09 Apr Disulfiram for Cocaine Abuse
There is currently no drug that is approved for use in cocaine addiction, so the search for new candidates has continued at a rapid pace. Behavioral interventions are effective for treating drug addiction, but effective medications are an invaluable additional tool for rehab centers and doctors. Disulfiram (commonly known as Antabuse) was developed to combat alcohol addiction by provoking a severely unpleasant reaction when anybody taking it has an alcoholic drink, but research suggests it could be the long-sought treatment for cocaine addiction too.
What is Disulfiram?
The effect of disulfiram is a direct consequence of a chemical called acetaldehyde, which it produces when the body metabolizes alcohol. When you have a drink, an enzyme breaks the molecules down into a form your body can manage, and acetaldehyde is one of the most dangerous of these. The body has a couple of enzymes which break this down too, one of which is called glutathione, and the system balances itself out quite quickly. However, the stores of glutathione deplete rapidly, which means more acetaldehyde builds up in the drinker’s body. This is what makes you feel sick during a hangover and often leads to vomiting. Disulfiram increases the concentration of acetaldehyde in combination with alcohol, meaning that anybody taking it who has a drink has a very unpleasant time.
How Might it Work for Cocaine?
Cocaine addiction is very different from alcohol addiction because it primarily works on dopamine. This is the neurotransmitter responsible for rewards in the brain, usually reserved for activities such as eating and having sex, which are essential to survival and reproduction. When somebody takes cocaine, the levels of dopamine in the brain are drastically increased, which causes the euphoria commonly associated with the drug. It also has a similar effect on norepinephrine, which further adds to the energetic effect of the drug.
Disulfiram actually has numerous other actions on the body, and one of these is blocking a specific form of dopamine. It has been shown to inhibit this chemical, which is an essential component in the production of norepinephrine, thus making it a double-pronged attack on the effects of cocaine. When combined with cocaine, the suppression of norepinephrine production combines with a hyper-stimulation (which is related to the drug’s impact on dopamine), which is extremely unpleasant for the user. However, this is only a theory at present, and it looks like disulfiram may be more of a stepping stone onto more effective treatments for cocaine addiction.
A New Method
Although the idea has generated a lot of interest, a review of studies into its effects concluded that there is currently not enough evidence to say that it is definitively effective. However, when it was compared to no treatment at all, disulfiram showed a definite positive effect. These contradictory results seem to suggest that there is some mechanism which makes the drug effective, but it isn’t direct enough to be completely effective.
This has led researchers to speculate about the possibility of targeting the form of dopamine that disulfiram inhibits with a different drug. This drug is called nepicastat, and it is now a hot topic of research. This is a better option for treatment of cocaine addiction because it focuses on the specific neurotransmitter rather than being a more haphazard drug like disulfiram, which affects numerous chemicals in the brain. The main promise for nepicastat is that it will deliver the benefits of disulfiram for cocaine abuse but without the associated side effects.
Disulfiram also offers hope for the treatment of cocaine addiction if it is a co-existing problem along with heroin. Research as shown that around 50 percent of patients who abuse heroin in addition to cocaine will benefit from the combination of buprenorphine and disulfiram as treatments. Since buprenorphine is already used for the treatment of heroin addiction, this combination of drugs has genuine potential for poly-substance abusers. Theoretically, however, the use of nepicastat in combination with buprenophine could be even more effective.
What Does this Mean for Treatment?
This potential breakthrough in drug treatment of cocaine addiction exists thanks to the supplementary effect of disulfiram, but the majority of the treatment will remain the same. Medication doesn’t offer a “cure-all” approach to drug addiction, because it is ultimately a mental health issue, which means that the core treatment is counseling. Medication can never address the underlying psychological issues which lead to drug addiction, and therefore can only ever be a complementary treatment. Attacking the specific neurotransmitters active in drug addiction is just a surface solution; if the psychological problems persist, the individuals will simply find a new substance to satisfy their needs. Addressing the underlying reasons the individual abuses substances is the only real solution.
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