Families struggling with addiction want help. There is little doubt we would go to the ends of the earth if we thought we could help loved ones cope with their disease. So the following offers a tantalizing bit of hope for the future. As a recent article on addiction vaccines in the NY Times puts it:
“Imagine a vaccine against smoking: People trying to quit would light up a cigarette and feel nothing. Or a vaccine against cocaine, one that would prevent addicts from enjoying the drug’s high.
I do not think there are too many people who would not want treatment in a syringe or bottle. After all, the disease of addiction is the only major disease where the primary treatment modality is some variation on the ‘suck it up and get used to it’ principal. Whether through self-help groups, through expensive inpatient treatment, or through one of a handful of drugs that help with varying degrees of success, current treatment modalities by and large rely on a person’s ability to quit using (and stay quit long-term) in spite of the addictive or dependent biology/psychology/’whateverology’ that drives the addiction and dependence. .
New research into vaccines, which will in a sense short circuit the wiring in drug and alcohol dependent people that says, ‘I like it…give me more.’…that is a whole different discussion. We rarely see the ‘suck it up’ approach taken with Cancer or heart disease. And there is not much self-help only going on with diabetes or asthma (both include self-help, but also have a robust medical treatment plan as well). So even the merest hint that there is a syringe with a cure out there is too compelling to ignore for families who see their family member’s addiction leading to pain and death without some form of outside help. From the article:
Even so, addicts and their families are clamoring to get into Dr. Janda’s clinical trials. He says he gets e-mails every week from addicts asking to be included. He has had to turn away parents who showed up at his office with their drug-addicted children after reading about his work. “What am I supposed to do, go in the lab and pull it out of the refrigerator and inject you?” he said. “I guess it’s been so devastating in their families that they’re looking for anything, and there’s just nothing out there. It’s really sad when you see these types of things.”
That kind of desperation hints at the huge hole that exists in the treatment (and some might even hope eventual cure) of addicts. But the pitfalls of such hopeful thinking are many.
First and foremost, it does not exist yet. And the money for research is in finding a vaccine for smoking first. Few would argue getting people to quick smoking is not urgent. But that means that the demand is driving other priorities beside alcohol and heavy narcotics first.
Second, there is still no evidence of success. Some recent trials have not shown the positive outcomes promised. And the complexity of addiction makes success elusive. Since we still do not understand all of the mechanisms that drive addiction, we are going to continue to struggle coming up with vaccine.
Third, the physiological and biochemical side of addiction do not the whole picture. There are behavioral and psychological elements that are hugely important in understanding the mechanisms of addiction.
And fourth, with no definitive sense that a vaccine is forthcoming, we as a society are still left with the painful truth that our treatment infrastructure is just not capable of dealing with the diseases of addiction. We have too little treatment, too few beds and too few programs, and too much reliance on self-help treatment modalities. We need more and better, and waiting on a magic syringe without also address these structural problems seems like a dangerous mistake.