July 2, 2015 • 29 mins
Highly addictive substances like meth and heroin are formidable enemies for the recovering addict, but what does the future hold for their treatment? In this episode of Stuff to Blow Your Mind, Robert and Julie explore the use of electromagnetic stimulation, vaccines and other treatments to help win the battle.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to Stuff to Flow Your Mind from how Stuff
Works dot com. Hey, welcome to Stuff to Blow your Mind.
My name is Robert Lamb and it's summer vacation people
who are on break. We thought it's a great opportunity
to replay a couple of our favorite episodes on the
very serious topic of addiction. Um. The last episode was
(00:25):
a repeat of the Science of Addiction, and today we're
going to repeat the Future of Addiction, where we look
to the future to see in different ways to to
deal with this crushing problem. Uh So, without further ado,
let's dive into the top. This episode is, uh, I'm
(00:46):
gonna look at the future of addiction. Uh. And we're
not talking about just what kind of crazy drugs would
have in the future. Now, we're talking about how can
we treat addiction in the future. What are some of
the cutting edge and emerging techniques and technolog only do
is that will be at our disposal to deal with
the disease of addiction. Yeah, and before we look at
the future stuff, let's just kind of look at what's
(01:07):
going on in the present. The number one driver of
aids in the world is used heroin needles, particularly in
countries where there's no needle exchange programs. So what if
you could get rid of the root problem, you could
eradicate heroin addiction, or for that matter, really any addiction. Yeah,
(01:28):
and we're not just talking instantly. Minds tend to turn
to Africa, and certainly that's one of the areas concerned here,
but other you know, countries that don't have needle exchange
programs include such large, uh populous nations as China and Russia. Yeah,
I think that people don't, you know, at least people
outside of the United States don't realize what in the
city is problem. This is half a trillion dollars or
(01:50):
spent worldwide to treat addiction. So here's just one little
prism of the addiction problem in the US. And estimated
one point four million Americans are addicted to pain, which
was the reason for more than four hundred and eighty
two thousand emergency department visits in two thousand and eight
and is a leading cause of heart attack and stroke
(02:10):
among people younger than age thirty five. So the problem here,
of course is that we have access and if you
look at you know, sort of where drugs are in
the time continuum of history here, Um, we have more
access to drugs than ever before, and more types of drugs,
(02:32):
and what emerges here are some highly, highly addictive substances.
I'm talking about meth, which creates one of the biggest
boosts of dopamine in the brain, and prolonged use of
this can lead to psychotic like symptoms, talking about strong hallucinations,
really violent behavior, and studies of the brain patterns of
(02:52):
some long term matthews have shown that up to fift
of their dopamine producing cells have been damaged. So if
you listened um to the other episode on this, then
you kind of know already that, Um, this is a
situation where the person is just getting deeper and deeper
into the hull because it's not about free will anymore,
(03:15):
because the parts of your brand, the executive function, have
been so eroded by drugs that even if you wanted
to stop, you might not be able to. Yeah, and
and and that's certainly the the anti drug messaging that
I think needs to be focused on more often with
meth amphetamy. Because I was reading and according to neuro
psychopharmacologist Carl Hart, there's actually no empirical evidence to support
(03:37):
the claim that meth amphetamy causes one to become physically unattractive,
which hopefully they've they're calming down on that, but for
the longest, like like meth mouth, you know, and the
transformation of the meth addict into some sort of subhuman
hyena person has been kind of the focus. When certainly
that's flashy that works on a billboard a little easier,
(03:58):
but the reality of what's actually changing with the brain
that is far scarier than some sort of decal on
hide ship. I agree. I have seen the ads before
where there's like this beautiful woman and then she takes
out her false teeth and she takes off her makeup,
and all of a sudden you see her meth attic
riddled face, and they are appealing to vanity. But vanity
doesn't matter. When addiction is highly routinized in your brain, um,
(04:22):
nobody cares anymore what they look like. So if you
were to instead crack open the brain and show people
this is how your brain is actually like completely mutating here,
that might be a far more compelling story to people.
The next one is another biggie, and that is of
course heroin derived from opium, and of course this one
has been wreaking havoc for for years and years. Yeah,
(04:44):
thirty of first time users will become addicted. In two
thousand and five, two point four percent of the American
population said they had tried heroin at least once. The
source of that is Department of Health. And withdrawal symptoms
are really acute. They arrive just a few hours after
a dose swears off, and because of this, users have
a really high chance for relapse. Because we talked about
(05:06):
this in the last episode. UM, at some point the
addiction becomes less about chasing the high and more about
chasing some sort of equilibrium and feeling normal again, which
can only happen if you get more of the substance
in your body. All right, And the next big one
to hit might come as surprise because it's not crack cocaine.
It is nicotine. Nicotine is a very addictive substance. But
(05:29):
we often overlook this why. Um, I think it's because
it's legalized, right something like of people who ever try
cigarettes will become nicotine addicts. At some point, you can
buy it legally at the store, at the gas station
used to. You can get out of a machine. Um,
someone's liable too, and it's given its legality and an
(05:50):
overall still social acceptance, um, people are liable to give
it to you without it being that big of a
deal as well. So and it still looks cool on TV, right, Yeah,
and it's not as big of a risk. And this
is something that David Lyndon, professor of neuroscience at Johns
Hopkins University, pointed out. He said, you know, hey, if
you have a bag of heroin, you're not going to
(06:12):
do a whole bag of heroin. You know you're gonna overdose.
But if you have a pack of cigarettes and you
have ten or twenty of those cigarettes throughout the day,
you get that little ding of dopamine each time. And
he kind of yeah, he kind of like likened it
to pav Offs dog, right, so he said that we're
really good at training or inner dog and sort of
being like, oh, I need a little pick up right now,
(06:32):
and you get that little dopamine um pleasure feeling from it.
