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David Friedman, Ph.D.
Professor of Physiology and Pharmacology, Associate Dean for
Research,
Wake Forest University School of Medicine
Former Senior Advisor, Substance Abuse Policy Research Program,
Robert Wood Johnson Foundation
“Parents must make it clear that some behaviors are not
acceptable. They must say in no uncertain terms that drug use is
not OK.”
“We must as a society recognize that addiction is a brain
disease.”
David Friedman, Ph.D., a professor at WFU School of Medicine, is
a leading researcher in substance abuse and directs the
Addiction Studies Program, an initiative Wake Forest
University offers collaboratively with National Families in
Action, the Treatment Research Institute, and the National
Conference of State Legislatures.
Dr. Friedman shared some brief comments with Bebe Somerville for
this issue of The Next Step.
What led you into research on addiction?
I was working in a lab on a fellowship at the National Institute
of Mental Health in Bethesda. I had a new baby and an old house,
and an interesting opportunity arose. The National Institute on
Drug Abuse created a neuroscience research branch, and I was
asked to be one of first members of the team that would develop
the program. This was the early ‘80s—neuroscience research was
still a brand new field.
As a grant reviewer for the Robert Wood Johnson Foundation
you’ve seen action in the applied health aspects of substance
abuse as well as the research (www.rwjf.org/cfp/saprp).
Would you comment on the role of addiction research in the
larger issue of public health?
Research provides the evidence from which to assess what kinds
of treatment and prevention models are most effective. One of
the most important pieces of information that research has
yielded is that addiction is a brain disease. Now, we as a
society need to have the recognition that addiction is a brain
disease. This knowledge takes addiction out of the realm of
character flaw, moral weakness, or poor upbringing, and
reorients us in how to deal with it.
Research has also proven that adolescence is a period of great
brain development, during which the adolescent brain is uniquely
susceptible to drugs. It is reasonable to call addiction a
pediatric problem. Virtually all addiction begins in the teen
years. Somebody who drinks before age 15 has a much greater
chance of developing alcoholism than someone who waits till
they’re 18 or 20.
It is through addiction research that we know about issues such
as risk factors: impulsiveness, sensation-seeking tendencies.
Until now, though, our culture has been accustomed to dealing
with adults, and dealing with the problem as an adult problem.
Again, it should be dealt with as a pediatric problem. Every
year there is a brand new crop of 11-year-olds we should be
educating about the dangers of drug and alcohol experimentation.
Research leads to effective evidenced-based treatment and
prevention measures, but at this point we as a culture seem to
do as little at this end as possible. Trouble gets in the news;
recovery does not. This is partly because people who are in
recovery do not want to be in the news, so the widespread
perception is that treatment does not work.
Some readers of The Next Step newsletter are family
members and friends who are interested in how they can be part
of the solution. What would you say about their role?
Parents need education. By and large, they don’t get it. Parents
play a very powerful role. They must make it clear that some
behaviors are acceptable and some are not. They have to say in
no uncertain terms that drug use is NOT OK. There is no drug
that’s legal for kids.
What do you say to people who would say there’s already
sufficient evidence that drug abuse is damaging. Why put more
funding into research on animals rather than funneling it all
into community education/prevention?
We need both. If it weren’t for research, we would not know that
adolescence is a unique time in brain development, or how
substances act in the brain. We wouldn’t have new drugs for
treatment, would not have a research basis for how to do
treatment well. We wouldn’t have evidence-based guidelines for
legislation.
Our stumbling block is getting the research results out into
community practice. Drug abuse treatment is underfunded. For
example, it’s rare to have an MD or PhD directing a treatment
clinic. And it is difficult to introduce new treatments without
adequate and ongoing funding support.
Are you optimistic that the community of researchers,
practitioners and families can lower drug abuse?
We’ve had major public health victories. Cigarette smoking is
down 20%. Drunk driving is down. These examples show we can
change the norms of the culture. But we as a society must be
willing to pay for treatment. It would be much less expensive to
put money into treatment than into prisons. With the latter, we
pay for the time addicts are in prison and then pay again after
they get out and continue the abusive behavior. Then we pay
again when they go back to prison, which they typically do
without proper treatment. We haven’t fully funded the treatment
system. The 12-step programs works fine for some people; others
need other options. (www.drugabuse.org)
Abuse is chronic. Treating substance abuse is like treating
diabetes, asthma, or hypertension. You have to keep at
it—practitioners and patients have to be persistent about
treatment. Failing at treatment is not unique to drug abuse.
