Ingmar Franken is professor of Clinical Psychology at the Erasmus School of Social and Behavioural Sciences and head of the Centre for Substance Use and Addiction Research. His research focuses on the neurocognitive aspects of addiction and substance use.
The wonder
“It was sad: when I worked as a psychologist in addiction treatment, I saw my patients throw away relationships, jobs, and health for the sake of a stupid high. ‘Why, despite proper treatment, do addicts keep relapsing?’, I wondered. I was young and brash, believing that I’d figure out things that would make people better.
“New brain scanning techniques, such as fMRI and EEG, made it possible to examine the brain. I enjoyed that. And while it was sad, it also fascinated me. I experienced parents being denied parental authority because they were severely addicted. What causes people to risk losing contact with their own children? The craving for that high is so strong. It must be something in the brain, I thought.”
The research
“We showed addicts pictures of the drug they were addicted to, for example pictures of a line of coke, while they were hooked up to a scanner. The results? The brain regions that are also responsible for attention became very active. Those brain regions immediately released dopamine when addicts were exposed to addictive stimuli, making them very focused.
“We also tried to hide the drugs. For example, we showed some lines on the screen, with a picture of the drug in the background. Participants had to count the number of lines as rapidly as possible. We wanted them to keep their attention on the lines, but the drug users didn’t manage that very well.”
The eureka moment
“Those scans confirmed the hypothesis: addiction is driven not only by the chemical rewards of the drug itself, but also by how the brain pays attention to the stimuli that signal the drug. The resulting dopamine production acts as a magnet. This automatically focuses the addict’s attention and behaviour on that which fuels the addiction.
“The big eureka moment wasn’t in the lab, but behind the computer. The tests involved a large group of addicts and, naturally, a control group. When the statistical results came back, the difference turned out to be huge. That was a great moment. That was when I thought: yes, I think this is how it works.”
The impact
“That paper has been cited about a thousand times, so it has been quite influential in the field. And it still is. However, I’d be a very lazy scientist if I thought that was the end of the matter.
“As a scientist, you have to question everything, including your own models. Since publication, I and others have refined the model, and some things turned out not to be reproducible.
“It’s not like we fully understand addiction now because of this. Such a mechanism as the one I found explains at best 10 per cent of addiction.
“It did affect clinical procedure. Training those attention processes helps a little bit to stay clean, but you shouldn’t overestimate that effect either. A 10 per cent success rate would already be an overestimate; I think it’s closer to 5 per cent. Then again, there are millions of addicts all over the world, so if you can help 5 per cent, it still helps a lot of people.”
