Emerging Treatments for Addiction are Treating the Disease as Chronic,
Relapsing Brain Disorder Advances Made in Understanding Biology of Addiction 'and That is Finally
Starting to Push the Thinking From 'Moral Failing,' to 'Legitimate
Illness,' Says Addiction Expert
NEW YORK, Feb. 24 /PRNewswire/ -- Although the American Medical Association recognized addiction as a disease back in 1956, only now are we beginning to see treatments that target the underlying biochemistry of that disease, Newsweek reports in the March 3 cover, "The Hunt for an Addiction Vaccine" (on newsstands Monday February 25). Health Reporter Jeneen Interlandi reports that this emerging paradigm treats addiction as a chronic, relapsing brain disorder to be managed with all the tools at medicine's disposal. The addict's brain is malfunctioning, as surely as the pancreas in someone with diabetes. In both cases, "lifestyle choices" may be contributing factors, but no one regards that as a reason to withhold insulin from a diabetic. "We are making unprecedented advances in understanding the biology of addiction," says David Rosenblum, a public-health professor and addiction expert at Boston University. "And that is finally starting to push the thinking from 'moral failing' to 'legitimate illness'."
Interlandi examines the science that is helping to understand how the addicted brain functions and the compounds being developed or tested by the National Institute on Drug Abuse (NIDA) that block the intoxicating effects of drugs, including vaccines that train the body's own immune system to bar them from the brain. To the extent that "willpower" is a meaningful concept at all, the era of willpower-in-a-pill may be just over the horizon. "The future is clear," says Nora Volkow, the director of NIDA. "In 10 years we will be treating addiction as a disease, and that means with medicine."
Vaccines that would arm the immune system against addictive drugs and prevent them from making the user high are, potentially, the ultimate weapons against addiction, Interlandi explains. A cocaine vaccine is poised to enter its first large-scale clinical trial in humans this year, and vaccines against nicotine, heroin and methamphetamine are also in development.
Nabi Biopharmaceuticals, a small biotech company in Maryland, has engineered a nicotine vaccine that is in late-stage clinical trials. Earlier studies showed that it was twice as effective as a placebo in helping people quit smoking. The cocaine vaccine, developed by Thomas Kosten of Baylor College of Medicine, could be on the market as early as 2010. It would have to be given three or four times a year, but presumably not for life, says Kosten. While the vaccine is being studied in people who are already addicted to cocaine, it could eventually be used on others. "You could vaccinate high-risk teens until they matured to an age of better decision-making," Kosten says. He acknowledges the obvious civil-liberties issues this raises. "Lawyers certainly want to argue with us on the ethics of it," he says, "but parent groups and pediatricians have been receptive to the idea."
The revolution these new drugs promise will have a huge impact on the addiction-treatment industry (or, as it prefers to think of itself, the "recovery movement"), which runs the gamut from locked psychiatric wards in big-city hospitals to spalike mansions in the Malibu Hills of California. And the reaction there is guarded; the people who run them have seen panaceas come and go over the years, and the same addicts return with the same problems. They also, of course, have a large investment in their own programs, which typically rely on intensive therapy and counseling based on the 12-Step Model. "We need four or five more years to see how [Vivitrol] does," says staff psychiatrist Garrett O'Conner at the Betty Ford Center, in Rancho Mirage, Calif., about the medication that prevents patients from drinking alcohol by obliterating its ability to intoxicate. "And we need to be very cautious, because a failed treatment will set a person back." The Ford Center and the Hazelden Foundation, in Minnesota, use drugs sparingly, and mostly just in the first days or weeks of recovery, the "detox" phase. "Hazelden will never turn its back on pharmaceutical solutions, but a pill all by itself is not the cure," says William Moyers, Hazelden's vice president of external affairs. "We're afraid that people are seeking a medical route that says treatment is the end, not the beginning."
Also in the cover package, Mitchell S. Rosenthal, M.D., the founder of Phoenix House and the executive director of the Rosenthal Center for Clinical and Policy Studies at Phoenix House, writes that although the vaccines sound great and the new medications will have their place as treatment protocols evolve, "In our passion for the prescription quick fix and pharmacological solution, however, we should recognize that drugs alone are not the answer to addiction. The law of unintended consequences warns us that there's a downside to just about every advance. So discovering that addiction involves profound changes in the brain has led to a widespread assumption that addicts are powerless over their condition-that drugs have hijacked their brains. This, in essence, rules out free will and the possibility that some addictive behavior may be voluntary. It is a seductive proposition, for it suggests that the addict is incapable of self-control, and hence cannot be responsible for his or her behavior."
(Read cover story at http://www.Newsweek.com)
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