Addiction Medicine

A functional Magnetic Resonance Imager (fMRI). The subject is put into the bore of the machine, or the center of the magnet.
Photo Courtesy of Singularity Hub

Twenty percent of US Adults smoke cigarettes. Half will die of a smoking related illness. In fact, in this century alone, it is projected that one billion people worldwide will die of a smoking related illness. If smoking causes so many deaths, then the solution is obvious: stop smoking. Unfortunately, cigarettes, like many substances, are addictive. Due to the overwhelming problem of addiction in our society, a relatively new field of medicine pertaining to the treatment and understanding of addiction has emerged.

Dr. Anne Eden Evins, Director of the Massachusetts General Hospital Addiction Center and Associate Professor of Psychiatry at Harvard Medical School, says that addiction medicine is both clinical and academic. Clinical medicine is the practice, prevention, and diagnosis of disease, where academic medicine focuses on research and development of new therapies and treatments. Dr. Evins does both.

“Most of my work is research,” says Evins, adding, “Occasionally I treat a spotted elephant.” By spotted elephant, she means a patient that is not your garden-variety addict or has money and wants the best, for example, a medicated schizophrenic who has tried every common treatment and can’t kick the habit or an alcoholic Bane capitol executive who needs treatment.

When she isn’t treating patients or collecting and analyzing data, Dr. Evins is writing grants. Most of her research is grant funded. Dr. Evins’ biggest expense is her lab. To keep her space at Harvard, she pasy 75% overhead of each of her grants to the Crimson. That means that any money she receives from grants is only 25% of the entire sum.

Dr. Evins’ success hinges on cutting edge technology to collect data. Perhaps one of the most interesting and useful tools at Dr. Evins disposal is the functional Magnetic Resonance Imager or fMRI. fMRI’s use a rapidly changing magnetic field to track blood flow in the brain. Parts of the brain that are more active than others require more oxygen, which means more blood flow to that area to the brain. Therefore, fMRI’s can highlight areas of the brain showing activity greater than the baseline, or average activity of the rest of the brain. Being able to compare healthy brain activity and healthy brain response to stimuli to addict brain activity and addict brain response to stimuli is essential to understanding addiction. When an addict sees a picture of a cigarette while in an fMRI, their “Christmas tree” (fMRI data is a lot of different colored lights indicated activity with hue) is way different than that of a non-smoker. This disparity between brains helps scientists like Dr. Evins develop new understanding of what addiction means in terms of brain activation.

Since Dr. Evins is the director of MGH’s Addiction Center, she has a lot of responsibility and manages a lab of 20 people. Recently, MGH has asked her to define their official stance on Marijuana legalization. “It’s a controversial area,” she says. In her mind, she has decided to evaluate the issue from a purely medical point of view, keeping political (like taxes or decriminalization) or Public Health (control the supply to regulate the substance) variables out of her decision. “The idea that cannabis isn’t a drug — because it’s natural or whatever — is stupid. Aside from the lung damage from the smoke, THC levels in marijuana are higher than ever, causing very physical addiction symptoms. It isn’t regulated. If you want to put your health in the hands of your dealer, that is your choice, but as a doctor, I can’t condone marijuana legalization.”

Getting to where she is today wasn’t easy. Dr. Evins completed medical school and did fellowships in molecular biology and in the clinical research of addiction. She also got a PhD. in Public Health from Harvard. All her education has paid off. Dr. Evins works flexible hours and can telecommunicate.

Dr. Evins loves her job. Working in academic medicine has its downfalls, such as lower pay and competition for limited resources, but life on the cutting edge of medical science, where your every breakthrough can change people’s lives in positive, tangible ways, is alluring.



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