These intimate photos shatter the stigma of addiction

Health

What does it mean to be addicted?

These Intimate Photos Shatter The Stigma Of Addiction As A Pathology

Photo by Max Aguilera Hellweg/INSTITUTE

In 1997, a one-page article entitled “Addiction is a Disease of The Brain, and It Matters” was published in the journal Science. The paper, written by Alan Leshner, Director of the National Institute on Drug Abuse (NIDA), was the first time someone made the case that addiction is a disease of the brain. Leshner based his claim on recent advances in neuroscience, citing research that “virtually all drugs of abuse (have) common effects, either directly or indirectly, on a single pathway deep within the brain.”

He wrote that the “activation” of this pathway, known as the reward pathway, “appears to be a common element in what keeps drug users taking drugs.” He also pointed out that “prolonged drug use cause(s) pervasive changes in brain function that persist long after the individual stops taking the drug.” These changes, he said, have been identified on “molecular, cellular, structural, and functional” levels.

Leshner’s theory came to be known as “the brain disease model of addiction.” And it can be summed up by the belief, as Leshner wrote, “that addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease.”

Proclaiming addiction was a medical problem in 1997 was like comparing alcoholism to diabetes. This understanding did not—and still does not—conform to commonly held beliefs that addicts are immoral persons lacking an ability to control oneself, people who just can’t “say no.”

Leshner confronted this issue in his landmark article. “The gulf in implications between the ‘bad person’ view and the ‘chronic illness sufferer’ view is tremendous,” wrote Leshner. “There are many people who believe that addicted individuals do not even deserve treatment.”

IAM 00084758 This doctor tried to convince Carl Sagan to stop smoking weed
Janna Raine, 48, a former makeup and nail technician, got started on heroin after taking prescription pain meds for a work-related injury 20 years ago. She has been living in a tent in this homeless camp under a freeway underpass south of downtown Seattle for the last two years. Janna has a daughter, age 30, who lives in a nice neighborhood within walking distance but hasn’t seen her in seven years. The last time she took heroin was the morning this picture was taken in Seattle, Washington on November 18, 2016.
(Photo by Max Aguilera Hellweg/INSTITUTE)

Twenty years have passed since the brain disease model for addiction was introduced. It remains largely unknown to the general public, the medical community and those making public policy. But the implications are indeed tremendous: We are in the midst of an Opiate Crisis in America, and it’s still far easier for a doctor to write a prescription for opiate painkillers than Methadone, an opiate that does not get addicts “high,” but is used to help them get off of addictive drugs like heroin.

Addiction remains so poorly understood that in 2016 the president of the Philippines, Rodrigo Duterte, vowed to kill 3 million addicts (having already killed an estimated 3,000 in the first few months of his presidency). NIDA has focused their addiction research not just on the brain, but on genetics—looking for a genetic explanation for addiction and on the behavioral and social mechanisms involved in it. But their core research remains focused on the brain and finding targets for treatment in the brain.

Baclofen, a generic medication used to treat muscle spasms, was accidentally found to treat cocaine addiction by a paralyzed cocaine-addicted patient at the University of Pennsylvania in the late 1990s. The efficacy of Transmagnetic Stimulation to treat cocaine addiction was also stumbled upon by chance by a researcher in Padua, Italy. These treatments work by actions on the Dopamine Reward Pathway and related circuitry in the brain, but there’s much more work needed to fully understand them.

Another major area of focus is the Prefrontal Cortex. Through neuroimaging, researchers have found that disruption of the Prefrontal Cortex—the area of the brain involved in judgment and decision-making—contributes to compulsive drug-taking.

There is a reason why addicts make poor decisions for themselves. A crucial, if not necessary, part of current addiction research must be to eliminate the stigma of addiction and promote wider recognition of addiction as a chronic, relapsing brain disease. When this happens, a new era of addiction treatment and how we view addicts will be upon us.

