It's all about the dopamine

The phrase "its all about the dopamine"?

That word also comes from Dr. Nora D. Volkow, who is director of the National Institute on Drug Abuse. And, for her, the worry is about prescription medications as well as illicit drugs.

The story notes early on:

She must say it a dozen times a day: Addiction is all about the dopamine. The pleasure, pain and devilish problem of control are simply the detritus left by waves of this little molecule surging and retreating deep in the brain.

From there, the story covers her research, and her policy work as to balancing legitimate needs for prescription medications with fighting addiction and their availability to addicts.

But that's not all.

There's a message to stop at least some guilt-tripping in support groups.

One of Volkow's colleagues tells us we should stop thinking alcohol/addiction recovery has a "miserable" success rate — actually, it's about the same as with some other conditions.

Also, there may be other help on this front in the future — the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism are supposed to be merged.

That said, the allegedly woeful success rate you hear about in addiction recovery?

Well, it’s not quite that bad:

“She’s been a champion of bringing addiction science into mainstream medicine,” said A. Thomas McLellan, director of the Penn Center for Substance Abuse Solutions at the University of Pennsylvania. Medicine is finally beginning to understand, Dr. McLellan said, that if you pay no attention to the behavioral factors leading to a chronic illness, be it diabetes or substance addiction, you can never catch up. “That’s been one of Nora’s big contributions.”

In a study published in 2000, Dr. McLellan pointed out that while the overall success rate for curing drug addiction with medications, therapy or both is not high (about half of treated individuals return to active substance use within a year), it is quite similar to overall successful treatment rates for other chronic medical conditions like asthma, diabetes and high blood pressure. Failure to take prescribed medications and backsliding to old bad habits is endemic, no matter what the condition.

So, let's hold ourselves and our recovery friends accountable, but realistically accountable.

That said, Volkow also has a philosophical angle on drug usage and biochemistry:

We think we have free will, she continued, but we are foiled at every turn. First our biology conspires against us with brains that are hard-wired to increase pleasure and decrease pain. Meanwhile, we are so gregarious that social systems — whether you call them peer pressure or politics — reliably dwarf us as individuals. “There is no way you can escape.”

To me, those aren't words for despair, but they are words for realism about everything a scientific investigation of the mind is starting to reveal.