The Thirteenth Step: Addiction in the Age of Brain Science

316 Pages·2015·1.39 MB·English

by  Markus Heilig

t h e
T H I R T E E N T H
S T E P
ADDICTION IN THE AGE OF BRAIN SCIENCE
M A R K U S H E I L I G
THE THIRTEENTH STEP

MARKUS HEILIG
THE THIRTEENTH STEP
Addiction in the Age of Brain Science
Columbia University Press / New York
Columbia University Press
Publishers Since 1893
New York Chichester, West Sussex
cup.columbia.edu
Copyright © 2015 Markus Heilig
All rights reserved
Library of Congress Cataloging-in-Publication Data
Heilig, Markus, author.
The thirteenth step : addiction in the age of brain science / Markus Heilig.
p. ; cm.
Includes bibliographical references and index.
isbn 978-0-231-17236-3 (cloth : alk. paper) — isbn 978-0-231-53902-9 (e-book)
I. Title.
[DNLM: 1. Substance-Related Disorders—therapy. 2. Alcoholism—therapy.
3. Behavior, Addictive—metabolism. 4. Brain—drug effects. 5. Brain—physiopa-
thology. 6. Pharmacogenetics. WM 270]
RC564
616.86'061—dc23 2014022405
Columbia University Press books are printed on permanent and durable acid-free paper.
This book is printed on paper with recycled content.
Printed in the United States of America
c 10 9 8 7 6 5 4 3 2 1
cover design: Noah Arlow
References to websites (URLs) were accurate at the time of writing. Neither the author
nor Columbia University Press is responsible for URLs that may have expired or
changed since the manuscript was prepared.
CONTENTS
Acknowledgments vii
1. US AND THEM
1
2. A GROCERY STORE THAT CLOSED
11
3. AN ENTITY IN ITS OWN RIGHT
18
4. A CHRONIC, RELAPSING DISORDER
32
5. MAN OR MACHINE?
41
6. HISTORIES, BRAINS, AND BEHAVIORS
49
7. THE PURSUIT OF HAPPINESS
57
CONTENTS
8. THE DARK SIDE OF ADDICTION
75
9. RASH ACTIONS
89
10. TURNING ON A BRIGHT LIGHT
104
11. GETTING THE CUE
113
12. A STRAINED MIND
123
13. FATHERS AND SONS
135
14. MOLECULAR CULPRITS
163
15. TRICK OR TREATMENT
185
16. PLEASE BEHAVE
194
17. PILLS FOR ADDICTION ILLS
206
18. PRAY IF YOU WISH, BUT PLEASE TAKE
YOUR MEDS FIRST
231
19. THE JOURNEY AHEAD
256
Notes 265
Index 287
vi
ACKNOWLEDGMENTS
I am indebted to more people than I can list—family, friends, colleagues,
collaborators, coworkers, competitors, and patients. Some deserve special
thanks:
Claes Wahlestedt has been a friend and collaborator for some twenty-five
years. As a fellow research student, he pulled me into the fascinating world of
neuropharmacology, and he has since always enriched my thinking with his
exciting perspective, often very different from my own yet so complementary.
Erik Widerlöv was many years ago my thesis adviser and was able to
strike the perfect balance between guidance and freedom, allowing me to
grow in the early stages of my training as a physician and research student.
Jörgen Engel introduced me to the neuroscience of addiction; Bob
Murison helped me as I moved into behavioral pharmacology. Both have
remained dear friends.
George Koob, currently the director of the National Institute on Alcohol
Abuse and Alcoholism in Bethesda, Maryland, was once my postdoctoral
mentor at the Scripps Research Institute in La Jolla, California. That expe-
rience continued to inspire me for many years.
Marie Åsberg supported me when I was starting my own research pro-
gram and became a role model. A lunch with Marie remains the most reli-
able cure for a temporary loss of inspiration.
ACKNOWLEDGMENTS
Lars Gunne, one of the pioneers of methadone maintenance treatment,
taught me to combine scientific rigor with empathy and respect for patients
with addictive disorders, in a field where those elements are too often lacking.
Rainer Spanagel, Roberto Ciccocioppo, and Donald Gehlert are remark-
able scientists and great friends whom I too rarely get to see or collaborate
with these days.
Daniel Hommer was a wonderful physician scientist, a close collabora-
tor who taught me much of what I know about brain imaging, and a friend
whose generosity and big heart touched us all. Tragically, Dan died while
this book was being written, leaving a huge void in our lives.
Yavin Shaham and his wife, Karin Helmers, are the best friends anyone
could ever wish for. Yavin is a stellar neuroscientist, a true scholar, and a
model of integrity and generosity. Without his friendship, I don’t know how
I would have gotten through some difficult times. Without his scholarship,
I would not know half of what I know.
I am indebted to countless patients encountered over some twenty-five
years. Many have taken journeys that were painful to follow, but sharing
their experience has also frequently been heartwarming and enlightening.
Occasionally sharing the joy of life winning out over disease is the ultimate
award in my line of work.
Numerous people at the Hazelden Foundation, Center City, Minnesota,
were immensely helpful as I was developing this project. I am particularly
grateful to President and CEO Mark Mishek; Provost Valery Slaymaker of
the Hazelden Graduate School of Addiction Studies; and Professionals in
Residence Program Specialist Roxanne McGurk.
Many members of my research group, past and present, have become a
second family and enabled me to do most of what I have done. Over time
and on both sides of the Atlantic, we have learned together, developed con-
cepts, generated data, shared joys and sorrows, and had fun while trying
to remember why we do what we do—because patients need it. As is the
nature of this strange, nomadic science life, people have moved to other
countries, other fields, their own labs, or clinical work. I proudly follow the
careers of former trainees as they build their own research groups or clinical
programs. They include Roberto Rimondini at Bologna University, Italy;
viii
ACKNOWLEDGMENTS
Annika Thorsell at Linköping University, Sweden; Wolfgang Sommer and
Anita Hansson in Mannheim, Germany; Christina Barr at the National
Institute on Alcohol Abuse and Alcoholism; Åsa Magnusson at the
Karolinska Institute; and Jesse Schank at University of Georgia, to name
a few. Among the current crew, staff scientists Jenica Tapocik and Melanie
Schwandt are as appreciated as they are indispensible. As for the postdocs
still in the lab, get a job and I’ll name you in the next edition!
Helena, Sara, and Hanna, my three muses, and Johan and Martin, my
guy friends in the family, have given meaning to it all and made my work
possible by following me wherever it has taken me. They have also provided
all the distraction from science I will ever need. Their happiness means more
to me than anything else.
This book is dedicated to the memory of my father. One of the toughest
men I have ever met, he once turned himself in to the Gestapo in exchange
for his little brother, only to live seven decades past the death sentence
brought upon him by that action. Rising from the ashes of the Holocaust,
he devoted his life to my mother, me, and my sister. To create opportunities
for us, he left behind a successful career and a home in Poland and started
over in Sweden in 1970. He always expected as much of himself as he did
of others; from my earliest years, it was clear that nothing short of solid
work would win his approval. Yet he was always there in an hour of need
and never stopped looking out for us, even in the end, when he was the one
in need of support. The best I can hope for is to be half as good a father as
he was.
ix