IAM 00084763 This doctor tried to convince Carl Sagan to stop smoking weed
Dr. Anna Childress (center), Director of the Brain-Behavioral Vulnerabilities Division at the Center for Studies on Addiction in the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine. Childress, who is well known for her early and longtime research studying the anti-spasm medication Baclofen as a possible treatment for addiction, has been conducting research on other targets in the brain. For this current study, she flashes a subliminal image, a picture of cocaine, for just 33 milliseconds, not anywhere long enough for the study participant to be cognizant of the image— and records the brain activity. Early results show a spike in the area of interest when these images are seen, as strong as if the study participant were looking at the image and told you they’d seen it. These spikes are thought to be “cues” and, with new brain imaging tools, can be identified and medicines targeted to blunt their effect. (Photo by Max Aguilera Hellweg/INSTITUTE)
IAM 00084757 This doctor tried to convince Carl Sagan to stop smoking weed
A man caught smoking heroin in an alley in downtown Seattle by King County Metro Bike Squad officers. The suspect’s body and possessions are being searched. Officer Ryan Mikulcik holds a plastic bag of heroin he has just found in the suspect’s wallet in Seattle, Washington on November 17, 2016. In response to the heroin and opium epidemic hitting their region, Seattle has adopted Drug Courts, distributed Narcan to addicts, and established the LEAD program, which allowed the police officer to refer this man to a treatment program for low-level drug offenders rather than take him to jail. The innovative program, underway for more than five years, reflects an increasing awareness that habitual drug abuse stems from addiction and can be treated as a disease, not a crime. The program has reduced recidivism among offenders diverted from the criminal justice system. (Photo by Max Aguilera Hellweg/INSTITUTE)
IAM 00084747 This doctor tried to convince Carl Sagan to stop smoking weed
Lisa Flores, a recovering gambling addict, in a car outside The Gold Coast Casino in Las Vegas on January 10, 2017. Flores spent a majority of her addictive gambling playing the poker machines in The Gold Coast. Imaging studies have shown that behavioral addictions, like gambling, activate the same areas in the brain— the dopamine reward pathway and prefrontal cortex— as substance abuse disorders — eg. alcohol, cocaine, heroin, etc. Lori Flores moved to Vegas with her boyfriend from California shortly after graduating from high school. She’d never gambled before and celebrated her arrival cashing in the $20 for nickels. She quickly won a hundred dollars playing nickel slot poker machines. She moved up to 25 cent machines, kept winning, half dollar machines, kept winning, kept moving up onto larger domination slot poker, and before the end of the day had won $60,000. Attributing her success to pure luck, the money was very useful, and helped her and her boyfriend-soon-to-be-husband, set up a house. The young couple got jobs and made a life for themselves. But Lori set aside a portion of the money from that very first win and allowed herself to gamble. She and her boyfriend went to the casino once a month for entertainment. Lori kept winning, and if she lost, she’d think nothing of it since she was only gambling the money she’d set aside from the times she’d won before. She had one child, then another, and continued her money casino trips unabated. She never spent the money she won on anything big but liked to help her family with what she won, it made her feel good. About five years into her marriage, she and her husband went through difficult times. To avoid her problems, Lori began gambling more frequently. She never gambled on the strip, she preferred The Gold Coast, and found she liked to gamble in bars and small, out of the way places. As the losses took their toll, Lori embezzled money from her telemarketing job. She didn’t think she was stealing, only borrowing, and after the first time, when she didn’t get caught, the second time was easy, and the third time, easier. It was 3 years and $325,000 later that she got caught. That was 2008, and the beginning of her recovery. She became a member of Gambler’s Anonymous and, every day since that day, she has spent her life helping others like her. (Photo by Max Aguilera Hellweg/INSTITUTE)
