Reader Mailbag: Is Medicine Going to Cure Addiction and Alcoholism Anytime Soon?

Reader Mailbag: Is Medicine Going to Cure Addiction and Alcoholism Anytime Soon?

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Is medicine going to cure addiction anytime soon?

A common topic that comes up fairly often when discussing addiction and general trends is that of medication.

Are we on the brink of a pharmacological breakthrough when it comes to treating alcoholism or drug addiction?

Are drugs going to cure addiction any time soon? Is it even possible?

Many readers have questions like these so let’s dive in and take a look at some of the current trends.

Existing medications for addiction only provide a marginal degree of help

I think that first and foremost it is worth pointing out that we are currently at a point where addiction medications are not a cure. They can help to some marginal degree but they are not really an all out cure by any means.

And this is important for the discussion because when people talk about the idea of a new pill being able to treat alcoholism or drug addiction, what they are really talking about is the idea that this new pill will totally fix the problem. The new drug will cure addiction completely. That is what people are really thinking of when they discuss the future of medications and alcoholism. They want a full cure in the form of a pill.

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Because really, the alternative to this is already here today. We already have a small variety of medications that do less than this, that are marginally effective, that “sort of work.” We have medications that reduce cravings for alcohol (such as Campral for example) and we also have medications that target other drug addictions (such as opiate or cocaine addiction). So there are already medications on the market today that can help to treat addiction to these specific substances.

And the problem is that none of them are a slam dunk cure. None of them work the way that we would hope (or even expect) them to. At best, they are marginally helpful. At worst, it is questionable if they help at all. But we all have this idea in our minds that medical science should, at some point, come up with a magic pill that flat out cures alcoholism and drug addiction. (But wouldn’t we then just get addicted to the cure?–so goes the old joke!).

So that is the current state of medical science when it comes to addiction. There are lots of new medications on the horizon that treat addiction as well, but many of them are still in trials and studies and such. But none of them (that I have heard about) are anywhere near being a slam dunk cure. None of them are the magic pill that we are all hoping for. They are all just marginally helpful and show slightly improved results under a controlled trial.

So the question is:

Is this about to change? Are we on the brink of discovering a magic pill that cures addiction?

My guess is “no.” But I am hopeful nonetheless.

On the other hand, I don’t think that anyone should pin their hopes on medical research to provide them (or a family member) with a cure for addiction in the form of a pill.

There are several problems with this approach, the most obvious of which is that no magic cure currently exists, and may never do so.

The attitude that seeks out medication for an addiction may be the problem itself

I think in order to create a magic pill that cures addiction you would have to create a pill that can magically motivate people to want to be sober. That sounds pretty impossible.

The struggling alcoholic or drug addict is caught in a dilemma of sorts. On the one hand, they get to a point where they are pretty miserable with their life due to addiction, and they wish that things were different. On the other hand, they don’t necessarily want to give up their drug of choice and make all sorts of difficult changes in their life. It isn’t comfortable or easy to do so.

The question is never really “how do I stop doing drugs or drinking?” but rather “Do I really want to go through the difficult and uncomfortable changes to give up alcohol and rebuild my life?” I am not sure there is a pill that can provide this level of motivation (without itself being addictive…there is that old joke again!).

I worked in a detox and short term residential treatment center for a little over five years. While I was working there I had the opportunity to watch a lot of people try to get clean and sober. Many of these people were offered the option to try a certain medication to help them fight their addiction. One group of these people were alcoholics and they were offered a medication that helps reduce alcohol cravings. The other group of addicts were addicted to opiates and they were offered a replacement drug that is similar to the idea of “methadone maintenance” but in a different medication (not as powerful or addictive as methadone, but the same idea).

So I had a chance to watch this over the period of several years. And I also had the chance to see people who relapsed after leaving treatment come back later on to try to get help again. And a few people I knew “on the outside” who remained clean and sober.

And what I learned from all of these observations is this:

The alcoholic or drug addict who is very eager to try this type of medication is almost certainly doomed to relapse.