But you're not going to necessarily, um render yourself unconscious
or unable to work or any of those things. But
still it is an addiction, and it is an addictive behavior. Yeah,
you hear about people being one or two back a
day smoker, whereas in the panel they pointed out that
(06:55):
that even a heavy heroine user is probably not going
to use more than through times a day. And so
to go back to what one of the topics were
discussed in the previous episode, chunking that idea that the
brain is forming habits give X, then Y and Z
and uh and then per forming a shortcut kind of
a hot key for the brain for behavior encoding the
memory of usage. Uh, you're going to have, what you know,
(07:17):
twenty times uh or more per day that you're enforcing
that shortcut as opposed to a maximum three times per
day with the hairin user. Yeah. And Charles do Hick,
the author of UM, the Habit Loop, I think I
totally slaughtered that. But um, he's talked about this and
written about this at length, and he says his claim
(07:38):
is that percent of our decisions every day that's just habit.
We think we're making these decisions, but really we're just
responding to environmental cues in these well worn neural pathways
in our brains. Yeah, because, if we've discussed before, habits
take up energy, if they take a cognitive power, and
we don't have a limitless amount of that. So we
handed over to to routine, we end it over to
(08:00):
habit so that we'll have some juice to handle the
actual decisions that are coming at and of course that
the problem with this is that again, your brain, your
brain secretary, isn't making any sort of like, hey, this
could be a terrible thing. Don't do this. Um and
your prefrontal cortex, your executive functions in your brain are
already sort of um lessened by the addictive behavior. All right,
(08:23):
The next thing we have here is prescription medication, one
of the rapidly growing substances of abuse in the US.
Between nineteen eighty and abuse of prescription drugs increased four
and it has about the same amount of usage in
America as cocaine. According to the National Institute on Drug Abuse,
(08:45):
drug overdose was the leading cause of injury death in
two thousand and ten, and among people twenty five to
sixty four years old, drug overdose caused more death than
motor vehicle traffic crashes. So the National Institute on Drug
Abuse goes on to say, by the way, and two
doesn't intend seventy eight percent of the drug overdose depths
(09:09):
in the US were unintentional seventy eight percent. And I
think that this is painting a story here about how
prescription drugs, uh have become so accessible in people are
mixing them with other drugs or mixing them with alcohol
to their detriment. Yeah, I mean, it's it's important to
to to to to to point out, yeah, that prescription
(09:31):
drugs just because it's prescribed, does not mean it is
necessarily a safe substance of Any of these are very
dangerous socis. I mean, any of these are amphetamines. Uh,
and they're not that different from the illegal variant. And
certainly methamphetamine itself is memory serves as scheduled to narcotic anyway,
which means that it consuvably has a medical purpose. Uh.
(09:52):
And it makes sense to like, which which car is
going to be faster, the one made in a garage
or the one made at at a at a factory. Right,
And what do we have with with drugs? Your street
drug is often made in a garage, whereas your your
pharmaceutical product, he's made by a billion upon billion dollar industry.
So it's it's kind of like a supercharged vehicle. Yeah.
(10:16):
And um, I'm sure that people are aware that there
are ways that people get their hands on drugs that
they shouldn't have. They were legal drugs prescribed and I
won't go into that. I will say that if you
are interested in learning more abound fist prescription drugs, check
out the documentary American Addict that goes into detail. It's
pretty depressing, um, but it's also very eye opening about
(10:37):
this topic. All Right, we're gonna take a quick break
and we get back. We're going to talk about the
treatments of addiction. Alright, we're back, So we've we've we
discussed addiction here. Let's talk about the ways that we
treat addiction. We have several different approaches that are currently
(11:01):
in play, and we're looking at some some new methods
of tackling in the future. Yeah, and before we go
into that, we should say, hey, by the way, rate
of relapse is really high for addicts. I think this
is something most people know. According to the National Institute
on Drug Abuse, relapse rates for drug addicted patients about
forty It's similar to relapse and those suffering from diabetes, hypertension,
(11:25):
and asthma, and drug addictions should be treated like any
other chronic illness with relapse serving as a trigger for
renewed intervention. So keep this in mind. Um, and we
talked about this, this idea of memory encoding behavior and
there are being triggers for that. So imagine that you
have just completed a program, say from heroin abuse, and
(11:48):
you get out and UM, I think I called them before,
these neural ghosts, these neural pathways in your brain, the
sort of cellular scarring that's still there. It's very easy
to tap into that and have that behavior express itself again.
A great example of this is Philip Seymour Hoffman, which
is brought up at the World Science Festival for the
(12:10):
panel of the Craving Brain. They said, look at this guy.
He was something like ten years sober from heroin addiction,
went to a rap party one night, had a beer,
and then something like I don't know, was it weeks
or months later, had died from heroin overdose. Yeah, I
just started him down the path, opened up those pathways
again in the brain, those those pathways of habit and
(12:31):
behavior in addiction, and uh, and then then that's where
he ended up. Yeah, So you know, you're not treating
something that's easily dealt with. Here, right, Just I keep
coming back to the idea of a cat's cradle, right,
you know where you take the shoe lace tied together
and you you string it between your fingers, and it's
all the different fingers holding the string out to form
this pattern. And you can't you know, put a point
(12:53):
at one particular finger and say that is the cause
of the pattern, that is the cause of the the
overall design here. And just as there's no over that
one finger you can pin the whole design on, there's
no one finger you can remove. There's no one treatment
plan that's going to to be a magic bullet against
the problem of addiction. Yeah, because in one sense, um,
(13:14):
it doesn't really matter anymore if you have genetic dispositions
to addiction, if you're in the middle of an addiction,
because at that point you've got habit taken over, you've
got the transfer station, there are significant changes to your brain,
and now you've got you know, memory all wrapped up
in it. So um. So, yeah, it is a bit
of a cat's cradle. But the treatments can't really treat
(13:38):
a cat's cradle. You can pretty much go after individual fingers. Yeah, Yeah,
there's no unified treatments. So the most widespread medication right
now is in a antidepressants, because this would address the
feelings of despair or you know, any sort of pre
existing condition like depression that may have led to the
addiction in the first place. So the album with that though,
(14:00):
is that you would have to really pair that with
behavioral therapy because it's not just enough to say, here's
a depressant and we have another a number of other
medications that sort of target individual parts of the chemical
cocktail involved in addiction. UM. We have, for instance, one
of the most famous being a methodone which suppresses withdrawal
symptoms and relieves craving. With the people are recovering from
(14:24):
from heroin, uh, you know, morphine addiction. UM. You have
other substance such as now trek zone, which works by
blocking the effects of heroin and other opiates at the
receptor sites. UM. You have of course, so when you're
dealing with nicotine nicotine, you have nicotine replacement therapy where
essentially you're still getting the nicotine, just not through the cigarette,
and that's used to help with the with the with
(14:47):
with the with cravings and whatnot. With alcohol, you have
now trek zone, which blocks opiate receptors that are involved
in the reroarting effects of drinking and in the craving
of alcohol. UM. So you see all these types of
medication there Again, they're going after sort of a particular
point in the chain and chain of effect and uh
(15:07):
and that. But they can't they can't deal with environment.
