It appears that we might have, as we say in the psychiatry world, a good ol’ fashioned throw down brewing. (Okay, no one actually says that, but I always wanted to write “good ol’ fashioned throw down in a post.) At the heart of this new mini-controversy is a bit of research that appears in the February issue of The American Journal of Psychiatry.
In this study, researchers used a known pharmaceutical drug addiction treatment, nalmefene, to treat pathological gambling. In essence, the theory that they tested was that one can treat most particular addictions in the same generalized way.
A more recent study reported only days ago backed up this claim. As published in the journal, Nature Medicine, a team from the University of Saskatchewan department of psychiatry “has found that a naturally occurring enzyme known as PTEN acts on the part of the brain where many drugs of abuse exert their rewarding effects – the ventral tegmental area (VTA).”
The implications are clear: find the neural pathways that control and reward addiction, find a miracle cure to addiction. But doctors, as you probably already know, are loathe to believe in miracles and even more loathe to believe in miracle cures.
In an essay in today’s New York Times, psychiatrist and author Sally Satel fires the opposing shot. Her piece begins with an anecdote about a patient who mentions the gambling research to her, having heard about it on NPR’s Research News. From there she goes on to dissect not only the research of the team working with nalmefene, but the idea of medicating addiction in general.
The brunt of her argument is as follows: “Medications are not going to displace therapists anytime soon. They simply don't work that well. Even methadone, considered effective for opiate abuse, does not always snuff the desire to get high. Up to half of the patients in some methadone clinics also use some heroin or cocaine or Valium-like tranquilizers sold on the street.” The proof, however, is in the metaphorical pudding. In examining the results of the gambling study, Satel notes that while there was a statistically significant drop in craving over the life of the study, the bulk of the drop off, for both the placebo and nalmefene occurred in the first couple of days, which indicates that participation in the study alone accounted form a large portion of the gamblers loss of compulsion. To this end, Satel also points out that two-thirds of participants dropped out before completing the study.
In the end, Satel sees the search for a drug to treat addiction to another drug as something of a pipe dream. “It may be possible to dull an intense, isolated urge that an addict experiences as alien; perhaps this is partly why we have been able to develop moderately effective medications for obsessive-compulsive disorder. But wanting a drug with your whole being involves a staggeringly complex interplay of motivation, emotions, memories and cognitions; resistance requires the user's conscious cooperation.”
When it comes down to it, is this search for a medicinal end to addiction pointless? No, of course not. Research should inevitably lead to better and more effective treatments. At the very least, it can stimulate new and groundbreaking ways of thinking about addictions and their treatments. But as Satel points out, the issues at play in any addiction are multi-faceted and more complicated than any single pill.
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