Technology is changing the way we look at drug and alcohol abuse. Long gone are the days of seeing addiction as a weakness of willpower or laziness. It’s about the drug and the addiction, not about willpower. Long term use of drugs and alcohol changes brain structure – damaging and changing neurons until recovery is not possible without extreme measures. The cycle of addiction is hard to break. The more drugs taken, the higher the tolerance grows and the more drugs are needed to get high. At this point, even if the addict is able to stop using, the chances of relapse are increased. The type of drug doesn’t matter, either. Although the side effects of a drug may differ, the lasting effect on the body’s reward system is similar. With that in mind, neurologists and researchers are looking to find alternative treatments for drug addictions. These treatments are meant to be used alongside conventional therapies and rehabilitation. There has not been (and nor will there likely be) a “cure” for addiction.
A New Brain Stimulation Treatment Has Been Seen to Reduce Drug Seeking Behaviors
The vagus nerve is the longest of the body’s cranial nerves and has the widest distribution in the body. It interacts directly with the heart, lungs and digestive tract. It can be activated for a variety of reasons including emotional stress. Excessive stress can cause overcompensation of a sympathetic nervous system response. It affects children and women more often than men. Vagus nerve stimulation, or VNS therapy, uses a device that resembles a pacemaker that’s implanted into the chest. Since 1997, it has been used to control seizures in patients suffering from epilepsy. VNS therapy reduces cocaine seeking and alters plasticity of the brain’s extinction network according to a new report. This study looked at drug abuse changes in the prefrontal cortex and associated regions that are known to impair inhibitory control over drug seeking. “Here we used vagus nerve stimulation (VNS) to induce targeted synaptic plasticity to facilitate extinction of appetitive behaviors and to reduce relapse. Rats self-administered cocaine and were given VNS during extinction. Relapse to drug-seeking was assessed in a cued reinstatement session.” This research supports growing evidence that VNS therapy can be beneficial for addicts. It’s also showing that people with Major Depressive Disorders and inflammatory disorders such as rheumatoid arthritis. In these studies, according to Psychology Today, “The researchers found that VNS therapy triggered changes in synaptic plasticity between the prefrontal cortex and the amygdala in cocaine-addicted lab rats. Through a complex process, VNS appeared to facilitate “extinction learning” of drug-seeking behaviors by reducing cravings and encoding new reward behaviors in place of those previously associated with pushing a lever to receive a hit of cocaine.” This is an exciting new prospect for the treatment of drug addiction and other disorders.
Changing How Pain is Treated in the United States While Deterring Addicts
The number of fatal overdoses from the drugs increased almost five-fold, from 4,000 deaths a year in 1999 to nearly 19,000 in 2014. That includes people who illicitly used prescription opioids and those who overdosed on pills prescribed for them. That is more than deaths in motor vehicle crashes. The FDA, doctors, and families are extremely concerned about this opioid epidemic. It’s becoming more and more apparent that one major contributor to these outrageous numbers is the number of opioids prescribed by doctors to patients for pain. This trend has led to patients becoming addicted to prescription painkillers. As their tolerance grows, their need for more drugs increases. When the prescription painkillers run out, they may move on to heroin. Heroin is far cheaper and easy to obtain. In 2016, the FDA’s Robert M. Califf, M.D.announced changes in the way the FDA is handling the rise in opioids prescribed for pain patients. “We’re going to focus efforts on approving drugs that have the potential to help mitigate the crisis. That means spurring the development of promising generics with abuse-deterrent formulations. The FDA will issue draft guidance with its recommendations for the approval standards for generic abuse-deterrent formulations. We believe the availability of less costly generic products should accelerate prescribers’ update of abuse deterrent formulations.” Many healthcare providers agree what’s needed is more doctor and patient education on alternative treatment options to opioids. According to PBS, “Amid the growing epidemic, many doctors also don’t learn much about pain management while in medical school. A 2011 study found that during four years of training, a typical U.S. medical student spends only nine hours learning about pain.” There is also the need for better drug monitoring for patients who exhibit signs of addiction.
New Research Leads to Medications That Can Help Addiction
The opioid epidemic has led researchers to work harder at creating medications that may help addicts stop using. For instance, the drug Probuphine was just approved for implantable use. According to the drug’s website, “Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is part of a complete treatment program that also includes counseling and behavioral therapy.” These come in small, solid implants that are placed by a healthcare provider under the skin of the upper arm. The drug is released slowly into the body and can last up to six months before replacement is needed. The drug itself is an opioid blocker. This provides a good alternative to methadone treatment. According to the Substance Abuse and Mental Health Services Administration, “Methadone works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. Methadone is offered in pill, liquid, and wafer forms and is taken once a day. Pain relief from a dose of methadone lasts about four to eight hours.” Although methadone may be a good treatment option for some people, it is still an addictive (albeit legal) route. Methadone cannot be used with other drugs without serious medical side effects. Methadone doses are also tailored to each person depending on their stage of recovery. The side effects of methadone include:
- Difficulty breathing or shallow breathing
- Feel lightheaded or faint
- Hives or a rash; swelling of the face, lips, tongue, or throat
- Feel chest pain
- A fast or pounding heartbeat
- Hallucinations or confusion
As more research is done, especially in genetics, the hope is to create medications tailored for each individual’s needs.
Genetic Testing is Leading to More Answers About Addiction
Why do some people become addicts and others do not? Studies following families, twins, adoptees, and siblings suggest there is a connection between addiction and genetic makeup. Genes are units of DNA that make up the human genome. They provide information that directs the body’s activities. From person to person, the genetic makeup only varies by .1 percent. Those tiny changes account for the varied people that populate the plant. Some diseases, such as sickle cell anemia, are caused by mutations in these genes. Now with proper testing, small genetic deletions and duplications are diagnosed as a syndrome. The same is true of single-gene diseases. Genetic testing is becoming easier, more cost-effective, and geneticists are learning more about the data they receive. According to an article entitled “The Genetics of Alcohol and Other Drug Dependence” by Danielle M. Dick, Ph.D. and Arpana Agrawal, Ph.D., “[…] many of the genetic factors affecting risk for dependence on alcohol or other drugs appear to act through a general externalizing factor; however, other genetic factors appear to be specific to a certain disorder. In recent years, researchers have identified numerous genes as affecting risk for dependence on alcohol and other drugs. These include genes involved in alcohol metabolism as well as in the transmission of nerve cell signals and modulation of nerve cell activity (i.e., γ-aminobutyric acid [GABA] and acetylcholinergic neurotransmission and the endogenous opioid and cannabinoid systems).” By learning more about the genetics of addiction, scientists and the National Institute on Drug Abuse hope to “translate this knowledge into new treatments directed at specific targets in the brain or to treatment approaches that can be customized for each patient—called pharmacogenomics. This emerging science, often called precision medicine, promises to harness the power of genomic information to improve treatments for addiction by tailoring the treatment to the person’s specific genetic makeup. By knowing a person’s genomic information, health care providers will be better equipped to match patients with the most suitable treatments and medication dosages, and to avoid or minimize adverse reactions.” As advances in medical technology grows, it’s exciting to see what new treatments will become available to alcohol and drug addicts. What’s certain: the need for conventional therapies will persist. Rehabilitation centers and detox centers are often the first stop for addicts who are ready to lead a sober lifestyle.
