Fighting Fire With Fire

Mood: fried

EXCITING NEW DISCOVERIES in drug addiction research suggest the possibility of erasing drug-associated memories. For recovering addicts and alcoholics, contextual and environmental reminders of substance abuse (e.g. being in a bar, passing by a former drug house, seeing an old drinking buddy) can trigger intense cravings. The likelihood of a relapse increases with these cravings. For most addicts/alcoholics, substance abuse permeates every aspect of their lives, so there isn’t much that doesn’t trigger a reminder of substance abuse.  Every time you eat.  Every time you vacuum.  Every time you see your friends.  Every time you wake up in the morning.  You think I used to do this drunk. This just isn’t the same sober. The impulse to return to what you know—what’s familiar—just compounds any physical cravings and remains long after the chemical dependency has subsided.

A compound has been tested in rats that eliminates their preference to explore an environment where they once received drugs. Could a drug that essentially causes you to not associate being drunk or high with a place or activity be the answer to the high relapse rates in addiction treatment, if such a thing is even possible?

It could certainly help with some aspects of recovery, but as with treating other conditions, drugs are not a singular answer. The undeniable hitch with this type of treatment is that the addict must take the drug in order to deter relapse. As with Antabuse, which induces vomiting when any alcohol is consumed, the recovering alcoholic just has to stop taking the drug once they get sick of vomiting and want to have a drink. With methadone, which essentially controls opiate addiction by replacing heroin with a regulated opiate, the addict will often return to street heroin when the methadone isn’t enough or the clinic is closed. A drug that reduces triggered-cravings, like the one described in this new study, will not help with what might be the single most difficult aspect of recovery—coping with new stress, excitement, lifestyle changes, sadness, anger, etc. All those emotions were once controlled or ignored with drugs and alcohol, and all I can say is damn, when you stub your toe sober it hurts so much.

Much like the context-triggered cravings experienced by recovering addicts, scientists are looking for ways to eliminate the triggered fear responses in individuals with PTSD. Traumatic memories can get stored improperly in the brain in a way that they lack narrative context, so when reminded of those memories, a person may just feel them as a flood of emotions or flashes of visualizations that are completely overwhelming as if the trauma was happening all over again.  But even if we could find a drug to disconnect fear responses from traumatic memories, it would not be enough.  The memory of the trauma would still be there, and while it may no longer trigger fear or flashbacks, the feelings of guilt and shame and confusion would remain. The goal in recovery from PTSD is not to forget the trauma, but to be able to remember it without being flooded with fear, guilt, pain, horror, and helplessness.  Even if there was some way to completely erase traumatic memories, I don’t know if that would be beneficial.  As long as the memories aren’t causing debilitating fear like they do with PTSD, we can learn a lot from our past experiences, especially traumatic ones.  We learn how to protect ourselves and become aware of our own strengths and weaknesses. What we need to do with traumatic memories is to consciously give narrative context to what happened by writing or talking about it in detail. Then, those memories will eventually be associated and stored with that narrative context, and when you get reminded of a traumatic event, you remember it as you do most other memories, as a chronicle of what happened without the overwhelming emotions and fear.

So this is where non-pharmaceutical treatments come in—counseling, psychotherapy, AA, meditation, yoga—that many scientists regard as pseudoscience. Most medical research focuses on novel drug targets, and I get it, that’s where the money is.  People want to hold a bottle in their hand that says Take this. Be cured.  But the maladaptive coping mechanisms, negative beliefs about oneself, guilt, shame, insecurity, and fear that come with substance abuse and mental illness develop over long periods of behavioral learning and cognitive information processing, and in turn, must be “un-learned” in the same way. In order to live a sober life, recovering addicts must be aware of what causes them to abuse—their triggers—and learn new ways of coping.  I just don’t think that can be done with medication. The awareness of one’s triggers can come through counseling and support groups, learning new ways of coping can come from psychotherapy, and some of the best coping mechanisms include exercise, meditation, yoga, etc.

Scientists keep emphasizing that there is no cure for addiction, depression, PTSD, etc., but what they mean is that there is no pharmaceutical cure. I’m not against medications by any means—I take medication for anxiety—but I do think there is great value in researching non-pharmaceutical treatments for the “cures” we want. There is compelling evidence that psychological interventions modify brain function, including the possibility that psychotherapy can reverse the structural and functional brain abnormalities associated with disorders such as OCD, panic disorder, depression, PTSD, and schizophrenia.  I’m sure we would find the same evidence if we systematically looked at the effects of yoga on the brain. So, in addition to searching for pharmaceutical treatments, we should also consider our body’s tremendous capacity to heal itself. Psychotherapeutic processes may be tedious and slow, but that’s because it takes time for the brain to form the strong, reinforced connections that can be made in recovery from addiction or trauma when cognitive and behavioral therapies are practiced.  These organic changes in the brain are more effective and longer-lasting than any current drug treatments, which generally just alleviate symptoms rather than repairing any damage.  And let’s be honest here, we really don’t know how most psychotropic drugs work any more than we know how yoga works.

So I guess the point of all this is to emphasize that non-pharmaceutical treatments do have scientific merit, and that we should be looking for a more holistic approach to treating complex problems like addiction and mental illness, which is not limited to pharmaceutical approaches.

Scientific American report on referenced drug-memory study:

Review on the effects of psychotherapy on brain function: