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Addiction Treatment: Treating Alcoholism the New Way

Some experts believe that one of the factors responsible for the success of Suboxone lies not only in the power of the primary drug, but also in a second compound contained in this drug -- a medication known as naloxone. A powerful anti-addiction drug in its own right, naloxone, sold under the brand name Narcan, has also become a mainstay in the modern treatment of alcohol addiction. In fact, it's one of just two medications approved by the FDA for this purpose.

"When used in alcohol addiction, naloxone reduces cravings and diminishes the length of time alcohol is used while increasing the length of time an abstinent person might remain abstinent, " says Marc Galanter, MD, director of the division of alcohol and substance abuse at NYU Medical Center/Bellevue in New York.

Now joining naloxone in the fight is the drug Campral, approved by the FDA in August 2004. Galanter says it works much the same way as naloxone to stimulate the reward centers of the brain -- in this instance, by elevating levels of a brain chemical known as GABA. This, he says, reduces the need for alcohol without activating the numbing effects patients normally get from drinking.

"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," says Haney.

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.

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.

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Reviewed: 3/2006