Treatments that Work

Proven methods to stop addictionnow.

By PT Staff, published on September 01, 1994

Theoretically, says Childers, such drugs would break the behavioral-chemical links, the cycle that keeps cocaine addicts craving the drug. "We so far have only a long-acting agonist. That would still help clinically, the way methadone does, and those addicted to cocaine binges or overdoses would be helped. It might give a hard-core crack addict a way to come off his high slowly and perhaps not have the terrible withdrawal and craving."

Another pharmacologic approach that is drawing interest and controversy is the African hallucinogen ibogaine, made from the shrub Tabernanthe iboga, which grows in Gabon. Anecdotal evidence and a few animal studies suggest that ibogaine can cure opiate addictions. It's banned in the U.S., but a white powder made from it is available in Holland and many American junkies have gone abroad to get it.

Some patients claim it not only stops cravings for long periods without withdrawal, but also suppresses all desire for any drugs and generates an emotional confrontation with their own thoughts and feelings, during which they are inspired to reorganize their lives.

Scientists at NIDA say there is no evidence that it works, even over the long haul. Studies at Johns Hopkins have shown that ibogaine interrupts dopamine release and stimulates other neurotransmitters.

Still, most experts say the long-term effects reported by some users probably have more to do with the desire addicts have to kick their habits and to their expectation that it will work. At Johns Hopkins, Mark Molliver, M.D., and his team have also found ibogaine kills brain cells in a part of the brain--the orbital frontal cortex--linked to obsessive behavior. At present, neuroscientists at the University of Miami have the go-ahead to test ibogaine at low doses for safety, but not yet on addicts.

Transformational psychology. The new view of addiction and some new ideas about treatment have been fed from such unusual sources as religion, philosophy, and literature. Recent research conducted on abrupt personality change is a case in point. The investigators, William Miller and Catherine Baca, M.D., of the University of New Mexico's Center on Alcoholism, Substance Abuse and Addictions, credit their study of Joan of Arc, Malcolm X, Alcoholics Anonymous cofounder Bill Wilson, Saint Paul, Buddha, Kierkegaard, and Dicken's A Christmas Carol for suggesting means by which some addicts might kick their habits overnight--much the way Ebenezer Scrooge went from wretched skinflint to kindly benefactor after a bad dream.

Whether or not their "transformational psychology" research translates into a practical treatment for addictive behavior, its publication this year by the American Psychological Association and presentation at international drug and alcohol research conferences reflect a shift in thinking about how people become addicted and how they might get free. Until now, says Miller, behavioral scientists have stuck to the conviction that real change, if it happens at all, is gradual and painstaking. Now, says Miller, we know that "relatively sudden and profound changes can and do occur, at least occasionally." If that capability could be harnessed, the impact on addiction could be profound.

Aversion therapy. Toni Farrenkopf uses aversion conditioning to treat addictions, particularly those involving gambling and sexual behavior. He's worked with patients for whom a single incident of voyeurism, or indecent exposure, sometimes at a very early age, was so arousing that the addiction held for decades.

"What we've learned is that people who are voyeurs and exposers are addicted to the rush they get from contemplating, planning, and doing the behavior, not necessarily from sexual release itself. With pedophiles, other factors drive the addiction. But in all cases, you want to try and countercondition the behavior."

Aversive therapy works by introducing negative consequences immediately after the pleasurable experience occurs. One reason that many people don't become addicted is that they rarely experience the worst consequences of their behavior soon enough to override the pleasure.

Farrenkopf uses covert sensitization with imagery. He'll show a sexual addict arrest scenarios--being handcuffed, jailed, searched--10 seconds after an erotic exposure and do this repeatedly. Or he'll expose them to a noxious odor or painfully snap a rubber band on a wrist. "I help the patients experience all of the painful things that happen when they are caught, or have to confront their families after getting caught," he says. "It works for many."

In a related therapy for gamblers and others "addicted to thrills," Farrenkopf makes them do an inventory of how people are hurt by their behavior, and visualize how their family would feel if they were killed or maimed, how humiliating it would be for a professional to be arrested for drunk driving.

Behavioral shaping. A recent study by NIDA researcher Kenzie Preston, Ph.D., uses this method to ease inner-city cocaine addicts off the drug; they get increasing rewards in the form of redeemable vouchers to encourage abstinence. At the end of his first 12-week trial, nearly half the subjects had stayed free of coke for at least seven weeks. Among the rewards purchased with the vouchers: tennis shoes, tires, clothing, and a lawyer's fee.