NEW DRUG THERAPIES MAY FIGHT ADDICTIONS

Addiction treatment no longer has to be a "drug-free zone," thanks to new
therapies designed to soften the trauma of withdrawal and blunt the
cravings that often drive addicts back to drugs or booze or cigarettes, no
matter how desperately they want to quit.

These new drugs mark a new path for addiction therapy. They act directly on
the symptoms of addiction. In that way, they differ from earlier
treatments, such as methadone, that substituted one drug for another.

These new treatments are slowly becoming available. That's due, in part, to
a new understanding of the biology of addiction and, perhaps in equal
measure, to pressures to shorten expensive treatment programs.

New therapies for addiction have the potential to touch millions of people
across the nation. An estimated 10 percent of the U.S. adult population,
for example -- or about 14 million people -- are believed to have a
drinking problem. Nearly 30 percent smoke. Drinking contributes to more
than 40 percent of the nation's traffic fatalities. Combined with
cigarettes, alcohol is a major contributor to leading killers like heart
disease, stroke and some cancers.

Some in the treatment business warn that sobriety requires an overhaul of
the soul and will never be as simple as popping another pill. Even
proponents insist that the drugs can only ease a patient's path to a new
life, but won't work without therapy to address the problems that lead
people to addiction and the behaviors that trap them there.

Some drugs that take this new approach have recently been approved and are
already available through doctors or treatment programs:

* Zyban, a drug aimed at reducing the desire to smoke. It can be prescribed
by a doctor and is often used in combination with over-the-counter nicotine
patches to help smokers quit.

* Naltrexone, sold under the trade name Re Via. It is approved by the Food
and Drug Administration to help alcoholics stay sober by reducing their
urge to drink.

* Ultra-rapid detoxification. It uses the drug naltrexone to rapidly
detoxify heroin addicts under sedation, to speed and ease their drug
withdrawal.

* Some of the newer antidepressants, like Prozac, currently used to fight
depression. These are being used to help drug addicts and alcoholics when
their substance abuse is thought to be related to an underlying mental
illness.

Insurance coverage for these therapies varies, but most health plans place
strict limits on what they will reimburse for mental health and addiction
therapy. Most plans, for instance, will not cover Zyban, though some
doctors have tried to work around this by prescribing another, similar
antidepressant.

The idea of treating an addiction with drugs results from scientists'
fast-growing understanding of substance abuse as a biological affliction,
and not strictly a behavioral problem. Researchers are finding new pieces
to this complex disease all the time.

Basically, they now believe addiction is a corruption of a bodily system
that evolution intended as a way to reward us for behaviors that ensured
the survival of the species -- most notably sex. There is a reward pathway
in the brain composed of nerve cells that signal pleasure. These cells are
particularly sensitive to a naturally occuring chemical in the brain called
dopamine, which is a neurotransmitter -- it ferries signals between nerve
cells.

On a very simple level, all enjoyable experiences -- whether a kiss or a
fine piece of chocolate -- translate to a rush of dopamine along this
reward pathway in the brain.

Addictive substances distort this natural pleasure system, flooding the
brain with dopamine and causing a "high." Eventually -- and this is
especially so for cocaine and heroin addicts -- this flood of dopamine can
desensitize the brain to the chemical. The trickle of dopamine that's
triggered, say, by a kiss is no longer enough to produce pleasure.

The addict goes into a state similar to depression, in which it's no longer
possible to truly enjoy life. Even the drug no longer produces a high; it
simply fends off a more desperate low.