They can only deal with with one point in in
the the chemical reaction, be it in how the brain
is receiving or how the brain is dealing with withdrawal
from the substance. And of course that has to have
to have a behavioral counterpoint counterpoint part in order to succeed. Yeah,
and in the case of methodone, that itself is highly addictive,
(15:30):
and it's going to argue that you're just delaying the
process of rehabilitation. Really, you're just moving the goalpost out.
So what do we have on the horizon in the future,
And you've got some really interesting things going on. UM
one is called optogenetics, and are excuse me optogenics And
this is basically kind of like UM a light sensitive
(15:54):
molecule that's beamed into the brain so far of rats,
So rats that are learning certain habits, the researchers can
use this optogenetics treatment to basically turn on or off
neurons in the rats brains and block the behavior and
block the the ability of that rat to sort of
(16:16):
remember like, hey, I want to go and do this. Um.
And what's interesting about this is that the rats change
their behavior in response to different rewards even when the
light wasn't present. So after they got the initial zap
with the light, they still didn't return to the bad
behavior even when a significant amount of time had passed.
(16:37):
So obviously this is happening in rats right now, not
in humans. Um. But it plays into this other idea,
which is electromagnetic magnetic stimulation. Yeah, this is the form
that this would likely take in the treatment of of
of human addicts, and certainly this is where the research
is headed. Um And and in this we would use
electromagnetic stimulation outside of the scalp I hope no surgery required, uh,
(17:01):
using transcranial magnetic stimulation on these particular parts of the brain.
Again to almost not to simplify it and say, it's
just like turning the switch on and off in terms
of addiction, but but but turning off that that that
that craving, right, Yeah, and increasing the neural activity in
the parts of the brain that deal with executive functions
(17:23):
like willpower. Right, So that's what we've talked about that
that's such a big part of this. So then you
have you know, willpower being ramped up and you have
the addiction behavior being ramped down. What you still have
to deal with is memory in those triggers. And David Lyndon,
the neuroscientists and author of the Compass of Pleasure, says
(17:44):
addiction is a form of learning. When we, for example,
puff on a cigarette or inject heroin in our arm,
we are developing associations between the act of puffing or
the act of injecting all the other sensory information that's
around the sites and the smells, the people were with,
the music, we're hearing, the room. We're in a situation
that surrounds us and the pleasure that is produced as
the result of puffing on that cigarette or injecting that heroin. Well,
(18:07):
I hate to invoke the title of the movie anymore
since it's invoked again in every every news article on
science that deals with erasing the memory. But you kind
of have to go eternal sunshine of the follower's mind
on that particular drug memory, because, as we discussed in
previous episode, the drug memory is has has is really
firmly encoded. It's not just the memory of taking the drug.
(18:29):
Is the memory of the environment, the situation of the drug,
All these things tied up into it. So, yeah, what
if you could go after that memory, if you could
blast that memory sort of photon torpedo it, then you
could conceivably have a leg up on beating the addiction,
or you could you could just like hose it down
with a chemical, which is essentially what researchers at the
(18:51):
Script's Research Institute have done. This is from a Fall
two thousand and thirteen study published online in Biological Yeah Tree.
For six days, they had rats alternate between one of
two rooms, and on the odd days they were put
in a chamber let's call it Chamber A and given meth.
On even days they were put in Chamber B and
(19:14):
given a sailine place debo. So a couple of days later,
half of these rodents were given a choice between those
two rooms, and the room associated with that meth, of course,
was preferred by those rats who were injected with meth.
But the other half of the rodents were then injected
with something called La trunculin a or lat A, and
(19:34):
this is a chemical that interferes with actin and that's
a protein known to be involved in memory formation. So
when they were injected with lack day excuse me, latte,
the animals showed no preference between rooms even up to
a day later. Again, this is all highly experimental, but
it's it's giving us an idea that there are certain
(19:55):
interventions that can happen to address all the different facets
of addiction. And the researchers do point out that you
don't have to worry about about this particular method being
used to just erase memories willy nilly. They say that
you actually couldn't take their discovery and erase your run
of the mill memory inside of the brain. Uh. They said,
(20:16):
you can only use this to get rid of these
strong drug associated memories. And of course there's gonna be
many more studies and they will have to be human
trials in order for this too for the FDA to
approve of it um. But that gets us into this
other territory in which the f d A has approved
one type of vaccine but not another. And when I'm
(20:37):
talking about our vaccines developed by Kim d Janda, he
was on that World Science Festival panel of the Craving
Brain to block the effects of heroin and users, but
also block the effects of nicotine and users. So guess
which one is being funded? Oh well, obviously they're going
to fund the nicotine one because that's your that's your
(20:58):
kind of your your white collar drug. Everyone is dealing
with nicotine. But heroin, Oh, that's that's a dirty that's
a dirty drug. That's that that's the at the bottom
of the circus tent, right, that's the that's down there
with the safety name. Yeah, even though an estimated twelve
million to fourteen million people used heroin as of two
thousand and nine, accorded to according to the United Nations
(21:19):
Office on Drugs and Crime, and Americans uh something like
two in two thousand and eleven. So obviously it's a
pervasive problem when we spend a lot of money on
that um. But the vaccine itself stimulates the immune system
to recognize the substance and has to be given over
a period of weeks, which eventually renders the person immune
to the drug. Because how do our immune systems try work. Right,
(21:41):
Our immune systems evolved to deal with foreign outside invaders,
so our immune system doesn't doesn't look at incoming cocaine
or heroin or nicotine or alcohol and say say, oh,
that's bad, let's go after that. They say, sorry, that's
not on our list of of suspects. We're not gonna go.
