19 Jul Can We Cure Addiction?
Addiction has plagued civilization for thousands of years, pre-dating the legendary conqueror, Alexander the Great, and the Greek and Roman empires. As long as there have been grapes for wine and ingredients for other liquids for imbibing that brought about an altered state of consciousness – or unconsciousness – addiction has been with us. It’s only in the last few decades that any serious attention has been paid to overcoming addiction. But are we any closer to finding a cure? Is it within the realm of possibility that we can ever cure addiction? And, if we can, will we?
All Addiction Is Not the Same
When you talk about addiction and finding a cure for it, the problem is magnified by the fact that all addiction is not the same. That is, the disease of addiction affects each person in unique ways and depends upon a multitude of factors. Genetics, family history, physical and mental condition, the environment, and a host of other factors play a contributing role in who becomes addicted and who doesn’t.
There’s also the difference between substances abused. Some are literally more addictive than others. For a vulnerable individual, the first encounter with an illicit drug may result in them being hooked – locked into a never-ending drug-seeking, using, and attempting to recover from the effects of the use, and then repeating the pattern all over.
Furthermore, many addicts suffer from multiple addictions, such as alcoholism, illicit and prescription drug abuse, or co-occurring disorder, which is substance abuse and mental health disorder. Combating just one addiction won’t overcome the others.
There’s also the problem of replacement addiction. When one addiction is overcome through treatment, without continuing counseling and an effective support network, those in recovery may quickly fall into a substitute addiction.
Relapse is very common, especially during the first six months of recovery.
Given all this, it’s no wonder that searching for a “cure” for addiction is difficult. If and when a cure is discovered, it will likely be for a narrow subset or a particular addiction. Such a cure will need to go through lengthy clinical trials for efficacy, safety, and effectiveness. Follow-up studies will be required before such a cure can be marketed or made available to the general public.
None of this should deter scientists, medical professionals, addiction specialists, and researchers from continuing to search for ways to unlock the secrets of addiction. But it is a reality that they all recognize.
Smoke and Mirrors
Throughout the past three decades or so, there have been a number of so-called cures for various types of addiction. Some have failed miserably, while others apparently work for a small number of individuals, only later to be proven ineffective or impossible to sustain. Some medications developed to counteract certain effects of withdrawal have been shown to have promise longer term, working, for example, to ease anxiety or depression during the early stages of recovery and enhance the individual’s ability to practice recovery strategies.
There have been potions, extracts from exotic plants, vitamins and herbs that have been touted at one time or another as a cure for everything from gout to anxiety to alcoholism to drug abuse. Before drug regulation and strict controls on advertising claims, if someone had a good idea to promote a product, they could pretty much do what they wanted. The result was a lot of smoke and mirrors – and no real progress toward a cure for addiction.
That all changed, specifically within the last 10 to 15 years. That’s when federal agencies such as the National Institute on Drug Abuse (NIDA) (http://www.nida.nih.gov/), of the National Institutes of Health (NIH), stepped up their efforts to support and help fund research on addiction. NIDA’s stated mission is: “to lead the nation to bringing the power of science to bear on drug abuse and addiction.”
No more smoke and mirrors. Now the search for effective treatments and medications to end addiction is serious stuff.
The Search Goes On
Addiction is also, without a doubt, a big business. Pharmaceutical companies play a huge role in funding and supporting research (for their products, naturally) that brings promising drugs or therapies closer to marketability. Leading universities, medical professionals, the National Institute on Drug Abuse (NIDA), private organizations and foundations are all heavily involved and invested in looking for ways to overcome addiction.
Research into alcoholism is conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (http://www.niaaa.nih.gov/), which is also a part of the National Institutes of Health (NIH). NIAAA’s mission is to lead in the national effort to reduce alcohol-related problems by:
• Conducting and supporting research in many scientific areas including genetics, epidemiology, neuroscience, health risks and benefits of alcohol consumption, prevention, and treatment
• Coordinating and collaborating with other federal programs and research institutes on alcohol-related problems and issues
• Collaborating with international, national, state, and local agencies, institutes, organizations, and programs engaged in alcohol-related work
• Getting the word out about research findings to the general public, policymakers, researchers, and health care providers
The NIAAA celebrates its 40th anniversary this year (2010), from its beginnings with the Hughes Act of 1970, subsequent growth and establishment as an independent institute in 1974, and highlighting its significant accomplishments, such as the first Fetal Alcohol Syndrome workshop, passage of minimum legal drinking age laws, and launch of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
If you want to know what’s going on in the area of clinical trials, check out the lengthy list of clinical trials underway at any given point through ClinicalTrials.gov (http://www.clinicaltrials.gov/). This is a registry of federally and privately supported clinical trials conducted in the United States and around the world. The site gives information about a trial’s purpose, who may be eligible to participate, locations, and phone numbers for more details. Studies can be searched by condition, drug intervention, sponsor, and location. During a recent search, some 92,530 trials were underway in 174 countries.