IAM 00084753 This doctor tried to convince Carl Sagan to stop smoking weed
Ivan (last name withheld for privacy), a 56-year-old Russian man with 15 years of drinking hard alcohol, having a disulfram “coding” procedure 5 days before discharge from Marshak Clinic, just outside Moscow, Russia. “Coding” refers to an old, somewhat macabre form of aversion therapy where the patient is forced to drink until they puke and feel like they are going to die. Today, “coding,” as practiced at the state-of-the-art Marshak Rehab, is performed on patients just prior to discharge from their 30-day stay. In this procedure, disulfiram (Antabuse)—a drug that blocks an enzyme that metabolizes alcohol in the body, and as a result, produces horrific nausea—is inserted by a small incision made just below the skin somewhere on the abdomen, and stays resident there before losing its bioavailability in approximately six months. It’s not active unless the patient drinks— the idea is for patients to have it in the back of their minds just so they don’t forget not to drink. (Photo by Max Aguilera Hellweg/INSTITUTE)
IAM 00084755 This doctor tried to convince Carl Sagan to stop smoking weed
Patrick (last name anonymous for privacy), a former cocaine addict who was treated in Padua, Italy and cured of Cocaine addiction by Transmagnetic Stimulation targeting to the Prefrontal Cortex. Here he is seen in the clinic of Psychiatrist Dr. Luigi Gallimberti on October 19, 2016. Off camera, Dr. Alberto Terraneo holds a tool to target the TMS pulse. It has been twenty years since the dopamine reward pathway was first identified as the central focus of addiction in the brain by addiction scientists, and addiction identified as an organic brain disease, not a disease of personal weakness or moral failing. TMS targeted at the pre-frontal cortex, another area of the brain identified as important in the addiction model of brain disease, has been shown in clinical trials and with several hundred patients like Patrick to have a completely curative effect in treating recalcitrant addictive behavior with cocaine addicts, and has shown promise in other addictions and co-morbidities (i.e., a cocaine addict who was also a gambling addict). Patrick was a hopeless cocaine addict who had been in rehab many times, only to begin taking cocaine again hours after leaving rehab each time. Though the treatment protocol lasted several weeks, Patrick was cured of his craving on his initial visit. (Photo by Max Aguilera Hellweg/INSTITUTE)
IAM 00084752 This doctor tried to convince Carl Sagan to stop smoking weed
Bernard Granger, French “ addictionologist,“ and his patient Samuel Blaise, whom Granger treated successfully for alcoholism with Baclefon. Here, they are shown in the office of Dr. Granger in Paris, France on October 8, 2016. Baclofen, a medication used to treat muscle spasms and often prescribed for patients suffering with multiple sclerosis and spinal cord injuries, acts as an inhibitor in the reward center of the brain, the area known as the Dopamine Reward Pathway. The typical dose to become free of alcoholism on Baclofen is much higher than the dose used for muscle spasms. Blaise began taking more Baclofen than the recommended dose. Like any medication, there are side effects, and Baclofen can lead to psychosis and mania for a few unlucky patients. That’s what happened to Blaise, who had a lovely wife and child, and found himself in jail. Granger reigned him in with anti-psychotics., and carefully titrated Blaise’s dose of Baclofen up and up. And then it came. He was walking down the streets at 4:00 a.m. and the cravings were gone, and it’s been that way ever since.(Photo by Max Aguilera Hellweg/INSTITUTE)

IAM 00084759 This doctor tried to convince Carl Sagan to stop smoking weed
PK is a 26-year-old South Korean man who was concerned with his personal use of his smartphone because “the device [was] taking up a great deal of my time and energy.” He came to the office and clinic of Dr. Jaewon Lee, MD, psychiatrist and engineer. Though not yet accepted in the United States, and elsewhere, Dr. Lee has done pioneering research using EEG and Identifying EEG markers and correlating them to specific psychiatric diagnoses. He uses EEG scans to diagnose the degree to which a given patient might or might not have an internet addiction. (Photo by Max Aguilera Hellweg/INSTITUTE)