Understanding How and Why of Addiction is Changing

As opioid drugs took hold in the United States over the past two decades, the medical profession’s understanding of how it actually occurred has undergone a transformation.

It’s a tale that’s somewhat unique to the U.S., although opioid overuse has become more of a problem in Europe. And it’s a tale that, in the words of neurobiologist Dr. Petros Levounis, attributes in part to a “medical mistake” compounded by an aggressive pharmaceutical industry.

“The same techniques that were used in the U.S. are now being applied on the international area, and it’s absolutely scary,” said Levounis, a professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School.

In a session with National Press Foundation fellows, Levounis detailed the growth of opioid overuse, and how the medical community’s understanding of it has changed.

It used to be that physicians considered it “rare” that patients treated with narcotics would become addicted, he said, pointing to a medical journal article that made that very point. In stepped the pharmaceutical industry, which aggressively marketed its pain medications, emphasizing just how easy it was to get them: “Telephone prescribing in most states,” one advertisement said. “Up to five refills in 6 months.”

The past two decades have seen a dramatic increase in legal, prescribed opioids, as well as illegal drugs such as heroin. Hospital admissions and deaths have skyrocketed as well. Levounis detailed how the dopamine levels in the brain responds to drugs, both legal and illegal, from nicotine to cocaine.

“Addiction is the war between the hijacked pleasure/reward pathways of the brain and the frontal lobes,” he said.

As for the best treatments, thinking on that is changing as well, he said. Mindfulness and a renewed consideration for psychodynamic psychotherapy are the next frontiers in the psychosocial treatment of addiction, he said.

This program is funded by Fondation Ipsen and under the aegis of the Fondation de France. NPF is solely responsible for the content.

Dr. Petros Levounis
Professor and chair, Department of Psychiatry, Rutgers New Jersey Medical School
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