We're not gonna go to right, you know. So the
(22:01):
idea who are this vaccine is? It is it puts
those offenders on the on the suspect list for our
immune system and keeps them from crossing a very important border,
at least in the case of the heroine. Yeah, the
blood brain barrier, because that's key here. That will actually
block any psychoactive effects. So in other words, you're not
going to get high. Yeah. And what they found in
(22:23):
the rats, or what Genda said he found is that
they would give the rats like uh doses overdose quantity, right, Yeah,
and the rats would survive when they were vaccinated. So
of course it's not something you would want to try
and human trials, but um, but it does lead us
to this idea that once you take the psychoactive part out,
(22:46):
the actual um blood brain barrier part, where it doesn't
get into your brain and then affect the rest of
the system. Is that you could render this this drug toothless. Yeah,
and it's it's important to know that this is not
like like a lot of other vaccines. It's not a
situation where you'd say, all right, give everybody in the
population the heroin vaccine and then heroin doesn't work on
any body. This would be more of a tool to
(23:08):
prevent a relapse. Really. Yeah, But again, the problem here
is the stigma, because of course the nicotine one has
human trials. It's brought to market. Just look at those
polite people and the TV commercials dealing with their nicotine problems, right,
and certainly many of our listeners are dealing with the
nicotin problems. I don't want to cheapen it or anything,
but it's it's far more socially acceptable. I think of
(23:29):
your TV version of the guy who's smoking too much,
and it's just a random guy. It might even be
Goofy from the Disney cartoons. I finally remember him trying
to quit smoking on the cartoon. I never saw a
Disney cartoon in which Goofy had to deal with a
heroin problem, even though that fits the time period right
the forties, you know perfect. I mean you could see
Mickey tying his arm off. I mean, we're making light
(23:50):
of this, but really, I mean this is this is
something that I think is very disheartening, especially for chimd Janda,
who came up with a vaccine in the first place,
for heroin to stop this spread of AIDS, because of
course the vector here as uh use needles. So I
think it's got to be uh, really just disheartening for
(24:13):
him to hear from um big pharma there's no market
for this. There's no market for a heroin vaccine, are
you kidding? Yeah, it's because again, when you look at
the huge public health benefit to something like this, it's
just it's an insane Yeah. And another thing that they
said on the panel is that this just has to
become more of the national discussion, and that, uh that
(24:37):
doctors need to have medical training on how to talk
to their patients about addiction, because they say right now
that they're not trained in that, and that the big
joke among doctors is that if a patient comes to
you and says, I drink four drinks a night, you
should probably double whatever it is that they say um
and you and not even really address the problem or
(24:59):
the situation a digny deeper. Yeah, it doesn't seem like
any time you're you're you're dealing with the doctor. It's
like it's not maybe it's not firmly established in the
public mindset that this is a safe tone and that
you can actually talk about what you're putting into your
body legally or illegally because it is bottom line essential
to your health. But you know, I think that if
(25:20):
the I think that if the medical field approached it
in a different way, and like, for instance, I went
to um my doctor and she said, hey, Julia, friend,
these tests on you. It looks like you've got some
genetic predispositions for addiction. I wanted to, you know, just
give you a heads up or are you in any
sort of stress loops in your life that you need
(25:42):
help with or that you're aware of. Then it I know,
it takes up more time with your doctor, but again,
it's opening up the line of communication and it's taking
out the stigma because you're talking about it. And if
this is something that is so pervasive in society. By
the way, something like eight percent of all pharmacutical suiticals
(26:02):
are consumed by the US by people in the United States.
Those are a lot of drugs, legal drugs, but still
drugs that are being distributed and um and consumed by people.
So this obviously is is not just a kind of
aside problem that some people have. You know, I want
(26:23):
to point out another possible application for the vaccine that
was brought up the heroin vaccine, is that, you know,
we were talking about rodents that were given this vaccine,
how they could take essentially almost like a lethal overdose
amount of the drug and and still be fine. Uh,
there's a possibility that the vaccine could be used to
treat people who are who have overdose symptoms. So healthcare
(26:44):
professionals pick someone up or arrive at a scene someone's
clearly overdosing on on heroin, they can apply the vaccine
as a curative measure. Yeah, so emergency medicine could really
benefit from this. But again, I just keep pointing to
this idea that if you start to talk about it,
if you start to remove the stigma, then you can
really get to the behavior part of it, and to
(27:07):
the root causes of it, the depression, anxiety, whatever it
is that's going on in a person's life and treat
them mental health part of this equation which is so important.
And it's a shame that the whole topic becomes so
political as well, because like even a story like we
mentioned Philips he more Hoffman earlier, I looked him up
again and was looking at some of the various articles
(27:27):
about him, and you still see this sort of the
gut reaction from from some commentators where some people, you know,
we're saying, oh, well, this is you know, horrible. This
is a very talented man who struggled with it with
his dean. I don't even want to say his demons,
because that personifies it as something supernatural and not something
that's based in in in physical illness. Um. But people
were saying, oh, this is terrible. We had to deal
(27:48):
with this disease and it eventually caught up with him.
And then there's still people who are going to say, oh, well,
he was just essentially saying oh well he was just weak,
Oh he was just this is you know, moral failure
of his character. He was just another you know, Hollywood
phony or whatnot. You like, you still see that kind
of attitude, uh, you know, all over the place. Yeah.
I remember reading an op ed piece, and I can't
remember if it was Slate or Salon, but there was
(28:10):
this forty five year old dad with a family who
wrote about, Hey, look, this is a reminder of the
slippery slope when it comes to what you know, he
would say, brain disease is when it comes to addiction,
because I was someone who was on the edge and
a very lucky to have not died with my addictions.
(28:32):
And I'm forty five years old, and I realized that
there are many triggers that could cause us, just as
it did with Hoffman. So there you have it, a
little little luxie into the future. Uh, ways that we
can deal with addiction, the way the way that we
might deal with addiction. But again, there there has to
be enough of investment in the public mindset um to
(28:55):
really see this. Uh, this heroin vaccine reached the point
where actually affecting world health. All right, So there you
have it. Hey, if you want to explore more topics,
(29:16):
so just this one and be sure to check out
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(29:39):
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Welcome to Stuff to Flow Your Mind from how Stuff
Works dot com. Hey, welcome to Stuff to Blow your Mind.
