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r. Nora Volkow has seen the ravages of addiction first hand. Growing up in Mexico City, Volkow watched as a beloved uncle battled alcoholism — an experience that, among others, prompted her to devote her life to fighting substance abuse. A psychiatrist and neuroscientist by training, she pioneered the use of brain imaging to study the biological roots of addiction.

Now in her 12th year as director of the US National Institute on Drug Abuse, Volkow is facing two major challenges: the explosion of heroin overdoses, and the growing public acceptance of marijuana. She spoke with STAT about prescription painkillers, dark chocolate, and her family’s famous legacy.

You’ve compared your love for dark chocolate to an addiction. Can someone really be addicted to chocolate?

I use it as a metaphor. It’s very difficult for people to understand the experience of addiction. If I were really addicted, it would mean I would constantly be thinking about chocolate, figuring out how to get it, and probably be overweight and with diabetes. Having said that, there are people for whom food is a very, very compelling drive.

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Has opioid addiction suddenly become a bigger problem, or are we just noticing it more?

It’s not that it’s gotten worse, but a very significant number of people are dying from opioid overdoses: 24,000 a year [in the United States]. That’s the highest it’s been since we’ve been collecting the data.

Are most getting introduced to heroin through prescription painkillers? 

Seventy-five percent of people who now are starting heroin have started with prescription opioids. That’s a new trajectory.

Is this epidemic changing the stigma of drug abuse?

The prescription-opioid epidemic was not launched by drug dealers. It’s the result of the health care system. It’s being recognized as a health care problem as opposed to a moral issue.

Do you expect legalization of marijuana to affect addiction rates? 

If you legalize marijuana, you will be ending up with a much greater population exposed to it, and then by randomness, you’ll end up with more people addicted and negative consequences.

What inspired your interest in studying and combating addiction? 

My personal experience with my mother’s brother — and my mother’s father, who was an alcoholic — and recognizing how that affected the family. Also, as a resident in psychiatry, it was very disturbing to me that we had so few options to help people who were addicted.

Your family tree also includes the Russian revolutionary Leon Trotsky, your great-grandfather, who was assassinated by a Soviet agent before you were born. Does that pedigree influence you at all?

I think definitely so. When you are born into a house where your family has been exterminated because they fought for a cause that in principle was to help others have a chance to a better life — that instilled in me the sense that you are alive and you have a responsibility to use your life and whatever talents you have in the best way … to help others who may not have been as fortunate as you.

Dr. Nora Volkow is the director of the National Institute on Drug Abuse. This interview has been edited and condensed.

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