Better Living Through Medicine:

NEW WAVE OF ADDICTION TREATMENT IS PHARMACEUTICAL

It sounds too good to be true. A patient walks into his doctor's
office and admits he's been drinking too much or tells the doctor he
wants to quit smoking. The doctor writes a prescription. The patient
drinks less or throws away the cigarettes.

Such a scenario is not likely in the near future, if ever, but
researchers are beginning to tease out the brain chemistry of
addiction -- or at least find drugs that allow them to tinker with
the neurochemical machinery of substance abuse.

A October study in the Journal of the American Medical Association is
the latest to offer the tantalizing possibility that pharmaceuticals
could eventually play a significant role in the treatment of
addiction. In the study of 371 men and women, those receiving the
anti-seizure drug topiramate, brand name Topamax, along with a weekly
psychosocial treatment, were more likely to achieve 28 or more days
of not drinking heavily or 28 or more days of abstinence than those
receiving a placebo. The drug is believed to work by blocking
pleasure receptors in the brain, making drinking less enjoyable.
Another drug, naltrexone, brand names Revia and Depade and extended
release form, brand-name Vivitrol, works in the same way.

A drug to treat cigarette smokers, varenicline, brand name Chantix,
is similar, taking away the neuro-rewards for smokers. In animal
studies with alcohol-addicted rats, the drug has also shown promise
as a treatment for alcohol addiction. Other drugs such as Zyban for
smoking and Campral for alcohol are prescribed to deal with nicotine
and alcohol cravings. They represent a different approach from older
replacement drugs such as the nicotine patch for smokers or methadone
for heroin addicts. They also are different from aversion therapy
such as disuliram, also known as Antabuse, for alcoholics.

And several new addiction drugs are in the pipeline.

"Medication development is one of the top priorities of the National
Institute on Drug Abuse," says Dr.Christian Thurstone, an assistant
professor at the University of Colorado and Denver Health Sciences
Center. But, he cautions: "I think medication will never be the sole
treatment for addiction. Addiction produces a lot of wreckage in
people's lives that can't be dealt with by medication alone."

Thurstone, who treats adolescents ages 12 to 19 for addictions, most
prominently marijuana use, smoking and alcohol addiction is currently
writing a grant to study the effects of Chantix on both cigarette and
marijuana smoking.

He says studies have shown very encouraging results for Chantix in
smoking cessation.

"It's double the effect of Zyban and quadruple the effect of a
placebo," he says. "It decreases craving, decreases withdrawal,
decreases the rewarding effect. If they do relapse and smoke, it
decreases the pleasurable effect."

However, he says, studies thus far have excluded people with other
problems such as depression and anxiety, which frequently occur at
the same time with nicotine addiction. And the smoking studies have
excluded people with other types of addiction.

"It's not clear what will happen in the real world," he says, where
addictions and psychological problems often cluster together.

And alcohol and drug addictions, with their destructive effect on
work, relationships and other areas of an addict's life, are more
complicated to treat than smoking.

"An active alcoholic is like a bull in a china shop. Even after
removing the alcohol, you still have to clean up the mess," says Sara
Milmoe, a psychotherapist and certified addiction counselor in the
recovery program at Mapleton Center in Boulder.

She says alcoholism is an all-encompassing illness.

"It's not just the physical piece. It's not just the emotional piece
or the spiritual piece. The whole self is involved. To have true
sobriety, you have to address all these areas in your life. There are
certainly some folks who stop drinking. Their lives don't drastically
change if they don't address the other things, too."

In rehab circles, such a person is known as a dry drunk, which Milmoe
defines as "all the behavior without the excuse."

She worries that alcoholics could get the message that drugs would
allow them to drink in moderation, an idea that most recovery
professionals do not accept. She says alcoholics often rationalize,
justify and deny the extent of their problem so they can keep using alcohol.

"The alcoholic voice will look for any available back door to keep
(drinking) going. It wants to be fed. It will destroy everything in
its path, including family, job and self-esteem."

Then there's the seemingly paradoxical notion of taking one substance
to quit taking another.

InnerBalance in Fort Collins offers an approach to addiction
treatment called biochemical restoration. The center's treatment
works on brain chemicals, but with supplements, vitamins and diet
rather than prescription drugs, after extensive testing. Clinic
Director Joe Eisele says hypoglycemia is an extremely common in
alcoholics after years of drinking. The treatment seeks to fix
chemical imbalances and includes social and spiritual support.

Eisele says he regards many medications that work on brain chemistry
as just another type of potentially problematic drug.

"Sometimes it takes two months to come off an antidepressant," he
says. "To me, that's an addiction."

Those open to a drug therapy in conjunction with other talk therapy,
say that a medical approach may lead to less stigma for addictions
and the potential benefit that a person could seek treatment earlier
in the addictive process.

"I think it will enable us to start treating in an earlier stage,"
Thurstone says. "People typically recognize there is a problem before
they hit rock bottom. They try to stop or use in moderation on their
own. Increasing access to treatment (could) help people get treatment earlier."

That said, a pill will likely never be the only treatment to fix the
complex web of problems caused by addiction.

"Everything in medicine has a biological, psychological and social
(component) to it," Thurstone says. "There are genetic reasons why
someone might be an addict. There (could be) psychological reasons
because of a co-occurring anxiety. There's the social, too. You're
more likely to use a substance if your friends are using as well."

Research can perhaps shed light on all three.