DRUGS VS DRUGS!DRUGS VS DRUGS!

Tristram Jones, Ph.D.Tristram Jones, Ph.D.PS375 Kaplan University Unit VIPS375 Kaplan University Unit VI

GLOOM & DOOMGLOOM & DOOM

Vaillant (1983) found a 95 percent Vaillant (1983) found a 95 percent relapse rate among a group of relapse rate among a group of alcoholics followed for 8 years after alcoholics followed for 8 years after treatment at a public hospital; and over treatment at a public hospital; and over a 4-year follow-up period, the Rand a 4-year follow-up period, the Rand Corporation found that only 7 percent Corporation found that only 7 percent of a treated alcoholic population of a treated alcoholic population abstained completely (Polich, Armor, & abstained completely (Polich, Armor, & Braiker, 1981). Braiker, 1981).

Some other encouraging figures:Some other encouraging figures:

Meth'sMeth's relapserelapse raterate is 92%is 92% Cocaine/crack between 92 and 99%Cocaine/crack between 92 and 99% Typical heroin recovery program has Typical heroin recovery program has

cure rates as low as five percent. 95 cure rates as low as five percent. 95 percent of heroin- addicted individuals percent of heroin- addicted individuals who have been through rehabilitation who have been through rehabilitation programs relapse.programs relapse.

Spontaneous remission=5% Spontaneous remission=5%

Consider how we measure these Consider how we measure these phenomena—it’s almost impossible! phenomena—it’s almost impossible!

Okay…that was a slip, not a relapse, and he had to have more than 8 ounces a week or it was a statistical non-event, and besides he was sober for 6 months by self report and there wasn’t visible organic damage until 2007, but that was a biologic!

But it’s pretty clear that But it’s pretty clear that something isn’t working too well!something isn’t working too well!

So what about doing something So what about doing something MEDICAL?MEDICAL? After all, it’s a After all, it’s a DISEASE!DISEASE!

FIRST CAME “ANTABUSE” (Disulfiram) FIRST CAME “ANTABUSE” (Disulfiram)

““The Cure” can kill you! The Cure” can kill you!

Actually, even before Actually, even before Antabuse…Antabuse…

In the 1950s In the 1950s and 1960s and 1960s drugs like drugs like LSD were LSD were used used experimentaexperimentally in an lly in an attempt to attempt to treat treat alcoholism alcoholism and other and other addictions. addictions.

GROOVY!

And in the late ’60s doctors were And in the late ’60s doctors were certain they had cured alcoholism!certain they had cured alcoholism!

““I quit drinking and I quit drinking and was put on Adderall was put on Adderall shortly after (not as a shortly after (not as a cure for alcoholism), cure for alcoholism), and I honestly never and I honestly never have a craving for have a craving for alcohol now. I don't alcohol now. I don't even think about even think about getting wasted getting wasted anymore, because anymore, because since my Adderall since my Adderall helps me think so helps me think so much clearer.” much clearer.”

So how about So how about NALTREXONE?NALTREXONE?

When an opiate antagonist When an opiate antagonist like naltrexone is like naltrexone is administered, drinking administered, drinking decreases the desire for decreases the desire for alcohol because of alcohol because of naltrexone's interference with naltrexone's interference with the brain's reward system.the brain's reward system.

(Theory)(Theory)Several studies, notably one at Yale one at one at Several studies, notably one at Yale one at one at

the University of Texas and one in Finland saythe University of Texas and one in Finland say it’s a flop. But DuPont loved it! it’s a flop. But DuPont loved it!

Then there’s Then there’s METHADONE!METHADONE!

Invented in Nazi Germany as a substitute Invented in Nazi Germany as a substitute for Morphine.for Morphine.

But there are a few bugs to work out!But there are a few bugs to work out!

Between 1999 and 2005, deaths that had Between 1999 and 2005, deaths that had methadone listed as a contributor methadone listed as a contributor increased nearly fivefold, to 4,462, a increased nearly fivefold, to 4,462, a number that federal statisticians say is number that federal statisticians say is understated since states do not always understated since states do not always specify the drugs in overdoses.specify the drugs in overdoses.

Withdrawal from methadone is similar to Withdrawal from methadone is similar to withdrawal from opiates or heroin, but is withdrawal from opiates or heroin, but is slower and more prolonged. slower and more prolonged.

Acamprosate StatsAcamprosate Stats

Percentage attending program

Abstinence

rates

Average number of days abstinence1

Days until first breach of

abstinence1

Acampro-sate group

66.1% 50.8% 45.07 days 26.79 days

Naltrexone group

79.7% 66.1% 49.95 days 26.7 days

Drug combination group

83.1% 67.8% 53.58 days 37.32 days

Subutex!Subutex! Suboxone is addictive as are Suboxone is addictive as are SubutexSubutex and and

methadone. Opiate replacement drugs are methadone. Opiate replacement drugs are on the market because the on the market because the relapserelapse rate is rate is so high for opiate users. Legal opiate so high for opiate users. Legal opiate replacement drugs are said to be better for replacement drugs are said to be better for the user. You CAN overdose on these the user. You CAN overdose on these drugs.drugs.

So what drugs would So what drugs would youyou consider consider legitimate in fighting drug addiction? legitimate in fighting drug addiction? Any? All? And what’s your rationale?Any? All? And what’s your rationale?