My name is Robert Lamb and it's summer vacation people
who are on break. We thought it's a great opportunity
to replay a couple of our favorite episodes on the
very serious topic of addiction. Um. The last episode was
(00:25):
a repeat of the Science of Addiction, and today we're
going to repeat the Future of Addiction, where we look
to the future to see in different ways to to
deal with this crushing problem. Uh So, without further ado,
let's dive into the top. This episode is, uh, I'm
(00:46):
gonna look at the future of addiction. Uh. And we're
not talking about just what kind of crazy drugs would
have in the future. Now, we're talking about how can
we treat addiction in the future. What are some of
the cutting edge and emerging techniques and technolog only do
is that will be at our disposal to deal with
the disease of addiction. Yeah, and before we look at
the future stuff, let's just kind of look at what's
(01:07):
going on in the present. The number one driver of
aids in the world is used heroin needles, particularly in
countries where there's no needle exchange programs. So what if
you could get rid of the root problem, you could
eradicate heroin addiction, or for that matter, really any addiction. Yeah,
(01:28):
and we're not just talking instantly. Minds tend to turn
to Africa, and certainly that's one of the areas concerned here,
but other you know, countries that don't have needle exchange
programs include such large, uh populous nations as China and Russia. Yeah,
I think that people don't, you know, at least people
outside of the United States don't realize what in the
city is problem. This is half a trillion dollars or
(01:50):
spent worldwide to treat addiction. So here's just one little
prism of the addiction problem in the US. And estimated
one point four million Americans are addicted to pain, which
was the reason for more than four hundred and eighty
two thousand emergency department visits in two thousand and eight
and is a leading cause of heart attack and stroke
(02:10):
among people younger than age thirty five. So the problem here,
of course is that we have access and if you
look at you know, sort of where drugs are in
the time continuum of history here, Um, we have more
access to drugs than ever before, and more types of drugs,
(02:32):
and what emerges here are some highly, highly addictive substances.
I'm talking about meth, which creates one of the biggest
boosts of dopamine in the brain, and prolonged use of
this can lead to psychotic like symptoms, talking about strong hallucinations,
really violent behavior, and studies of the brain patterns of
(02:52):
some long term matthews have shown that up to fift
of their dopamine producing cells have been damaged. So if
you listened um to the other episode on this, then
you kind of know already that, Um, this is a
situation where the person is just getting deeper and deeper
into the hull because it's not about free will anymore,
(03:15):
because the parts of your brand, the executive function, have
been so eroded by drugs that even if you wanted
to stop, you might not be able to. Yeah, and
and and that's certainly the the anti drug messaging that
I think needs to be focused on more often with
meth amphetamy. Because I was reading and according to neuro
psychopharmacologist Carl Hart, there's actually no empirical evidence to support
(03:37):
the claim that meth amphetamy causes one to become physically unattractive,
which hopefully they've they're calming down on that, but for
the longest, like like meth mouth, you know, and the
transformation of the meth addict into some sort of subhuman
hyena person has been kind of the focus. When certainly
that's flashy that works on a billboard a little easier,
(03:58):
but the reality of what's actually changing with the brain
that is far scarier than some sort of decal on
hide ship. I agree. I have seen the ads before
where there's like this beautiful woman and then she takes
out her false teeth and she takes off her makeup,
and all of a sudden you see her meth attic
riddled face, and they are appealing to vanity. But vanity
doesn't matter. When addiction is highly routinized in your brain, um,
(04:22):
nobody cares anymore what they look like. So if you
were to instead crack open the brain and show people
this is how your brain is actually like completely mutating here,
that might be a far more compelling story to people.
The next one is another biggie, and that is of
course heroin derived from opium, and of course this one
has been wreaking havoc for for years and years. Yeah,
(04:44):
thirty of first time users will become addicted. In two
thousand and five, two point four percent of the American
population said they had tried heroin at least once. The
source of that is Department of Health. And withdrawal symptoms
are really acute. They arrive just a few hours after
a dose swears off, and because of this, users have
a really high chance for relapse. Because we talked about
(05:06):
this in the last episode. UM, at some point the
addiction becomes less about chasing the high and more about
chasing some sort of equilibrium and feeling normal again, which
can only happen if you get more of the substance
in your body. All right, And the next big one
to hit might come as surprise because it's not crack cocaine.
It is nicotine. Nicotine is a very addictive substance. But
(05:29):
we often overlook this why. Um, I think it's because
it's legalized, right something like of people who ever try
cigarettes will become nicotine addicts. At some point, you can
buy it legally at the store, at the gas station
used to. You can get out of a machine. Um,
someone's liable too, and it's given its legality and an
(05:50):
overall still social acceptance, um, people are liable to give
it to you without it being that big of a
deal as well. So and it still looks cool on TV, right, Yeah,
and it's not as big of a risk. And this
is something that David Lyndon, professor of neuroscience at Johns
Hopkins University, pointed out. He said, you know, hey, if
you have a bag of heroin, you're not going to
(06:12):
do a whole bag of heroin. You know you're gonna overdose.
But if you have a pack of cigarettes and you
have ten or twenty of those cigarettes throughout the day,
you get that little ding of dopamine each time. And
he kind of yeah, he kind of like likened it
to pav Offs dog, right, so he said that we're
really good at training or inner dog and sort of
being like, oh, I need a little pick up right now,
(06:32):
and you get that little dopamine um pleasure feeling from it.
But you're not going to necessarily, um render yourself unconscious
or unable to work or any of those things. But
still it is an addiction, and it is an addictive behavior. Yeah,
you hear about people being one or two back a
day smoker, whereas in the panel they pointed out that
(06:55):
that even a heavy heroine user is probably not going
to use more than through times a day. And so
to go back to what one of the topics were
discussed in the previous episode, chunking that idea that the
brain is forming habits give X, then Y and Z
and uh and then per forming a shortcut kind of
a hot key for the brain for behavior encoding the
memory of usage. Uh, you're going to have, what you know,
(07:17):
twenty times uh or more per day that you're enforcing
that shortcut as opposed to a maximum three times per
day with the hairin user. Yeah. And Charles do Hick,
the author of UM, the Habit Loop, I think I
totally slaughtered that. But um, he's talked about this and
written about this at length, and he says his claim
(07:38):
is that percent of our decisions every day that's just habit.
