Will There Ever Be a ‘Cure’ for Addiction?

Will There Ever Be a ‘Cure’ for Addiction?
Illustration: Vicky Leta/Gizmodo

Up top we should note that there are many different kinds of addiction, and many different kinds of people, and many complicated and contradictory theories re: addiction’s psychological/physiological mechanisms. There are various approaches to treating addiction as well. Proponents of a “harm reduction” strategy aren’t necessarily interested in reducing people’s drug use, for instance, but rather managing the negative health impacts that come from that use. Which is all to say that a silver bullet in the form of a pill or vaccine is not likely to ever exist. So think of this week’s Giz Asks — wherein we investigate whether there could ever be a cure for addiction — as a kind of thought experiment. Below, our experts weigh in.

George Koob

Director of the National Institute on Alcohol Abuse and Alcoholism

Probably not — but it’s possible.

Drug addiction involves changes in the brain, and those changes are in brain circuits that we use for everyday life — for seeking food and shelter, procreating our species, avoiding things that are aversive and painful, and so on. When drugs initially tap into those systems, they make you feel really good. And then there’s payback. There’s no free ride in the brain. When you overwork the feeling-good circuits, then you engage the feeling-bad circuits — what you would call, in common parlance, a hangover. And hangovers can also evolve into withdrawal syndromes, or protracted withdrawal syndromes, and make people miserable for long periods of time.

That makes curing addiction a challenge, because you have to get those circuits back into homeostasis — i.e., a normal range of functioning — and that’s not always so easy, because sometimes, the changes are actually permanent. Alcohol and drug overdoses can damage the frontal cortex, and create deficits there that persist for a long period of time. You can’t grow back circuits that you’ve killed. What you can do is, in a sense, rewire things, by strengthening other circuits.

There’s an area of psychology called self-regulation, and it applies particularly to addiction. Self-regulation can be taught to young people and adolescents and even pre-adolescents. Strengthening those muscles ahead of time, before you’re exposed to some of these challenges — if there’s ever going to be a ‘cure’ for addiction, it’s going to be in that realm. It’s probably not going to be a pill. Pills can maybe help you along the way to self-regulation, but it’s really going to require a strengthening of our ability to self-regulate as human beings. Self-regulation means setting appropriate standards, it means monitoring our activities, it means having the strength to resist the things that tempt us.

Judith Grisel

Professor, Psychology, Bucknell University, whose whose research focuses on determining root causes of drug addiction, and the author of Never Enough: The Neuroscience and Experience of Addiction

I don’t think so, no.

Addiction is a totalising phenomenon: it affects the way you think, the way you value opportunities and experiences; it affects your emotions and your behaviour. It becomes a huge part of who you are. And I think some of the tendencies that give rise to addiction — the tendency to take risks, to try new things, to go out on a limb — are baked into our neurobiology. These tendencies are so widespread in our genes, in our brains, in our behaviours, that you would have to alter a person profoundly to effect any kind of ‘cure.’ Afterwards, they might not even be the same person.

That said, there are currently new approaches being tested. Deep brain stimulation, for instance, is being used to reduce relapse and cravings. The results have been mixed, but promising in some cases. This is happening to different degrees around the world. Some countries are actually removing the relevant pleasure pathway, which is obviously controversial. Ultimately, to cure addiction, you’d have to eliminate the desire to get high — and that has major implications.

So while I’m not hopeful for a cure, I am very hopeful about better, more effective, and more precisely-targeted tools to help people through a transition process — from not being able to stop yourself from self-destruction, to developing other ways to cope with frustration or anxiety. I think deep brain stimulation might be a little bit of overkill, and maybe less than beneficial at the population level.

There are many, many things we could do to reduce the incidence and consequences of addiction, and to support people who struggle, that we’re not doing. It’s interesting to me, as a recovering addict, that we look to biomedical strategies rather than things like social support and help with the dentist. It’s a long, arduous, resource-intensive process, and I don’t think there will ever be a quick fix.

Antoine Bechara

Professor, Psychology, University of Southern California, who studies the neuroscience of decision-making, addiction, substance abuse and gambling

Addiction is a disease of decision-making. Most people have intact brain mechanisms of decision-making that prevent them from succumbing to an addiction. The question is: who is more vulnerable, and how do we best determine that? Our research aims to identify who those vulnerable individuals are before they’re exposed to addictive substances, as well as how to treat those who have become addicted.

During more than three decades of research on drug use, little attention was paid to the importance of a brain region that sits above our eye sockets called the prefrontal cortex. This region is important for decision-making, self-regulation, long-term goal setting, impulse control and the ability to predict consequences of behaviour. A weak prefrontal cortex can render an individual susceptible to addiction. But there are two other key neural systems that can drive addictive behaviours. One is relatively old, and that’s the old mesolimbic dopamine system and the well-established role of dopamine in drug as well as non-drug reward (e.g., shopping, eating, smartphones, etc…). The other is relatively new, which is the discovery that a small region in the brain, called the insula, is critical for smoking addiction (and potentially other substances of abuse).

Hence a futuristic approach to treating addiction would involve targeting these three systems in the brain: dopamine/ventral striatum/nucleus accumbens; the prefrontal cortex; and the insula.

Given the available research, there should be efforts to develop clinical tests, similar to the Iowa Gambling Task (IGT), to screen and sort out people who are more likely to misuse and abuse drugs such as opioids. This methodology can also be applied to screen people who may become addicted to heavy smoking, pathological gambling, and excessive social media use.

For those who are already addicted, investment in research can lead to several potential avenues for treatment. The first is trying to boost or strengthen the function of the prefrontal cortex. There are several promising behavioural approaches, including training designed to increase working memory capacity, that can boost the functions of the prefrontal cortex. Another promising approach that needs more research is training in “mindfulness.” We should do studies on mindfulness using functional neuroimaging approaches to understand potential links between this mental practice, the prefrontal cortex, and the ability to improve self-control and resist addiction.