Now I realize that is a very harsh conclusion and it probably does not seem fair to people. But that is what I had to conclude after a very short time, and then for the remaining years that I worked at this rehab the results that I saw kept reinforcing this conclusion. People who were most eager to get this medication that could “help them fight addiction” were almost certainly doomed to relapse. They never made it. In fact, I cannot think of a single example of someone who was eager to try such medication and they ended up staying clean and sober for the long run.

This was shocking to me. The doctor who was in charge of all had told us (the rehab employees) about a study that was done in Europe. The study was double blind and placebo controlled so he placed a great deal of faith in the results. The study was based on opiate addicts who were trying to overcome an addiction to opiates and they were all given counseling and treatment. But one group was given the medication while the other group was given a placebo. And both groups got the counseling and therapy.

Well, the results of this clinical trial were a slam dunk. Of the people who got the placebo medication, all of them relapsed except for one person. Of the other group that got the medication, I believe approximately 60 percent remained clean and sober for the duration of the trial. My numbers may be a bit off but that was the basic idea behind the results. It was quite convincing in favor of this medication.

So I went into this thinking that the medication was very effective and that I would see some impressive results. But the reality was that I never saw the medication turn out well for anyone. Not once. Of course this is a very limited observation, I was just one person working in one detox center that wasn’t even very big (9 beds in detox, about 33 beds in residential). But I worked there for 5 years and during that time I never got the impression that these medications helped anyone. At all. Ever.

And so I started to believe that maybe it is about the attitude of the individual.

You see, when they conduct these double-blind placebo controlled studies, they are not necessarily asking a room full of struggling addicts “who wants a new pill that will help them with their cravings?” If you do that (as was the case at my treatment center), the hands that go up are the people who are looking for the easy way out.

Addiction treatment is a funnel. A whole bunch of struggling people go into rehab, and only a few manage to achieve long term sobriety. The people who jump at the chance for an easy fix (a medication that reduces cravings) are not the people who are destined to achieve long term sobriety.

I know that sounds horrible. Because it really isn’t that logical. For example, if it were my son or daughter who was going to rehab to try to overcome an addiction, I would want them to use every resource available to them in order to get the help that they need. If there is a medication that is proven to improve success rates by even 20 percent, then I would hope that they would make use of that resource. Why not?

But the reality is that my observations have created doubts along this line of thinking. I almost believe that it is better to shun the idea of medication so that you are fully prepared to do the work necessary to stay sober. Because ultimately what we are finding is that no pill for addiction can negate the fact that recovery is a whole lot of work. And it seems like it is easy to deceive ourselves about this.

Another example that comes to mind is with my own cigarette addiction. Years ago I was addicted to cigarettes. This continued for a few years after I got sober. And I struggled for many months to try to quit the nicotine. I used medications to help with this, including both pills and a nicotine replacement patch. Nothing worked for me. I continued to struggle. It got to the point where my friends and family were sick of hearing about how I was trying to quit smoking!

Then one day I got desperate, and I got really determined. And I thought to myself: “I need to cast aside all of these quit smoking aids and just do it.”

So I did. I stayed up really late one night and then I slept through most of the next day. I timed it so that I slept through the worst of my withdrawals. And when I finally got up from this little hibernation session I knew that I had it beat. It felt like I had finally drained all of the nicotine from my system. I was finally free. And I ultimately did it “cold turkey.”

That has never been my style. I am not known for strong will power. This only happened after months and months of struggling with various quit smoking aids. I finally surrendered to the fact that it was just going to be really tough to get through. And so I faced the challenge head on, without resorting to tricks or gimmicks, and I was finally successful.

And I think this is the right attitude for recovery. At some point you have to face the idea of sobriety head on, and deal with the truth. Of course every drinker tries to solve their alcoholism on their own first. They try to switch from liquor to beer, or only drinking on the weekends, and so on. They make up rules, they play games. But at some point they realize that they are just going to have to bear down and get serious and overcome their addiction.

