Brenner is a physician-scientist and president and chief executive officer of Sanford Burnham Prebys and lives in La Jolla.
“If an alcoholic or drug addict comes up to me and says, ‘Will you help me?’ I will always say, ‘Yes, I know how to do that. I will do that for you, even if I can’t always do it for myself!’”
— Matthew Perry (1969-2023)
As I write this, the official cause of Matthew Perry’s death remains unknown. It may be directly or indirectly linked to drugs and alcohol. Certainly, his life was. For most of his 54 years, the popular actor and celebrity struggled with addiction, first to alcohol, then to drugs, again and again despite many efforts to quit.
In that sense, Perry has a lot of friends.
Tens of millions of Americans are addicted to alcohol, drugs, tobacco and other substances, including most notoriously, opioids. Neary 71,000 Americans died from fatal overdoses of fentanyl and other synthetic opioids in 2021. The odds of dying accidentally from an opioid overdose are now greater than the chances of dying in a motor vehicle crash.
Perry sought help, repeatedly. Most people do not. A 2021 national survey on drug use and health found that 94 percent of people aged 12 and older with a substance use disorder did not receive any treatment. Nearly all of them thought they did not require it.
Some of that reluctance or self-denial can be blamed on the persistent stigmas of addiction, but there’s another, more practical reason: Treatments for addiction are myriad, but success is limited. In his memoir, “Friends, Lovers, and the Big Terrible Thing,” Perry said he spent decades trying to get sober, spending more than $7 million and going into rehab at least 15 times. Nothing worked for long.
Whatever the source of an addiction, the result is a chronic, relapsing brain disorder. Whether tobacco, alcohol or fentanyl, addictive substances work by fundamentally altering brain function.
Specifically, addictive substances target the brain’s dopamine-based reward system. Dopamine is a neurotransmitter that serves critical roles in memory, movement, mood and attention. High or low dopamine levels are associated with conditions such as Parkinson’s disease, attention deficit hyperactivity disorder and restless leg syndrome.
But dopamine is best known for its role in the brain’s reward system where it acts as the “feel-good hormone.” Our brains are hard-wired to practice or seek out behaviors that release dopamine. It encourages us to do the things we need to do to survive, from eating to reproducing. It’s also why junk food and sugar can be addictive. They trigger the release of dopamine too. The more you eat them, the greater the release.
The good news, maybe, is that effectively treating all manner of addiction may boil down to blocking or disabling how addictive substances fundamentally affect the reward system. Substances as different as alcohol, tobacco and opioids may share underlying mechanisms or therapeutic targets. A remedy for one may be the beginning of a remedy for all.
It’s not that simple, of course. There will never be a single cure-all, but researchers here and around the country are peeling away and parsing the cellular secrets of addiction. Promising investigational drugs for quitting smoking are getting close to clinical trials. They might also prove useful for treating addictions to cocaine and methamphetamines.
Smoking research has helped inspire other efforts to target different brain cell receptors associated with alcohol use disorder. Researchers at Sanford Burnham Prebys and elsewhere are pursuing novel drugs that modulate the function of a different brain receptor linked to opioid drugs and the anguish of withdrawal.
Progress is happening. That’s encouraging. But addiction is a many-headed monster that deeply messes with our heads. There will be new challenges, no easy answers. But we cannot quit trying. Perry didn’t.