We think we're making these decisions, but really we're just
responding to environmental cues in these well worn neural pathways
in our brains. Yeah, because, if we've discussed before, habits
take up energy, if they take a cognitive power, and
we don't have a limitless amount of that. So we
handed over to to routine, we end it over to
(08:00):
habit so that we'll have some juice to handle the
actual decisions that are coming at and of course that
the problem with this is that again, your brain, your
brain secretary, isn't making any sort of like, hey, this
could be a terrible thing. Don't do this. Um and
your prefrontal cortex, your executive functions in your brain are
already sort of um lessened by the addictive behavior. All right,
(08:23):
The next thing we have here is prescription medication, one
of the rapidly growing substances of abuse in the US.
Between nineteen eighty and abuse of prescription drugs increased four
and it has about the same amount of usage in
America as cocaine. According to the National Institute on Drug Abuse,
(08:45):
drug overdose was the leading cause of injury death in
two thousand and ten, and among people twenty five to
sixty four years old, drug overdose caused more death than
motor vehicle traffic crashes. So the National Institute on Drug
Abuse goes on to say, by the way, and two
doesn't intend seventy eight percent of the drug overdose depths
(09:09):
in the US were unintentional seventy eight percent. And I
think that this is painting a story here about how
prescription drugs, uh have become so accessible in people are
mixing them with other drugs or mixing them with alcohol
to their detriment. Yeah, I mean, it's it's important to
to to to to to point out, yeah, that prescription
(09:31):
drugs just because it's prescribed, does not mean it is
necessarily a safe substance of Any of these are very
dangerous socis. I mean, any of these are amphetamines. Uh,
and they're not that different from the illegal variant. And
certainly methamphetamine itself is memory serves as scheduled to narcotic anyway,
which means that it consuvably has a medical purpose. Uh.
(09:52):
And it makes sense to like, which which car is
going to be faster, the one made in a garage
or the one made at at a at a factory. Right,
And what do we have with with drugs? Your street
drug is often made in a garage, whereas your your
pharmaceutical product, he's made by a billion upon billion dollar industry.
So it's it's kind of like a supercharged vehicle. Yeah.
(10:16):
And um, I'm sure that people are aware that there
are ways that people get their hands on drugs that
they shouldn't have. They were legal drugs prescribed and I
won't go into that. I will say that if you
are interested in learning more abound fist prescription drugs, check
out the documentary American Addict that goes into detail. It's
pretty depressing, um, but it's also very eye opening about
(10:37):
this topic. All Right, we're gonna take a quick break
and we get back. We're going to talk about the
treatments of addiction. Alright, we're back, So we've we've we
discussed addiction here. Let's talk about the ways that we
treat addiction. We have several different approaches that are currently
(11:01):
in play, and we're looking at some some new methods
of tackling in the future. Yeah, and before we go
into that, we should say, hey, by the way, rate
of relapse is really high for addicts. I think this
is something most people know. According to the National Institute
on Drug Abuse, relapse rates for drug addicted patients about
forty It's similar to relapse and those suffering from diabetes, hypertension,
(11:25):
and asthma, and drug addictions should be treated like any
other chronic illness with relapse serving as a trigger for
renewed intervention. So keep this in mind. Um, and we
talked about this, this idea of memory encoding behavior and
there are being triggers for that. So imagine that you
have just completed a program, say from heroin abuse, and
(11:48):
you get out and UM, I think I called them before,
these neural ghosts, these neural pathways in your brain, the
sort of cellular scarring that's still there. It's very easy
to tap into that and have that behavior express itself again.
A great example of this is Philip Seymour Hoffman, which
is brought up at the World Science Festival for the
(12:10):
panel of the Craving Brain. They said, look at this guy.
He was something like ten years sober from heroin addiction,
went to a rap party one night, had a beer,
and then something like I don't know, was it weeks
or months later, had died from heroin overdose. Yeah, I
just started him down the path, opened up those pathways
again in the brain, those those pathways of habit and
(12:31):
behavior in addiction, and uh, and then then that's where
he ended up. Yeah, So you know, you're not treating
something that's easily dealt with. Here, right, Just I keep
coming back to the idea of a cat's cradle, right,
you know where you take the shoe lace tied together
and you you string it between your fingers, and it's
all the different fingers holding the string out to form
this pattern. And you can't you know, put a point
(12:53):
at one particular finger and say that is the cause
of the pattern, that is the cause of the the
overall design here. And just as there's no over that
one finger you can pin the whole design on, there's
no one finger you can remove. There's no one treatment
plan that's going to to be a magic bullet against
the problem of addiction. Yeah, because in one sense, um,
(13:14):
it doesn't really matter anymore if you have genetic dispositions
to addiction, if you're in the middle of an addiction,
because at that point you've got habit taken over, you've
got the transfer station, there are significant changes to your brain,
and now you've got you know, memory all wrapped up
in it. So um. So, yeah, it is a bit
of a cat's cradle. But the treatments can't really treat
(13:38):
a cat's cradle. You can pretty much go after individual fingers. Yeah, Yeah,
there's no unified treatments. So the most widespread medication right
now is in a antidepressants, because this would address the
feelings of despair or you know, any sort of pre
existing condition like depression that may have led to the
addiction in the first place. So the album with that though,
(14:00):
is that you would have to really pair that with
behavioral therapy because it's not just enough to say, here's
a depressant and we have another a number of other
medications that sort of target individual parts of the chemical
cocktail involved in addiction. UM. We have, for instance, one
of the most famous being a methodone which suppresses withdrawal
symptoms and relieves craving. With the people are recovering from
(14:24):
from heroin, uh, you know, morphine addiction. UM. You have
other substance such as now trek zone, which works by
blocking the effects of heroin and other opiates at the
receptor sites. UM. You have of course, so when you're
dealing with nicotine nicotine, you have nicotine replacement therapy where
essentially you're still getting the nicotine, just not through the cigarette,
and that's used to help with the with the with
(14:47):
with the with cravings and whatnot. With alcohol, you have
now trek zone, which blocks opiate receptors that are involved
in the reroarting effects of drinking and in the craving
of alcohol. UM. So you see all these types of
medication there Again, they're going after sort of a particular
point in the chain and chain of effect and uh
(15:07):
and that. But they can't they can't deal with environment.
