Conquering Cravings
A wave of new drugs targeting addiction offers hope to people battling the habit
Vivitrol is actually a reformulation of naltrexone, taken as a once-a-month injection rather than as a daily pill. That's a big improvement, say addiction experts. With a daily regimen, the many people who are ambivalent about giving up alcohol often neglect to take the medicine. Vivitrol, which stays at a constant level in the blood for a month, "is the first treatment of any sort for any type of addiction that addresses noncompliance in a meaningful way," says Michael Bohn, a psychiatrist specializing in addiction at Aurora Psychiatric Hospital in Wauwatosa, Wis. Bohn was an investigator in the Vivitrol study and is on the joint advisory board of the two companies that developed it.
People taking Vivitrol reported 25 percent fewer days of heavy drinking-defined as four drinks for women and five for men-than those on a placebo treatment. (A differently focused study of the old daily dose found that people on naltrexone were abstinent 81 percent of the time, a 6-point lead over people taking dummy pills.) Nausea and irritation at the injection site were the most common side effects. Both Chantix and Vivitrol were administered over 12 to 26 weeks, though patients may end up taking them longer. Some Vivitrol patients have been on the drug for four years, while those who succeed after 12 weeks on Chantix are encouraged to take it for another 12 weeks, for good measure.
Next up. Behind the new arrivals lies a field of comers still in development. NicVax, for example, is a vaccine that would activate the immune system to respond to nicotine as a foreign invader, blocking it from reaching the brain. Rimonabant, approved in Europe to tame the desire to overeat, may also help people quit smoking. Topiramate, for seizures, is being studied for tobacco and alcohol addiction as well as compulsive eating. It "calms" the brain by helping to regulate neurotransmitters thought to be involved in addiction. The alcohol medication naltrexone, used in its original pill form along with counseling and nicotine patches, boosted female smokers' success rates (but not males' rates) by almost 50 percent, says a study in the October issue of Nicotine and Tobacco Research.
Applying one drug to different addictions makes sense, since the same pleasure centers and pathways in the brain are activated by many different substances and behaviors. Indeed, it's believed that the drives to eat in obese people and to take drugs in addicts spring from similar brain circuits. Some of these medications are now being studied for compulsive gambling.
But researchers caution that no drug will painlessly transform an addict into an abstainer, because addiction isn't purely a physical disease. "Addiction, whether it's to alcohol or nicotine or heroin, is really a complex disorder," says Roger Weiss, clinical director of the alcohol and drug abuse treatment program at McLean Hospital in Belmont, Mass. "There's a biological component, a psychological component, a social component. They all come into play." That's why counseling is so important; cognitive behavior therapy, for example, may allow addicts to form new, healthier habits by helping them recognize what situations or patterns of thinking trigger an urge to use alcohol or drugs.
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