how we’ve been able to identify
genes that regulate addiction. I’m lucky to work
at The Jackson Laboratory, which is one of the leading genetics
and genomics institutes in the world. There’s just one small issue: most of us at The Jackson Laboratory
work on mice. This is literally a small issue. You may wonder, how do you model
something like addiction in a mouse? It turns out that mice are actually
very good model systems to study complex behavioral disorders. In terms of genetics, we share
much of our genes with mice. So genetically, we’re very similar. In terms of brain structure, humans and mice actually
have similar brain structure. Obviously, a mouse
has a much smaller brain, but all the relevant
circuitries are there, all the relevant cell types are there. Finally, in terms
of environment and genes, we can exquisitely manipulate
the environment and the genes of mice. There are hundreds and thousands of mouse model systems
available for us to study. We can carry out long-term
behavioral experiments in these mice where we can manipulate the environment. Mice, like humans,
respond to drugs of abuse, so we can train a mouse to press a lever, poke its nose in a hole to get the drug. In fact, in my own lab,
we study cocaine abuse, and one of these mice
has been given cocaine. Can you tell which one? (Laughter) Right, so cocaine elicits
a release of dopamine in key regions of the brain. Dopamine causes hyperactivity, and that’s what you’re seeing
on the right hand side. These mice are hyperactive
because they’ve been given cocaine. In fact, we can use this hyperactivity as a measure of animal sensitivity
to the drug of abuse. And so, how much a mouse moves
after it’s been given the drug is kind of how sensitive it is to cocaine. I’m going to take you
back in time to 1951. Something critical happened in 1951
for us, mouse geneticists. A colony of mice were shipped
from Bar Harbor, Maine to the National Institutes of Health
in Bethesda, Maryland. These mice were clones of one another,
they were exactly identical, just half of them
are maintained in Bar Harbor, the second half are shipped to Maryland. In order to maintain these lines of mice,
you breed them amongst one another. We know the process of DNA replication
is not 100% accurate. There are always some errors
that are picked up. Over the last 50, 60 years, you can imagine certain changes are occurring
in these two populations of mice, even though they were identical in 1951. In 2013, I tested the mice from Bar Harbor,
from Maine, and from Maryland, for that cocaine response assay
that I’ve just showed you, the locomotor assay. It turns out that they’re very different. The Maryland mice
respond much less to cocaine – that’s the green bar
compared to the blue bar. As a geneticist, this is kind of cool. These guys were exactly identical. What happened? We used a process of genetic mapping,
genomics, sequencing, and it turns out that sometime
between 1961 and 1974, there was a single mutation
that was picked up in the Maryland mice. This mutation causes a difference
in the behavior that I’ve just showed you, in this cocaine response behavior. This is one mutation
out of 2.8 billion letters in the mouse’s genetic code. This is like taking
the combined population of India and China and finding the one individual
that’s culprit. We can do this because of modern techniques
and technology that has been available. Don’t get me wrong, this work took
two and a half, almost three years to do. What we discovered was a new gene
that regulates cocaine response. Now that we have this, and what we learned also from this gene is that this gene controls
the structure of neurons in a very specific part of the brain
that regulates cocaine response. We started with this observation
that the behavior’s different, we worked hard to figure out
what is the genetic difference, and then, once we had
the genetic difference, we said, “Well, what does this gene do?” This gene controls structure
and functioning of neurons. What do neurons do?
Neurons control behavior. So we come full circle. Now that we have this finding
in a mouse model system, we can look in human cases
and addicts to see, is this gene or this pathway perturbed? We could even ask the question:
could we target this for therapy? This work, this discovery
and basic animal models can take years to materialize
into therapy for humans, but now we have a handle
that we can work on. Now that we have this handle,
you can imagine, let’s take, for instance, someone with a genetic
vulnerability for addiction. In fact, let’s say
for any chronic disease. In fact, look around. Most of us in this room
have some family history, some vulnerability for some disease. In fact, if you think about this disease, you’re born with this mutation, you have to manage
the fact of that mutation for the rest of your life. You inherited it from your parents,
you’ll pass it on to your offspring. This mutation is not going away; the effects of this mutation
have to be managed. In my family, we have
a family history of diabetes. Most males in my family
get diabetes in their 30s or 40s. I can’t control my genetics,
so I try and control my environment; I try and eat healthy, I try and exercise – “I try and exercise.”
My daughter will laugh. – but I know that with proper
environmental manipulation, I can prevent or delay the disease, but if I do get the disease, then I have to be treated
for the rest of my life. If I don’t get that treatment, I will die. This is the dissonance with Coleen. We knew the treatment she needed,
and we failed to provide it, and she paid for it with her life. Modern addiction science teaches us that someone like Coleen,
addicts, need medical services, they need pharmacotherapy
to stabilize their addiction. Many addicts have other, secondary
co-morbid diseases such as mental illness. In fact, many people use drugs of abuse
because they have the mental illness. The use of addictive substance
is a symptom of the mental illness. They’ll also need behavioral therapy
to change their pattern of behavior. They may need legal services, they may need family child services
to reintegrate into society, they may need educational services,
vocational services, housing to start to work, and live,
and be productive members of society. This is holistic evidence-based
addiction treatment. This has been proven to work. This brings me
to what I think is the real reason why the state of Maine failed Coleen: this is expensive; treating someone at this level of customized treatment,
long-term, is very costly. But what is the cost
of not taking care of addicts? In the United States,
we spend 700 billion dollars, which is the cost of addiction. This is healthcare cost,
lost productivity, the criminal justice system. Yet, we only spend 10.3 billion dollars
on prevention, treatment, and research. We’re spending the money, it’s just, which pie
do we want to put it in? In the state of Maine, it’s even worse;
this ratio is even more skewed. We’ve got to correct this discrepancy. Addiction is a chronic brain disease with clear genetic
and environmental underpinnings. Addiction scientists taught us
how to treat addicts effectively. If we want to prevent
the future Coleen Singers, we’ve got to have the wisdom
to listen and act. Thank you very much. (Applause)

13 thoughts on “Addiction Is a Chronic Disease | Vivek Kumar | TEDxDirigo

  1. Relapse rate for substance misuse is well over 90 per cent unfortunately ….not 50 per cent last I checked … I'm I wrong ?

  2. If you or someone you know has been affected by the disease of addiction come find online support with people who care. Find us on Facebook @ No Addict Left Behind. Resources may be available.

  3. It’s a choice not a disease get your research straight your just giving everybody a crutch to fall back on for the bad choices they make

  4. I really wish that more ppl looked at addiction like you do. Because my parents were addicts I was predisposed to this disease. The facts are…my DNA was actually altered and now my tolerance might be a bit higher than the average person. I wish that there were programs in place to help ppl in recovery reintegrate into society as productive members. Please ppl educate yourselves and don't give up hope on the addict in your life. Thank you.

  5. Good talk however addiction is not a disease. If the medical establishment doesn't label addiction as a disease or syndrome then insurance won't pay for treatment methods such as medication or high dollar treatment centers.

  6. The problem is that we don't look to and use treatments that are natural and highly efficacious for addiction treatment. Number one by far is ibogaine. Unfortunately, it is a schedule one drug in USA despite medical efficacy and its non-addictive properties.

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