I feel like the majority of my understanding and outlook on addiction has been influenced more by Danny Boyle's film Trainspotting than by any scientific research or news story. Of course, Trainspotting is not as much about addiction or heroin as it is about reliance and personal growth, yet it has become a cultural calling card of addiction and our societal perceptions of it.
One line which highlights this is the protagonist detailing that, to aid in weaning off heroin, he requires 'one bottle of Valium, which I have already procured from my mother who is, in her own domestic and socially acceptable way, also a drug addict'. From my perspective, this fairly innocuous line details much of the stigmatisation, double standards, skewed priorities, and misunderstandings at the centre of society's fight against the somewhat abstractly described concept of 'addiction'.
The necessity to treat and research addiction, in particular substance abuse, was detailed in no uncertain terms by Professor Henrietta Bowden-Jones, president of the Royal Society of Medicine's Psychiatry Section and director of the National Problem Gambling Clinic, the first speaker of the evening of the seventh webinar in the Royal Society of Medicine's 'The genetics of…' series. She vividly described growing up in Italy during its devastating heroin epidemic, which resulted in its 'disappeared generation'. Professor Bowden-Jones also detailed the shocking statistics surrounding addiction in the UK, which included 76,000 people treated for problematic drinking in 2019, and over 270,000 adults in contact with drug and alcohol services between April 2019 and March 2020. Additionally, the issue surrounding addiction has been thrust back into the public eye recently with the revelation that Denise Coates, the chief executive of online bookmakers Bet365, earned £421 million in 2020, demonstrating the immense profitability of hacking and exploiting addictive behaviours.
While Professor Bowden-Jones stressed the societal implications of addiction, I was fairly surprised by how infrequently this was discussed throughout the rest of the webinar, bar the questions at the end. Indeed, Professor Bowden-Jones suggested that the priorities in understanding addiction fundamentally centre on understanding the underlying genetics and neurobiology, in order to identify markers of vulnerability, develop more effective treatment strategies, and decrease relapse rates following discharge.
These questions were addressed by the event's next two speakers. Professor Eric Nestler, director of the Friedman Brain Institute and dean for academic and scientific affairs at the Icahn School of Medicine at Mount Sinai Hospital, New York introduced a biomolecular approach to addiction research. This included his own research in mice concerning how transcriptional profiles in the nucleus accumbens and other brain reward regions, are transformed by chronic cocaine administration. Finally, Dr Nora Volkow, director of the US National Institute on Drug Abuse, introduced a plethora of factors, both biological and environmental, which contribute to addictive behaviour. She reaffirmed how her research has established addiction as a 'disease of the human brain'.
The key goal of the Royal Society of Medicine's 'The genetics of…' series is to present cutting edge research into the established roles played by genetics in a variety of contexts, and I admired how this event was intriguing without being dramatic and thorough without being overly technical. Like the excellent first webinar in the series (see BioNews 1067), concerning the genetics of mental health, the online event was excellently handled by Dr Melita Irving, and I was struck by Professor Nestler's talk and the clarity with which he explained his experimental procedures, and how they led to meaningful conclusions, in a way which even I could comprehend. However, the webinar also didn't go in the direction I thought it would, focusing significantly on the biochemical and neurological mechanisms of addiction, as opposed to its association with societal factors.
This was a pleasant surprise, as it meant a level of immersion in a subject which I had next to no understanding (Trainspotting, evidently, doesn't count). I am curious if the audience had been expecting this too, as a significant proportion of the questions featured a list of, what Dr Irving referred to as, the audience's 'favourite addictions'. These ranged from methamphetamines, caffeine, and rolling tobacco, to food, social media, and video games. One of the key takeaways of this event for me was the shared mechanisms and aetiologies of addiction, and how one addiction can effectively 'prime' the formation of another. Notwithstanding this, I'd argue this highlights a perception that, although 'addiction' is worth considering as an umbrella term, many are more comfortable discussing them individually.
This potentially included myself, as I harboured a little hope that the event would extend to discussion of video game and screen 'addictions', for which Professor Bowden-Jones is a renowned authority. It feels like the conversation around these factors in the context of addiction, has been transformed in recent years, especially by the pandemic. The past year has encouraged a rethink of the implications of 'screen-time', and there seems to have been movement away from 'violent' video games as a scapegoat for other anti-social behaviours.
That said, overall the webinar was a well-handled, fascinating event, and is further demonstration that the Royal Society of Medicine's 'The genetics of...' series is one of the most informative and worthwhile scientific webinars around. Whether or not the Royal Society of Medicine wase expecting to have reached episode seven of the series without returning to in-person events, the series' staying power and continuing interest is undeniable. Hopefully these events detailing the complicated role of genetics in our lives can continue for the foreseeable future.