Fighting Back: Part 6b

MEDICATIONS WOULD TREAT ADDICTION AS DISEASE

Some Question Idea Of Giving Addicts More Drugs

For some people, joy, love, success - the magic that makes life worthwhile
- - are not bewitching enough. They trade happiness for cocaine, heroin,
painkillers, alcohol, cigarettes or food.

These people are addicts, and they are all around us.

Now science is on the brink of developing breakthrough medications to treat
addiction. The federally funded work is bringing the country to the verge
of a new era in medicine, in which addiction will be treated as a disease,
not a personality defect.

The change in thinking is based on a fundamental insight gleaned from the
coordinated work of hundreds of brain researchers: that addiction actually
rewires the brain, dooming its owners to a downward spiral of
self-defeating behavior.

"What's coming are medications and behavioral treatments that are going to
be both subtle and effective," said Francis Vocci, director of the division
of treatment research and development at the National Institute of Drug
Abuse in Bethesda, Md.

A slew of medications - drugs that could break the death grip of illicit
and prescription drugs, alcohol, cigarettes, even food and other substances
- - are coming to market, under review or in the research pipeline.

Though some treatments, such as vaccines for addiction to tobacco and
cocaine, are new concoctions egged into being by the aggressive federal
program, many are available now for other purposes. For instance,
buprenorphine, under review by the Food and Drug Administration as a
treatment for heroin addiction, is a painkiller used to counter
postoperative pain. Selegilene, a promising treatment being studied to
fight cocaine addiction, currently is used to treat Parkinson's disease.

While interest in such approaches is steadily growing, as evidenced over
the spring and summer by oversubscribed sessions at national medical
meetings, the possibility of such a change in treatment is not endorsed
unanimously within the medical establishment. Sally Satel, a psychiatrist
who lectures at Yale University and conducts research at the American
Enterprise Institute, is one of those who say willpower still plays a key
role in behavior.

Others question whether it is appropriate to give addicts more drugs,
furthering the cycle of dependence.

"I don't buy the whole biological model of addiction," said Stanton Peele,
a Morristown, N.J., psychologist and attorney who has written and lectured
extensively about addiction. "People become addicted to substances or
things because there is something missing from their lives. Taking a pill
is not going to address the problem."

Scientists who have been involved in the development of new drugs for
addiction dismiss such qualms. Rather than a social problem, drug addiction
needs to be viewed in a new light, they say: as a chronic health issue that
requires prevention and long-term treatment.

The changes that are coming in the treatment of addicts are based on the
combined efforts of hundreds of researchers who, working over the past
decade with lab animals and human subjects, have explored the complexities
of the human brain. Armed with powerful imaging technologies, scientists
now know more about the effects of addictive drugs on the brain than about
almost any other aspect of brain function.

Stigma of addiction

"The search for an effective treatment for addiction has been hampered by
social strictures," said Walter Ling, a professor of psychiatry at the
University of California at Los Angeles and director of its integrated
substance abuse program. "For so long, society has thought of drug addicts
as sinners - making them jump through hoops, hoping that the treatment
doesn't make them feel so well. As people begin to understand that this all
comes from the brain, my hope is that attitudes - and treatment - will change."

The bible of American psychiatry, the Diagnostic and Statistical Manual of
Mental Disorders, defines dependence or addiction as a pathological
condition in which patients must exhibit three of seven distinct criteria.

More generally, addiction is defined by researchers as an overwhelming
compulsion to perform certain acts with the full knowledge they are
self-destructive.

Government studies show that alcoholism costs American society about $90
billion a year and drug addiction an additional $67 billion a year.

If cigarettes and food are included in the damage assessment, the figures
are believed to be much larger.

"People take drugs for two reasons - to feel good and to feel better," said
Herbert Kleber, a former White House drug adviser and now a
physician-researcher at the National Center on Addiction and Substance
Abuse at Columbia University in New York.

If a person tries a drug once, what is the likelihood that he will become
dependent on it? "Surprisingly high," said Kleber, who has studied the
syndrome. In the case of nicotine, 32 percent of those who smoke will get
hooked, according to a federal study. For heroin, the study shows, it's 23
percent; for cocaine, between 17 and 23 percent; for alcohol, 15 percent;
and for marijuana, 9 percent.

At present, addiction is mostly treated with a combination of psychotherapy
and a handful of drugs. For those with access to treatment, the offered
brand of psychotherapy is designed to provide intensive counseling and
coping and training skills. Twelve-step programs, like those offered by
Alcoholics Anonymous, are designed to address the underlying reasons for
the patient's substance abuse.

For many, they are not enough to avoid relapse. Between 40 percent and 60
percent of patients treated for alcohol or other drug dependence return to
active substance abuse within a year after being discharged from treatment.

The basic research of today, scientists say, will lead to far better, more
customized therapies a decade from now. As research scientists learn how
abused substances affect brain chemistry, they are hoping to design highly
targeted drugs that eventually will treat addiction on a chemical and even
a genetic level.

Understanding what parts of the brain are affected will aid in the
development of targeted medicines. Much of the search by scientists centers
on the hope that there is a common "pathway" for addiction - a route
through brain circuitry shared by heroin, cocaine, nicotine, alcohol and
food - so that a "magic bullet" drug can be developed to address any form
of compulsive, self-destructive behavior.

In the long term, scientists are working to develop medications that keep
abusive substances out of the brain. This will be done by finding drugs
that zero in on the addictive processes of the brain, targeting the brain
chemicals known as neurotransmitters that block the abusive substance's
action or reverse the biochemical changes that cause the compulsion,
craving and loss of control that are characteristic of addiction.

Researchers expect to combine medication with therapy for optimal
treatment. Such a combination is the ideal approach, said NIDA's Vocci,
because it would address both the social and biological problems that cause
and perpetuate addiction.