And I think this attitude is part of what the mystery is when it comes to these addiction medications. I realize that the medications are at least marginally effective based on the clinical trials. But I think the psychology of the individual is important, and the way the medications are presented makes a real difference.

I wonder if they have done any double blind studies where the people who were being treated did not even know what the medication was for in the first place. This would be an amazing demonstration of efficiency if it could be shown that a medication helped people to recover who did not even know what the purpose of the pill was. But I seriously doubt that has ever been attempted and I also doubt that we will ever get medications that are that effective. In other words, my belief is that even the marginally effective addiction medications are mostly placebo anyway!

The size of the market dictates the dollars spent on research and drug development

I think another important point has to do with the size of the market and the research dollars that are being spent.

Pharmaceuticals are a huge industry, obviously. But there are only so many research dollars chasing a fixed amount of diseases and conditions.

And so these giant drug companies have to make decisions as to how they can create new medications and still turn a profit.

So there are so many millions of people who struggle with drug addiction and alcoholism.

And a certain percentage of these people are willing to seek help for their problem.

And a certain percentage of those who seek help will be interested in medications to assist them in overcoming addiction.

So when you look at how much money is being poured into a pharmaceutical cure for addiction, you have to look at how big that potential population is. The number of addicts and alcoholics, then the percentage of that who is seeking help, then the percentage of that who is interested in medication.

Now if you look at these same sort of numbers for things like diabetes, high cholesterol, high blood pressure, and obesity–you can quickly see that the amount of dollars being poured into addiction research is never going to be huge. Sure, there is some progress being made, and drug companies ARE doing some research and developing new medicines, but it is not anywhere near the level of research being done in other areas.

So I think we need to be realistic when we are pinning our hopes on medical science to cure addiction in the future. One, the research is expensive. Two, the potential audience is not very big compared to other diseases and conditions. And three, the efficiency of the medications is questionable and lacking (they can’t seem to make a slam dunk “cure” at this point).

Don’t cross your fingers

My advice is not to cross your fingers when it comes to the idea of a pill curing your addiction.

It is true that these medications that currently exist may help some people. And I would not discourage you from exploring those options as part of your recovery. But I would caution you to keep a healthy attitude in terms of your overall recovery.

In other words, don’t expect for the pill to make it that much easier for you. Don’t expect for a pill to make your recovery effort substantially easier. This is the trap that I think many people are falling into. They believe that they can make a modest recovery effort, take this medication that is supposed to help, and they will magically overcome their addiction.

No such pill exists, and it is unlikely to exist in the future. The reality is that overcoming an addiction is going to take a huge amount of effort and commitment. You cannot outsource this commitment to a pill or a medication. You cannot buy willpower in the form of a daily pill. This is not a realistic approach to recovery and I think you would be doing yourself a disservice to try to use this approach.

If an addiction professional suggests that you supplement your recovery with a medication then this may be helpful. But only if you have the correct attitude. And that attitude is one where you realize just how much hard work and commitment will have to accompany this medication in order to fight your addiction. The pill is not magic. The only way to a successful recovery is through hard work and dedicated action.

You must commit to sobriety. You must commit to building a new life through positive action. You must trade in your old habits for new ones. You must take positive action every day and start accumulating small “wins” in your recovery. And you have to have faith that things will get better. Because in early recovery you will probably go through some ups and downs. There may be some rough patches. I would be surprised if there are not any rough times for someone in their first few years of recovery!

So you must commit to this journey. And I do not believe they will ever have a pill that can strengthen that commitment in any way. You must dedicate your life to recovery and to personal growth. Now if you can do this and then also take a medication to help with cravings, all the better. But the pill is secondary to the commitment and the dedication to personal growth. And anyone who believes that the pill is part of their primary strategy is, in my opinion, setting themselves up for failure.

Just my 2 cents and I hope that I am wrong. I really do. Because it would be so nice for a magic pill to come along that completely cures addiction. I just don’t believe that this is a realistic thing to hope for, and I think that hoping for such a cure distracts us from the real journey that is in front of us, right now, today. And that journey is one of personal growth in order to overcome an addiction.

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