Fewer than half of hypertension patients, for example, follow
the regimen prescribed by their doctors.
There are numerous effective prevention approaches--the Federal
Department of Education and
SAMHSA
have reference lists of these (http://www.nida.nih.gov/infofacts/treatmeth.html).
But the effects are not dramatic and immediate—we as a
prevention community need to be persistent. It’s behavioral
change—we have to keep at it all the time.
When I started at NIDA, one of the first things we were asked to
do was we were asked to review drug abuse prevention ads. Folks
wanted to use scare tactics—we told them then that scare tactics
do not work in prevention, but convincing them of this was
difficult.
You’ve been in your field for some 25 years. What
achievements, changes, trends, have you observed?
One big lesson is the role of genetics in drug abuse. Genes can
account for more than 60% of the risk that someone will become a
drug abuser or addict. Some of our genes are related to how much
an individual will be affected by a drug, while others influence
other factors.
Over the next 5-10 years we will learn a tremendous amount about
issues surrounding addiction. We’re studying the effects of
environment, for example. We know that childhood stress and
trauma are linked to later drug and alcohol abuse. The question
is, what are the changes that take place in the brain of a
traumatized child that predispose him/her to want to drink or do
a drug?
Another important question we’ll know much more about is how
genes interact with environment. Not all children who experience
trauma become addicts—the outcome can be affected how well his
parents deal with him, or by a his genes. For example, there’s
one gene— the serotonin transporter gene— that comes in a more
or less effective variety. If you have the less effective one,
you’re more likely to become depressed as a result of serious
stress. Once we can identify genetically at-risk people, we can
get to them early. When Craig Ventner, the scientist who first
finished sequencing the human genome, was here, he predicted
that in 5-10 years a parent will be able to have a CD (or
whatever technology replaces CDs) with a readout of their
child’s gene sequence when they take their baby home from the
hospital. .
So, personalized medicine, such as genotyping tumors, will
become part of the picture. There may be a day when we can give
kids a prophylactic vaccine against nicotine. Some of the
cutting edge research going on now includes vaccines against
getting high.
And much of that work is being done within the higher
education community in North Carolina?
Yes. Mark Wolfson here at Wake Forest has numerous studies on
alcohol abuse prevention and is developing an evaluation model
for the Coalition on Drug and Alcohol Abuse in this community.
Mike Nader is doing very exciting cocaine research which shows
that social status can affect drug taking. UNC-Chapel Hill has
major programs in alcohol abuse prevention, and Duke has
significant work in nicotine.
Tell us about your Addiction Studies Program’s national
institute for legislators and media.
Much of the information the general public gets about substance
abuse is either wrong or superficial. Our seminars were
developed to address this problem in the two groups of people
where new, accurate information can have the most direct impact.
We’re in the sixth year of offering workshops for 15-20
journalists each seminar, and the legislators’ series is two
years old.
The state legislatures are where the rubber meets the road. They
decide how much education is going to be in the schools, how
much funding will go to prevention. In some ways, state
legislatures have even more power than Congress in this issue.
And like most of the general public, their knowledge and
experience in this area is thin.
We give them informational workshops, but the most powerful
thing we do is take them to a treatment clinic. Many of them
typically start out thinking this treatment is just trading one
addiction for another. After going to the methadone clinics and
actually meeting the people, they’ve told us they changed their
opinions entirely. As one group left a clinic, a patient was
driving away in his BMW. This was a striking example of how
effective methadone can be.
And you’re also targeting journalists?
Yes. The workshops have a problem-based format where
participants interact with program faculty -- internationally
known scientists and others in the drug-abuse research,
treatment, prevention, and education fields. Faculty are not
only from Wake Forest, but Harvard, Emory, Columbia, Duke,
Chapel Hill, University of Illinois, University of California at
Los Angeles, Berkeley, University of Miami, NYU, and other
research institutions.
Journalists learn about the scientific basis of addiction,
including neurobiology, neuropharmacology, genetics, and drug
abuse treatment . They get information about the latest advances
in the field of drug-abuse research and learn how to better
convey accurate information so readers or viewers can make
better decisions about drug policy. And they gain access to a
bank of resources for future reference via the Program's
internet resource center. They learn how to keep up with results
of research funded by the
National
Institute on Drug Abuse (NIDA), through sources such as
NIDA’s NewsScan, which summarizes drug studies published in
peer-reviewed scientific and medical journals.
The Next
Step
Editor: Bebe
Somerville
Designer: Virginia Hart
Partnership for a Drug-Free
NC
665 W. Fourth Street
Winston-Salem, NC 27101
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