Why it's Vital We Study the Science of Addiction
Harris and Carlton K. Erickson
October 11, 2004
The professor for UT-Austin's undergraduate course, Neurobiology of Addiction begins the semester by asking who intends to obtain a master's or doctoral degree. Many students raise their hands.
The professor then asks: How many of you will die of addiction? No hands go up. The instructor explains to students that they have it exactly backwards -- it is likely that more will die of addiction than will complete graduate degrees.
One wonders whether enrollment in this class or academic research conducted by faculty can reverse such an outcome? More to the point: Does the university's academic structure stand in the way of discovering and putting to use knowledge important to society?
Addiction science is multidisciplinary, controversial, not usually supported by large foundations, donors, businesses, or most government agencies -- exactly the sort of obstacles not easily overcome by the university.
Many of the barriers to addiction research are shared with other complex scientific problems. First is the challenge of academic geography. At UT, addiction expertise resides in neurobiology, pharmacology, psychology and social work. These sites of knowledge are housed in four separate colleges, each functioning as a semi-feudal domain that inadvertently limits collaborations across academic units.
Second is the matter of funding. The university provides little monetary support for research; investigators must obtain money from donors, businesses, or government agencies to support their science. This is a wonderfully entrepreneurial system responsible for tremendous advances produced by American science, but, sadly, addiction receives relatively small amounts of funding compared with other health problems.
Why don't stakeholders--taxpayers, donors, and the university itself--make addiction research a priority? Part of the answer is that addiction is still seen as a moral failing unlikely to be improved by science--despite the overwhelming documentation by researchers that addiction is a brain disease. The role of genetics in susceptibility to addiction is established and the ‘re-wiring' of the brain during addiction is as clear as the reprogramming of the cells that become cancer.
Where people's beliefs get short-circuited is when addiction is mistaken for voluntary overuse of drugs such as alcohol, a problem common among college students. Certainly not all alcohol drinkers are “alcoholic” or alcohol dependent. We know that some drug misuse is a behavioral problem. But “addiction” is a state beyond simple bad behavior, and an unwillingness to recognize this ultimately prevents us from saving the lives of people who are truly dependent on drugs such as alcohol and nicotine. These people desperately need new therapies now being developed by addiction scientists.
Why have academics been so unsuccessful in establishing this perspective in public consciousness? One issue is personal accountability. If addiction is a disease, are addicts somehow less responsible for what they do under the influence of drugs? No! In Minnesota, a diabetic with a history of blacking out cannot get a driver's license. Just like the diabetic, there is no need to absolve the addict of anything.
Another issue is the lingering and false dichotomy illustrated by the frequent question of students: Is addiction “psychological,” or is it “physical”? All behavior is represented in brain chemistry. Brain imaging studies dramatically illustrate that psychotherapy changes brain function, thus psychological is physical. The pathological changes in brain function associated with addiction are as real as those produced by Alzheimer's disease, but it is difficult for many people to accept that the emotions and behavior and the loss of humanity produced by addiction are represented chemically.
To address these issues, addiction researchers must have a mechanism for easily collaborating with their colleagues in other disciplines--including those in the humanities and social sciences who study human attitudes and behavior. In addition, scientists should be encouraged (and rewarded) by the university to spend time communicating new research findings and working with those sectors of society for whom their knowledge matters. Such multi-disciplinary effort and communication will elicit open dialog, create fuller understanding of addiction and correct many of the misperceptions people have about drugs and addiction.
The questions raised by UT professor Rick Cherwitz in the first essay of this series on academic engagement, therefore, are manifested abundantly in addiction research. While the university is beginning to change, the discovery and delivery of knowledge remain primarily the jurisdiction of autonomous departments and colleges who compete for university support. Moreover, the emphasis for tenure and promotion is placed on individual research accomplishments--despite our realization that teamwork and the communication of knowledge are essential to solving complex problems.
The time has come to change the structure and reward system of academic institutions in a manner that will produce networks of ideas and people able to fully understand addiction and other complex diseases. Only then will science serve as a positive agent of change.
R. Adron Harris is M. June & J. Virgil Waggoner Professor (Neurobiology and Pharmacy) and Director of the Waggoner Center for Alcohol and Addiction Research and Carlton K. Erickson is Pfizer Centennial Professor of Pharmacology (Pharmacy) and a member of the Waggoner Center, University of Texas at Austin.