While there’s no cure for addiction yet available, there is promise to report in a number of different areas.
Genes that Influence Brain Wave Patterns
NIAAA scientists have recently identified new genes and pathways that influence a person’s typical pattern of brain electrical activity. This is a trait that may serve as a useful surrogate marker for more genetically complex traits and diseases. One of these genes, for example, is associated with alcoholism.
The study, which was reported in the May 20, 2010 edition of The Proceedings of the National Academy of Sciences, is summarized in the NIAAA Spectrum (http://www.spectrum.niaaa.nih.gov/newsfromthefield/GenesBrainWave.aspx). The news magazine reports that one of the paper’s authors, David Goldman, M.D., chief of the NIAAA Laboratory of Neurogenetics, said, “While our main findings are for genes that influence EED wave patterns, this study represents an important step towards the use of EEG as a surrogate marker for alcoholism. It also reveals new molecular pathways involved in addiction processes.” The abstract of the original article, “Genome-wide association identifies candidate genes that influence the human electroencephalogram,” can be found on PubMed (http://www.ncbi.nlm.nih.gov/pubmed/20421487).
NIH-supported Finding on Cocaine Addiction
A recent study funded by NIDA, a component of the NIH, has discovered that a specific and very small fragment of RNA appears to protect rats against cocaine addiction – and may also protect humans. The study, which was published in the journal Nature is summarized on the NIDA news section of its website (http://www.drugabuse.gov/newsroom/10/NR7-07.html).
In essence, the study findings suggest that microRNA-212 plays a pivotal role in regulating rat intake of cocaine, and, perhaps, in the rodent’s vulnerability to addiction. What greatly interests scientists is the fact that the same microRNA-212 is found in the human dorsal striatum, a brain region linked to drug abuse and habit formation (addiction). Paul J. Kenny, senior study author and associate professor at the Scripps Research Institute in Jupiter, Florida, is even more upbeat, commenting: “The results of this study offer promise for the development of a totally new class of anti-addiction medications. Because we are beginning to map out how this specific microRNA works, we may be able to develop new compounds to manipulate the levels of microRNA-212 therapeutically with exquisite specificity, opening the possibility of new treatments for drug addiction.”
Search for Cocaine Vaccine Has Mixed Results
Another NIDA-supported study on a cocaine vaccine shows promise, but also some mixed results. The study, published in the October 2009 issue of Archives of General Psychiatry is also summarized on the NIDA website (http://www.drugabuse.gov/newsroom/09/NR10-05.html), which says it is “the first successful placebo-controlled demonstration of a vaccine against an illicit drug of abuse.” NIDA Director Dr. Nora Volkow is quoted as saying: “Provided that larger follow-up studies confirm its safety and efficacy, this vaccine would offer a valuable new approach to treating cocaine addiction, for which no FDA-approved medication is currently available.”
The study’s principal investigator, Dr. Thomas Kosten, of Baylor College of Medicine in Houston, Texas, said that immunization did not achieve complete abstinence from cocaine use in this study. He did add that, “Previous research has shown…that a reduction in use is associated with a significant improvement in cocaine abusers’ social functioning and thus is therapeutically meaningful.”
The Washington Post, reporting the story January 5, 2010, identified the vaccine as TA-CD and said that, according to Dr. Kosten, “the vaccine…shows promise but could also be dangerous; some of the addicts participating in the study of the vaccine started doing massive amounts of cocaine in hopes of overcoming its effects”.
