Why Medication Alone Will Never Be the Only Answer to AddictionAnna Ciulla
The idea of popping a pill or taking a vaccine to eliminate addiction forever has a certain appeal. There’s only one problem: it won’t work. There’s much more to overcoming addiction to alcohol, illicit and prescription drugs, and process addictions than mere medication. Furthermore, medication alone will never completely vanquish the vestiges of addiction, the cravings and urges, the psychological pull that draws users back into its seductive grip, or the brain changes brought about by addiction that make using nearly impossible to resist.
Success in overcoming addiction requires a multi-pronged approach. There are stages or phases of treatment involved, along with a great deal of education, learning healthier behaviors, adopting a different mindset and making a commitment to sobriety.
Granted, this is a lot more complicated than simply taking medication, but it has been proven to be the most effective way to deal with addiction.
WHAT IS ADDICTION?
To better understand why medication alone won’t stop addiction, it’s necessary to look first at what addiction is. According to the National Institute on Drug Abuse (NIDA), drug (including alcohol) addiction is a “chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.”
While people voluntarily decide to consume alcohol, or do drugs, and do so repeatedly, the hidden damage is already underway. These substances are toxic, leading to potentially long-term harm to the brain. In addition, repeated drug use can lead to addiction, where the user is unable or unwilling to forego the drugs and alcohol that have become so necessary to his or her existence. Indeed, once addiction sets in, the user cannot stop using without professional help. They also don’t want to, in most instances, because they’ve become so fixated on the using lifestyle that they cannot see any legitimate reason to change.
It’s also a fact that addicts, even those who have been sober for years, are at risk for relapsing. Addiction is therefore considered a relapsing disease. There is no cure for addiction, but it is treatable and can be managed successfully.
MEDICATIONS USED DURING TREATMENT
Medications do play an important role during treatment to overcome addiction to alcohol, illicit and prescription drugs. Whether used primarily during detoxification from the substances of abuse or used as short-term medication therapy in combination with professional counseling, education, and introduction to self-help groups, these medications provide the recovering addict with a safe and effective means of transition from active drug using through detoxification and into intensive treatment. They are not, however, a substitute for comprehensive treatment.
Some of the medications approved by the FDA for the treatment of addiction include:
- Opioid addiction: Buprenorphine (Suboxone), Methadone and Naltrexone (Vivitrol)
- Alcohol addiction: Acamprosate, Naltrexone and Disulfiram
- Tobacco addiction: Bupropion (Zyban) and Varenicline (Chantix)
There are still no FDA-approved medications to treat cocaine addiction or methamphetamine addiction.
WHAT ABOUT VACCINES FOR ADDICTION?
There’s been promising research into vaccines to end smoking (NikVAX), cocaine, heroin and, more recently, to help with synthetic opioid addiction. Yet none of these potential vaccines will eliminate the need for recovering addicts to receive ongoing therapy and support through self-help or 12-Step groups.
Anti-cocaine vaccine enters clinical trial
A Phase 1 clinical trial of an anti-cocaine vaccine began enrolling active cocaine addicts in August 2016. The vaccine, developed by Weill Cornell Medicine and New York-Presbyterian, was previously shown to block cocaine from entering the brain in animal studies. With more than two million people addicted to cocaine in the U.S., and no medications currently approved by the Federal Drug Administration (FDA) to treat cocaine addiction, there’s a great deal of interest in developing a safe and effective medication to help blunt cocaine’s effect on the brain.
It should be noted that each participant in the Phase 1 clinical trial of the anti-cocaine vaccine will undergo standard drug dependency therapy throughout the study. Three groups of participants will be involved in the study, which is expected to last three years.
Work continues on heroin, fentanyl vaccines
A vaccine to combat heroin addiction, first developed by The Scripps Research Institute (TSRI) in 2013, having proven safe and effective in mouse models of heroin addiction, is progressing toward testing with primates. In 2015, TSRI received a $1.6 million, two-year grant from the National Institutes of Health National Institute on Drug Abuse to continue preclinical studies on a potential heroin vaccine. The vaccine blocks heroin’s active products from reaching the brain and creating a high. Minus the high, addicts in recovery should be much less likely to relapse. Data from the research will lay the groundwork for human clinical trials and application for future approval by the FDA.
In early 2016, TSRI also announced successful preclinical tests of a vaccine that blocks the synthetic opioid fentanyl from reaching the brain. In theory, say TSRI lead researchers, this blocking ability could lessen or stop drug-seeking and drug-taking behavior.
WHAT DOES WORK IS TREATMENT
Even though a pill or injection won’t be a complete answer to overcoming addiction, certain medications, used during detoxification and/or in combination with ongoing therapy, offer a hopeful outlook for successful recovery. In addition to professional therapy (individual, group or family therapy) and various treatment approaches and modalities, another linchpin of recovery is participation in self-help support groups.
With professional treatment, a comprehensive plan is tailored to the individual. Weaning off substances of abuse and learning healthy behaviors and solid coping strategies, along with examining the roots and causes of addiction, tending to any co-occurring mental health and substance abuse problems, finding encouragement and support in self-help groups is a proven, effective way to enter and maintain recovery.
It’s not a single pill or injection, and treatment does take time. But this approach does work.
ASAM, American Society of Addiction Medicine, “Cocaine Vaccine: Research Review.” Retrieved February 18, 2017
ClinicalTrials.gov, “A Comparability Study of the Phase 3 Lot and a Single Commercial Lot of NicVAX in Healthy Adult Smokers.” Retrieved February 18, 2017
National Institutes of Health (NIH) National Institute on Drug Abuse (NIDA), “Treatment Approaches for Drug Addiction.” Retrieved February 18, 2017
National Institute on Drug Abuse (NIDA), “Understanding Drug Use and Addiction: What is drug addiction?” Retrieved February 17, 2017
The Scripps Research Institute, “TSRI Scientists Awarded $1.6 Million Grant to Bring Heroin Vaccine Closer to the Clinic.” Retrieved February 18, 2017
The Scripps Research Institute, “TSRI Scientists Create Vaccine Against Dangerous Designer Opioids.” Retrieved February 18 2017
Weill Cornell Medicine, Newsroom, “Anti-Cocaine Vaccine Approved for Clinical Study in Humans.” Retrieved February 17, 2017