Addiction Treatment: New Prescriptions (cont.)
"Research has shown that if you give [Campral] and naloxone together you can get an even better and more enhanced effect with somewhat better outcomes," says Galanter. Though not specifically approved for the use of alcohol addiction, Galanter adds that at least two other medications are being used effectively -- the epilepsy drug Topamax and the muscle relaxant Baclofen. Both are also undergoing testing as treatments for addiction to cocaine, heroin, and other opiates as well.
The Cutting Edge: The Addiction Vaccine
Experts say one reason almost any kind of drug addiction maintains such a strong hold on its victim has to do with not only the direct effects on the body, but also the somewhat indelible impression these substances make on our brain.
More specifically, imaging tests show that when exposure to drugs occurs with any kind of consistency, certain environmental and emotional cues associated with drug use become encoded in our psyche -- so much so that for some folks undergoing addiction treatment, even limited exposure to those original cues can activate a craving that causes a relapse. This, say experts, is particularly true of cocaine addiction, where the risk of falling off the treatment wagon can be quite high.
One way around the problem -- an "addiction vaccine" -- is a new way of helping to "cushion" the fall and keep relapses from overtaking treatment successes.
"The idea here is that if you've been vaccinated and you relapse, the effects of the cocaine are blunted, and that shifts the probabilities that you will relapse further, so you should be able to get your life back in order more quickly," says Margaret Haney, PhD, associate professor of clinical neuroscience at Columbia University and a researcher on the cocaine vaccine at New York State Psychiatric Institute.
Haney says the vaccine works by blocking the effects of cocaine not in the brain, but in the blood, beginning almost as soon as the patient takes the first "hit."
"It's a brand new treatment approach to drug abuse: The vaccine binds to the cocaine itself before it has a chance to cross the blood-brain barrier, and this prevents, or at least dramatically decreases, it's pleasurable effects," Haney tells WebMD.
Though an addict determined to get high can overcome the protection of the vaccine, Haney says within two to three months after treatment starts, there are enough antibodies in the blood to prevent at least three times the normal dose of cocaine from getting to the brain. So even if a craving is triggered, using cocaine will have little or no effect.
"It's still in the very early stages, and it will mostly likely be the most helpful when used in conjunction with other drug treatments, but it is our hope that it will prevent serious relapses from occurring in those who are motivated to overcome their addiction," says Haney.
Other vaccines under development include one for nicotine addiction, which researchers say is the furthest along, as well as others for heroin and other opiates.
Surgery for Addiction
When it comes to even more dramatic cutting-edge treatments, some doctors are turning to what we have already learned from two totally unrelated problems: Parkinson's disease and epilepsy. One treatment proving effective in both these conditions is a surgical intervention known as "electrical deep brain stimulation," and some experts believe it may work in drug addiction as well.
"For people who are sufficiently affected by their [addiction], deep brain stimulation it might be totally appropriate -- as appropriate as it is for Parkinson's or epilepsy," says Michael Kaplitt, MD, director of stereotactal and functional neurosurgery at Columbia Presbyterian Medical Center.
In this treatment, doctors implant a tiny electrode deep within the brain. Attached wires run under the skin to a small device located in the chest, not unlike a cardiac pacemaker. Using a hand-held unit similar to a remote control, patients can turn the electric current to their brain on and off, and in some instances, even regulate its strength.
In Parkinson's, Kaplitt says deep brain stimulation is being used to help control muscle tremors. In epilepsy, the treatment helps offset the occurrence of seizures. In drug addiction, he theorizes it may be useful in either stimulating the same area of the brain as the addictive substance -- thereby eliminating the need for the drug -- or by simply short-circuiting the cravings when they do occur.
"The anatomic pathways of drug addiction are similar to the Parkinson's pathways. Anatomically the areas affected are extremely close ... and thus far, animal studies suggest if you put electrodes into these same areas you can simulate or block drug addiction depending on how you stimulate," says Kaplitt.
While he stresses there are no human trials using deep brain stimulation under way for drug addiction, there are some in progress for depression and obsessive compulsive disorder. As such, Kaplitt believes the potential is also there for electronically wiping away drug addiction, and he hopes to start a clinical trial in the near future.
"Given that we have an even better understanding of the [changes in the brain that occur in] people with drug addictions as compared to depression, it seems perfectly reasonable to consider that we might be able to apply what we have learned from treating other diseases with deep brain stimulation to help people addicted to drugs. We can't predict or promise, but there's a definite possibility," says Kaplitt.
Published Oct. 18, 2004.
SOURCES: Gopal K. Upadhya, MD, medical director, Areba Casriel Institute, New York. Marc Galanter, MD, director, division of alcohol and substance abuse, NYU Medical Center/Bellevue Hospital, New York. Margaret Haney, PhD, associate professor of clinical neuroscience, Columbia University; researcher, New York Psychiatric Institute, New York. Michael Kaplitt, MD, director of stereotactal and functional neurosurgery, Columbia Presbyterian Medical Center, New York. The 2003 National Survey on Drug Use and Health, Department of Health and Human Services Substance Abuse and Mental Health Services Administration. Drug Abuse Report: Buprenorphine, National Institute on Drug Abuse.
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