The Drugs Don’t Work

Over the past two days I’ve had an excellent two-part workshop in my neuroscience course on addiction, covering what we know about the causes of drug addiction at a molecular, cellular and cognitive level, reward pathways in the brain and possible treatments, vaccines and cures for drug addiction. Definitely one of the most thought provoking workshops I’ve attended, and it’s also made me appreciate the unique way we’re taught in our course.

I don’t have any lectures, not in the traditional sense. Every week, we have two three-hour long workshops that cover a specific topic; usually the teaching is a mixture of didactic and interactive, depending on the subject material and the organiser. Sometimes it’s more one than the other, but even the most didactic organisers try to get us to talk in discussion groups to figure out problems. The end result is that people feel far more comfortable about asking so-called ‘stupid’ questions and voicing their opinions than in traditional unidirectional lectures, which of course is a good thing.

After the two workshops, we split up into four groups that each reviews a paper or two, and presents the review at another three-hour session. Apart from the useful variety of viewpoints this gives you, it also helps people develop their speaking skills tremendously – I’ve seen great improvements in my and other people’s presentations over this year.

Given that the total course size is hovering around 13 or 14 these days, I’d say it’s pretty decent. Of course, it isn’t always good and we’ve had some boring workshops. Plus, no amount of good workshops could lift me out of the malaise I found myself in after being forced to study development of organisms.

Anyway, this last session was great; it helped that one of the organisers was Prof. Wolfram Schultz, the most recent recipient of the Golden Brain award.

We started off with a discussion of how you can become addicted to something psychologically.

Wolfram: The real problem is not drugs like cocaine or heroin, it’s tobacco and alcohol. Those two are the biggest health problems, and they cost the country the most. Part of the problem is the availability and the context-dependency of addiction and withdrawal – if you’re trying to abstain from drinking and there’s a wine bottle in front of you, you’re just going to start drinking again. And there’s a big problem with obesity these days as well – it’s all these supermarkets all over the place! You go into Sainsburys out of town and you just want to spend �2 but end up spending �50!

I find it great when people go off on bizarre tangents.

So, a lot of our talk today concentrated on how we’d treat drug addiction, which isn’t doing so well at the moment, what with a recent study that tracked a group of addicts over a long period of years. Most of the addicts were either dead or in prison, and the best case scenario was that they were back in rehab. Clearly not ideal from anyone’s point of view.

The problem with treating drug addiction is that the changes drugs make to your brain on a neurological level are so pervasive and long-lasting (the effects can last for years or decades) that it really is not possible to create a magic bullet that will quickly and easily ‘cure’ a full addict. Drug addiction is a mixture of a lot of different and nasty things; it seriously upsets the balance of chemicals in your brain, and it creates a literally warped form of learning that is the basis of the addiction. To cure addiction, you’d basically have to erase something that you’ve learned; a bit like erasing your liking of chocolate, but much much harder (since liking chocolate is far less intense than being addicted to cocaine).

So, appropriately, one of the best ways to overcome an addiction is simply to relearn it, over a long time, through cognitive therapy.

Current treatments for addiction address four areas:

1) Alleviate withdrawal symptoms to prevent craving and relapse. Also related to point 4.

2) Prevent drugs from reaching their targets in the brain and causing addiction. Unfortunately, this doesn’t work for addicts at all since along with preventing addiction, it also prevents the rush – so what’s the point, really? Apparently some addicts dedicated to rehab take these drug antagonists though.

3) Substitute the drug, e.g. methadone. Many people are opposed to this, seeing it as jumping out of the frying pan and into the fire, hence this exchange during the workshop:

“Over a hundred thousand people-”
“-are addicted to methadone.”
“No, I was going to say, use methadone as an alternative to heroin. Since it’s less dangerous, it’s an improvement.”

4) Alter the addiction process. Treatments such as Zyban and naltrexone help reduce addiction and craving. The only problem is, no-one knows exactly how they work, and they have some particularly nasty side-effects. Zyban, for example, gives 1% of people seizures.

A fair few people found my suggestion intriguing. If you want to both prevent addiction and help addicts, you need some kind of positive alternative – a drug that you can’t get addicted to! Or at least create a situation where people won’t want to take harmful drugs. Evidently not many people have read Brave New World.

Others suggested creating a new association for drug paraphanalia other than euphoria – pain, for example. This would mean that addicts would be too scared to relapse. It all got a bit Clockwork Orange-ish after that…

It’s important to realise how context-dependent drug addiction is. A famous study found that thousands of Vietnam veterans who were addicted to heroin had absolutely no problems back in the United States, because the environment in which they took drugs in Vietnam was so different to back home.

There’s also a fair bit of work being done on genetic susceptibility to drug addiction. As yet, there haven’t been any genes or polymorphisms identified in humans, but there have been interesting studies done in fish, of all things. They basically took some zebrafish and conducted a place preference test – in other words, they addicted zebrafish to cocaine. It turns out that some mutant zebrafish don’t get addicted. Interesting stuff.

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