They can only deal with with one point in in
the the chemical reaction, be it in how the brain
is receiving or how the brain is dealing with withdrawal
from the substance. And of course that has to have
to have a behavioral counterpoint counterpoint part in order to succeed. Yeah,
and in the case of methodone, that itself is highly addictive,
(15:30):
and it's going to argue that you're just delaying the
process of rehabilitation. Really, you're just moving the goalpost out.
So what do we have on the horizon in the future,
And you've got some really interesting things going on. UM
one is called optogenetics, and are excuse me optogenics And
this is basically kind of like UM a light sensitive
(15:54):
molecule that's beamed into the brain so far of rats,
So rats that are learning certain habits, the researchers can
use this optogenetics treatment to basically turn on or off
neurons in the rats brains and block the behavior and
block the the ability of that rat to sort of
(16:16):
remember like, hey, I want to go and do this. Um.
And what's interesting about this is that the rats change
their behavior in response to different rewards even when the
light wasn't present. So after they got the initial zap
with the light, they still didn't return to the bad
behavior even when a significant amount of time had passed.
(16:37):
So obviously this is happening in rats right now, not
in humans. Um. But it plays into this other idea,
which is electromagnetic magnetic stimulation. Yeah, this is the form
that this would likely take in the treatment of of
of human addicts, and certainly this is where the research
is headed. Um And and in this we would use
electromagnetic stimulation outside of the scalp I hope no surgery required, uh,
(17:01):
using transcranial magnetic stimulation on these particular parts of the brain.
Again to almost not to simplify it and say, it's
just like turning the switch on and off in terms
of addiction, but but but turning off that that that
that craving, right, Yeah, and increasing the neural activity in
the parts of the brain that deal with executive functions
(17:23):
like willpower. Right, So that's what we've talked about that
that's such a big part of this. So then you
have you know, willpower being ramped up and you have
the addiction behavior being ramped down. What you still have
to deal with is memory in those triggers. And David Lyndon,
the neuroscientists and author of the Compass of Pleasure, says
(17:44):
addiction is a form of learning. When we, for example,
puff on a cigarette or inject heroin in our arm,
we are developing associations between the act of puffing or
the act of injecting all the other sensory information that's
around the sites and the smells, the people were with,
the music, we're hearing, the room. We're in a situation
that surrounds us and the pleasure that is produced as
the result of puffing on that cigarette or injecting that heroin. Well,
(18:07):
I hate to invoke the title of the movie anymore
since it's invoked again in every every news article on
science that deals with erasing the memory. But you kind
of have to go eternal sunshine of the follower's mind
on that particular drug memory, because, as we discussed in
previous episode, the drug memory is has has is really
firmly encoded. It's not just the memory of taking the drug.
(18:29):
Is the memory of the environment, the situation of the drug,
All these things tied up into it. So, yeah, what
if you could go after that memory, if you could
blast that memory sort of photon torpedo it, then you
could conceivably have a leg up on beating the addiction,
or you could you could just like hose it down
with a chemical, which is essentially what researchers at the
(18:51):
Script's Research Institute have done. This is from a Fall
two thousand and thirteen study published online in Biological Yeah Tree.
For six days, they had rats alternate between one of
two rooms, and on the odd days they were put
in a chamber let's call it Chamber A and given meth.
On even days they were put in Chamber B and
(19:14):
given a sailine place debo. So a couple of days later,
half of these rodents were given a choice between those
two rooms, and the room associated with that meth, of course,
was preferred by those rats who were injected with meth.
But the other half of the rodents were then injected
with something called La trunculin a or lat A, and
(19:34):
this is a chemical that interferes with actin and that's
a protein known to be involved in memory formation. So
when they were injected with lack day excuse me, latte,
the animals showed no preference between rooms even up to
a day later. Again, this is all highly experimental, but
it's it's giving us an idea that there are certain
(19:55):
interventions that can happen to address all the different facets
of addiction. And the researchers do point out that you
don't have to worry about about this particular method being
used to just erase memories willy nilly. They say that
you actually couldn't take their discovery and erase your run
of the mill memory inside of the brain. Uh. They said,
(20:16):
you can only use this to get rid of these
strong drug associated memories. And of course there's gonna be
many more studies and they will have to be human
trials in order for this too for the FDA to
approve of it um. But that gets us into this
other territory in which the f d A has approved
one type of vaccine but not another. And when I'm
(20:37):
talking about our vaccines developed by Kim d Janda, he
was on that World Science Festival panel of the Craving
Brain to block the effects of heroin and users, but
also block the effects of nicotine and users. So guess
which one is being funded? Oh well, obviously they're going
to fund the nicotine one because that's your that's your
(20:58):
kind of your your white collar drug. Everyone is dealing
with nicotine. But heroin, Oh, that's that's a dirty that's
a dirty drug. That's that that's the at the bottom
of the circus tent, right, that's the that's down there
with the safety name. Yeah, even though an estimated twelve
million to fourteen million people used heroin as of two
thousand and nine, accorded to according to the United Nations
(21:19):
Office on Drugs and Crime, and Americans uh something like
two in two thousand and eleven. So obviously it's a
pervasive problem when we spend a lot of money on
that um. But the vaccine itself stimulates the immune system
to recognize the substance and has to be given over
a period of weeks, which eventually renders the person immune
to the drug. Because how do our immune systems try work. Right,
(21:41):
Our immune systems evolved to deal with foreign outside invaders,
so our immune system doesn't doesn't look at incoming cocaine
or heroin or nicotine or alcohol and say say, oh,
that's bad, let's go after that. They say, sorry, that's
not on our list of of suspects. We're not gonna go.
