15 October 2018

A Cure for Cocaine Addiction? It’s a Question of Science Versus Nature

Scientists say gene therapy could eradicate cravings for cocaine and prevent overdose. Is their discovery really a cure for cocaine addiction?

Treating the Science of Addiction

The Guardian have reported that researchers at the University of Chicago are developing a stem cell implant, which could make cocaine users immune to the effects of the drug. It works by releasing an enzyme that removes cocaine from the bloodstream – breaking it down into harmless byproducts.

The enzyme called butyrylcholinesterase (BcHE) is naturally occurring in blood plasma but it does not act fast enough on cocaine in normal conditions. By modifying DNA in stem cells, scientists believe they can create a new form of BcHE, which is thousands of times stronger. This could be implanted under the skin of cocaine users, to cancel out highs if they take the drug.

The Chicago research team are also working on similar treatments for alcohol, nicotine and opioid addiction. They believe their techniques could prevent fatal overdoses in people who cannot stop using or drinking.

Other medications to prevent cravings, relapse and overdose have been available for many years. In the case of alcohol, Disulfiram (marketed as Antabuse) was first approved in 1951 by the Food and Drug Administration in the USA. Antabuse causes adverse physical reactions if alcohol is consumed, which can include nausea, vomiting and dizziness. In the UK, the NHS also prescribe naltrexone, nalmefene (Selincro) and acamprosate (Campral), which are intended to block alcohol cravings or the effects of alcohol.

Treating the Nature of Addiction

In terms of counteracting the effects of drugs and alcohol, there is no doubt that scientific knowledge has come a very long way. These advances need to be considered alongside the very human nature of addiction, however – to understand how addictions develop and how people can recover most effectively.

The holistic view of addiction is that beneath every addictive substance or process, there is always an individual person with a unique history and set of motivations. Every addict develops a distinct pattern of using or acting out. This forms over months, years or decades in response to their personal triggers and desires. Typically, addictions develop because people seek repeatedly to change the way they feel. They want to feel better than they do in ordinary life. They want life to be more exciting or unpredictable or certain. Often, people want to escape uncomfortable, painful or frightening emotions. Addiction centres around chasing feelings or sensations, which people believe they cannot experience naturally.

For example, people who use cocaine often seek a heightened sense of control or alertness that they don’t feel without taking the drug. Alcohol users sometimes believe they can only be confident or relaxed with a drink inside them. Heroin users seek comfort or happiness, which they do not feel without their drug of choice. In all these examples, it’s the mood-altering effect that people want – the substance is simply the means of achieving that effect.

Sometimes, addicts also self-medicate with substances or behaviours, attempting to block out distressing feelings, mental illnesses or traumatic memories. Addictive patterns often develop with particular drugs, alcoholic drinks or processes – but it’s the end result of escaping painful reality that is actually desired.

Over time with all addictions, people usually find they need to increase how much they use or act out to achieve the same effect. Changes in brain chemistry lead to greater levels of tolerance to alcohol and drugs. Even addictive behaviours like sex, gambling or gaming produce physiological effects in the body, which can drive cravings to pursue more intense highs.

So, as one drug or behaviour stops working so well, then addicts will seek out another. They will combine the new addiction with the old one – or they will replace it entirely. This is called cross addiction and it’s a very common feature in the life stories of addicts. This is where medical interventions for addictive substances cannot control the true nature of addiction.

Abstinence-Based Addiction Treatment – The Permanent Solution

Medications and therapies that reduce the harm of drugs and alcohol do play a significant role in addiction treatment worldwide. For those seeking permanent recovery, however, the root causes of their addiction must be uncovered and treated.

Abstinence-based treatment for addition requires people to stop taking drugs or drinking alcohol, in order for therapeutic interventions to begin. With process addictions, abstinence is defined according to individual patterns and whether it’s possible to stop entirely. With gambling and gaming, for example, it is possible for addicts to abstain completely. With food addictions or sex addiction, recovery is about finding a healthy relationship with these aspects of life – people typically define a set of abstinent behaviours, supported by addiction therapists and recovery peers.

Treatment modalities include 12-step therapy, cognitive behavioural therapy, dialectical behavioural therapy, trauma therapy and family therapy. These can all bring about powerful and long-lasting recovery from addiction. Alternative therapies including music, drama, dance, art, meditation, mindfulness, yoga and nutritional guidance can also provide breakthroughs in the treatment of addiction – accessing feelings, memories, new perspectives and skills that help people to recover.

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