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Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), who was one of the first scientists to demonstrate that addiction is a disease, is the recipient of the Joan and Stanford Alexander Award in Psychiatry by Baylor College of Medicine, Houston, Texas.

The award was established in honor of Stuart C. Yudofsky, MD, who is professor and chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Dr. Yudofsky was also the first recipient of the Alexander Award.

The award is given annually. Last year's recipient was Nobel Laureate Eric R. Kandel, MD, of Columbia University in New York City, who received the 2000 Nobel Prize in Physiology and Medicine for his research into basic molecular mechanisms underlying learning and memory in the brain.


Dr. Volkow shares Dr. Kandel's interest in how the brain works. She told Medscape Medical News that she has always been intrigued by the human brain and the complexity about what makes us human."Since I was a child, I wanted to understand how the brain works and how diseases of the brain affect behavior and emotions," she explained. "That is why I went to medical school."

Born in Mexico, where she still has family, Dr. Volkow received her medical degree from the National University of Mexico in Mexico City and then went to New York University in New York City to complete her residency in psychiatry.

Addiction a Personal Interest
She became interested in drug addiction for scientific and personal reasons.
"On my mother's side of the family there is a history of alcoholism. My uncle was an alcoholic. He was an extraordinary person, but when he was intoxicated his behavior was so profoundly disrupted, and I wanted to understand that.

"So I had that scientific curiosity about the brain, and then I had this person I loved very much, so I wanted to figure out how to help someone overcome the overpowering drive to drink alcohol. That's why I ended up in the whole area of drug addiction," said Dr. Volkow.
One of the first scientists to show that brain circuitry is altered in cocaine addicts, Dr. Volkow used positron emission tomography (PET) imaging to demonstrate that the prefrontal cortex is involved in the reward circuitry of the brain and that it modulated cognition and motivation.
"My work solidly established that addiction is a disease of the brain, and it identified circuits that are pathologically involved in drug addiction, giving us a much more complex picture than was originally believed about the addiction process," she said.
Dr. Volkow has also made discoveries about attention-deficit/hyperactivity disorder (ADHD). One important finding is that ADHD is associated with a deficit in the reward circuitry of the brain, and as a result, people with the disorder are unable to function because they have a deficit in motivation and interest.
"We've turned the whole concept of ADHD upside down. Everybody has been concentrating on inattention, but we are showing that ADHD patients have a deficit in their reward circuitry and lack motivation and interest," she said. "In fact, I'd like to propose that we change the name of attention-deficit/hyperactivity disorder to attention and motivation deficit disorder."

Cell Phone Use Good or Bad?
More recently, Dr. Volkow was in the news for her study on cell phones, which was published in February in the Journal of the American Medical Association. Using PET imaging, she demonstrated that brain glucose metabolism, an indicator of brain function, was significantly increased when subjects were using their cell phone.
"I don't know if this is bad or good, but we did find that we could change excitability of brain tissue, make it more responsive and more reactive. So there is no evidence that cell phones produce damage at this point, but we need to explore whether this has therapeutic uses. If you can increase excitability then perhaps you could stimulate a part of the brain when it starts to atrophy," she said.
Dr. Volkow admits that her own brain is very active. "My brain jumps around a lot. I am very curious. They say curiosity killed the cat, but I'm still alive. I must have many lives."She also admits that she is a very determined person who likes challenges. "To me, the greatest challenge of all — the greatest challenge — is to understand how the brain works. Why are we so different from animals? Why do we get attached to one another to form families? Why is the brain so powerful? Why does someone become schizophrenic and then their reality is so different from mine? Why does someone get depressed, and then everything gets so dark, and they lose their enjoyment and desire for life? I have always been curious about it all."

Addiction Is a Disease
"Nora has done some major, seminal research in the addiction field that really has pushed the field into thinking about drug addiction as a brain disease," David Shurtleff, MD, acting deputy director of NIDA, told Medscape Medical News. "She was one of the first people to use positron emission tomography imaging to show changes in the brain of drug addicts, particularly, cocaine addicts. When it was first presented people didn't actually believe it, but she kept persisting," Dr. Shurtleff said.

People used to think of addiction as a moral failing or lack of will power, he said. "What Nora Volkow has done is show, both with her leadership at NIDA and through her research, that the drugs do affect the brain in fundamental, profound ways that lead to this compulsive taking that we call drug addiction. She has definitely been a leader in this area."

Dr. Shurtleff also praised Dr. Volkow's leadership of NIDA.

"Nora is voracious in reading and learning about all the research that goes on in the addiction field and related areas, and she's very good at connecting the dots and formulating hypotheses that the field can latch onto to develop further. "She is also very much translational in the sense that she looks at the epidemiological data, the clinical data, and then thinks about what that means in terms of underlying basic mechanisms of the brain," he said. "She identifies the problem and then she looks for solutions and that is a real strength of a leader in this field," he said.

Por Ricardo Giner - Valencia Adicciones - Drogodependencias y otras Conductas Adictivas