The 2008 National Survey on Drug Use and Health (NSDUH) shows that 2.1 million Americans used cocaine in the month prior to the survey. After media reports of TA-CD hit, one researcher was deluged with calls from people desperate to get their family members off the cocaine addiction downward spiral. According to the Washington Post story, Margaret Haney, a professor of clinical neuroscience at Columbia University Medical Center who has been researching the cocaine vaccine (although not part of Kosten’s study), said: “They have a mistaken view of how a vaccine might work, thinking of it as magic, where what it’s doing, at best, is blunting the effects. They get very excited, and it’s heartbreaking.”
Anti-Smoking Vaccine on the Near Horizon
Nicotine addiction causes nearly a half million deaths annually in the United States, and many more millions worldwide. After years of research and development into finding effective treatments to help people stay off cigarettes, a promising new anti-smoking vaccine, NicVAX, by Nabi Biopharmaceuticals (http://www.nabi.com/pipeline/pipeline.php?id=3) of Rockville, Maryland, entered the first pivotal Phase III trial stage in November 2009. In March 2010, NicVAX entered the second Phase III study.
NicVAX is an injectable vaccine that is intended to help people quit smoking and keep them from relapsing. Successful completion of the trial will bring the vaccine closer to final approval by the U.S. Food and Drug Administration (FDA), which has already given the drug fast-track status. In order to reach fast-track status, a medication or treatment must first pass the regulatory hurdles showing the proposed drug or treatment is sound.
How it works: Like other vaccines, NicVAX works by boosting the immune system. Here, the goal is to generate antibodies that bind to nicotine. In smoking, normally nicotine is a small molecule that travels quickly through the lungs, bloodstream, and into the brain. NicVAX, by trapping the nicotine in an antibody, makes it too large to get into the brain, thus subverting the effects of the nicotine.
Scientists know that nicotine, once it reaches the brain, activates the release of dopamine, a chemical linked to pleasure and addiction. Once addicted to nicotine, it is very difficult to achieve and sustain abstinence. Complicating matters and triggering relapse are withdrawal symptoms, environmental cues, and stress.
A vaccine that lasts for 6-12 months gives smoker’s a chance to end the addiction/relapse cycle and quit smoking for good. In the future, NicVAX may prove helpful in preventing smoking in the first place.
Nabi Biopharmaceuticals, which has been actively researching and developing the anti-smoking vaccine, received a $4.1 million grant from NIDA in 2005, which partially offset the company’s funding requirements for the vaccine development program. In September 2009, Nabi received an additional $10 million in funding from NIDA to continue development. In March 2010, Nabi entered into a worldwide optioning and licensing agreement with GlaxoSmithKline Biologicals.
How Much Longer?
In the search for new medications and treatments that may prove effective for addiction to substances, it is easy to become excited and then disappointed at the progress or stalling of development. It takes many years to get through the rigorous FDA approval process. Safety, efficacy, and effectiveness are primary considerations. That takes years of post-marketing follow-up as well.
Perhaps it’s best to look at a cure for addiction in smaller increments. The potential anti-smoking vaccine may be one of the first to hit the market, thus helping millions of motivated smokers kick the habit for good. Following its release to the public as an anti-smoking cessation aid, further studies into its use for prevention of smoking may follow.
Another potential vaccine that may come to market in the coming years – after further testing and validation of effectiveness in helping cocaine users abstain and sustain abstinence – is the so-called cocaine vaccine.
As for other substances of abuse, as well as process addictions such as compulsive gambling, sex, work, and eating disorders, among others, the outlook for a vaccine or “cure” is quite a bit cloudier.
This is not to say that research won’t continue into many of these areas. But it will take a resounding success in the effectiveness of one “cure” before others may potentially receive funding and/or attention from researchers and developers. After all, R&D costs many millions of dollars and takes years – often without success.
Can we cure addiction? Will we cure addiction? Only time will tell. In the meantime, there are effective treatments that can help motivated individuals overcome their addiction – although they will have to be vigilant for the rest of their lives in order to maintain sobriety in recovery. As addiction treatment professionals say, overcoming addiction is the beginning of a lifetime in recovery.
In other words, if you or someone you love is currently addicted to drugs, alcohol, or compulsive behavior, don’t wait for the “magic bullet” or “cure.” Get into treatment and take charge of your destiny. Should a cure come around in the future, you’ll be that much further ahead.
Find relief in recovery. Life gets better with addiction treatment.
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