We're not gonna go to right, you know. So the
(22:01):
idea who are this vaccine is? It is it puts
those offenders on the on the suspect list for our
immune system and keeps them from crossing a very important border,
at least in the case of the heroine. Yeah, the
blood brain barrier, because that's key here. That will actually
block any psychoactive effects. So in other words, you're not
going to get high. Yeah. And what they found in
(22:23):
the rats, or what Genda said he found is that
they would give the rats like uh doses overdose quantity, right, Yeah,
and the rats would survive when they were vaccinated. So
of course it's not something you would want to try
and human trials, but um, but it does lead us
to this idea that once you take the psychoactive part out,
(22:46):
the actual um blood brain barrier part, where it doesn't
get into your brain and then affect the rest of
the system. Is that you could render this this drug toothless. Yeah,
and it's it's important to know that this is not
like like a lot of other vaccines. It's not a
situation where you'd say, all right, give everybody in the
population the heroin vaccine and then heroin doesn't work on
any body. This would be more of a tool to
(23:08):
prevent a relapse. Really. Yeah, But again, the problem here
is the stigma, because of course the nicotine one has
human trials. It's brought to market. Just look at those
polite people and the TV commercials dealing with their nicotine problems, right,
and certainly many of our listeners are dealing with the
nicotin problems. I don't want to cheapen it or anything,
but it's it's far more socially acceptable. I think of
(23:29):
your TV version of the guy who's smoking too much,
and it's just a random guy. It might even be
Goofy from the Disney cartoons. I finally remember him trying
to quit smoking on the cartoon. I never saw a
Disney cartoon in which Goofy had to deal with a
heroin problem, even though that fits the time period right
the forties, you know perfect. I mean you could see
Mickey tying his arm off. I mean, we're making light
(23:50):
of this, but really, I mean this is this is
something that I think is very disheartening, especially for chimd Janda,
who came up with a vaccine in the first place,
for heroin to stop this spread of AIDS, because of
course the vector here as uh use needles. So I
think it's got to be uh, really just disheartening for
(24:13):
him to hear from um big pharma there's no market
for this. There's no market for a heroin vaccine, are
you kidding? Yeah, it's because again, when you look at
the huge public health benefit to something like this, it's
just it's an insane Yeah. And another thing that they
said on the panel is that this just has to
become more of the national discussion, and that, uh that
(24:37):
doctors need to have medical training on how to talk
to their patients about addiction, because they say right now
that they're not trained in that, and that the big
joke among doctors is that if a patient comes to
you and says, I drink four drinks a night, you
should probably double whatever it is that they say um
and you and not even really address the problem or
(24:59):
the situation a digny deeper. Yeah, it doesn't seem like
any time you're you're you're dealing with the doctor. It's
like it's not maybe it's not firmly established in the
public mindset that this is a safe tone and that
you can actually talk about what you're putting into your
body legally or illegally because it is bottom line essential
to your health. But you know, I think that if
(25:20):
the I think that if the medical field approached it
in a different way, and like, for instance, I went
to um my doctor and she said, hey, Julia, friend,
these tests on you. It looks like you've got some
genetic predispositions for addiction. I wanted to, you know, just
give you a heads up or are you in any
sort of stress loops in your life that you need
(25:42):
help with or that you're aware of. Then it I know,
it takes up more time with your doctor, but again,
it's opening up the line of communication and it's taking
out the stigma because you're talking about it. And if
this is something that is so pervasive in society. By
the way, something like eight percent of all pharmacutical suiticals
(26:02):
are consumed by the US by people in the United States.
Those are a lot of drugs, legal drugs, but still
drugs that are being distributed and um and consumed by people.
So this obviously is is not just a kind of
aside problem that some people have. You know, I want
(26:23):
to point out another possible application for the vaccine that
was brought up the heroin vaccine, is that, you know,
we were talking about rodents that were given this vaccine,
how they could take essentially almost like a lethal overdose
amount of the drug and and still be fine. Uh,
there's a possibility that the vaccine could be used to
treat people who are who have overdose symptoms. So healthcare
(26:44):
professionals pick someone up or arrive at a scene someone's
clearly overdosing on on heroin, they can apply the vaccine
as a curative measure. Yeah, so emergency medicine could really
benefit from this. But again, I just keep pointing to
this idea that if you start to talk about it,
if you start to remove the stigma, then you can
really get to the behavior part of it, and to
(27:07):
the root causes of it, the depression, anxiety, whatever it
is that's going on in a person's life and treat
them mental health part of this equation which is so important.
And it's a shame that the whole topic becomes so
political as well, because like even a story like we
mentioned Philips he more Hoffman earlier, I looked him up
again and was looking at some of the various articles
(27:27):
about him, and you still see this sort of the
gut reaction from from some commentators where some people, you know,
we're saying, oh, well, this is you know, horrible. This
is a very talented man who struggled with it with
his dean. I don't even want to say his demons,
because that personifies it as something supernatural and not something
that's based in in in physical illness. Um. But people
were saying, oh, this is terrible. We had to deal
(27:48):
with this disease and it eventually caught up with him.
And then there's still people who are going to say, oh, well,
he was just essentially saying oh well he was just weak,
Oh he was just this is you know, moral failure
of his character. He was just another you know, Hollywood
phony or whatnot. You like, you still see that kind
of attitude, uh, you know, all over the place. Yeah.
I remember reading an op ed piece, and I can't
remember if it was Slate or Salon, but there was
(28:10):
this forty five year old dad with a family who
wrote about, Hey, look, this is a reminder of the
slippery slope when it comes to what you know, he
would say, brain disease is when it comes to addiction,
because I was someone who was on the edge and
a very lucky to have not died with my addictions.
(28:32):
And I'm forty five years old, and I realized that
there are many triggers that could cause us, just as
it did with Hoffman. So there you have it, a
little little luxie into the future. Uh, ways that we
can deal with addiction, the way the way that we
might deal with addiction. But again, there there has to
be enough of investment in the public mindset um to
(28:55):
really see this. Uh, this heroin vaccine reached the point
where actually affecting world health. All right, So there you
have it. Hey, if you want to explore more topics,
(29:16):
so just this one and be sure to check out
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