Care and Treatment of Drug Addiction

When I worked in medical biochemistry, testing for both illicit and legal drugs had a dedicated department. The dose, even for legal drugs such as lithium, must be strictly controlled. Too little drug fails to treat the condition and too much of the substance can lead to harmful side effects. This section of the medical laboratory also tested recovering drug addicts. That was all we saw, the blood and urine for testing. There was no sense that these were people struggling. For a forensic scientist drug usage is an issue where it becomes or causes a crime. Both of these views are limited when it comes to the care and treatment of drug addiction.

What Sort of Drugs are we talking about?

Many types of drugs are used in the modern world. When used to treat illnesses, the drugs are termed medicine. They have a specific purpose and when the illness is cured the medicines are stopped. However, the ones cause addiction are psychoactive, which means they affect the brain. A psychoactive drug causes mood alterations as well as changes in behaviour through its action on the brain and nervous system. These drugs do not invariably cause dependence or addiction, but in most cases of drug addiction, psychoactive drugs are involved (WHO, 2024). These types of substances, also called psychotropic, include not only pain medication and marijuana, but also caffeine and alcohol. Falling into this category are illegal drugs such as amphetamines, heroin, cocaine, and LSD (NIH).

Writing laws that prohibit drugs is a difficult task. In 2016, a UK law was so broadly written that, if taken literally, would have outlawed coffee. To get it passed, they had to include a list of substances that were exempt from the law, such as nicotine and alcohol (Transform).

I have discussed forensic analysis for drugs in another article here. (https://mozartcultures.com/en/detection-and-analysis-of-drugs/) So, let’s move onto the medical side and discuss how to treat drug addiction, but first, let’s look at previous centuries’ ideas on drug use.

A Short History of Drug Use

Ancient History

Drug addiction is often considered a moral failing, but this has not always been the case. Priests and shamans of many cultures have taken entheogenic—literally ‘inside god’—substances to reach for spiritual understanding. The mushrooms Amanita Muscaria and Psilocybe served this practice.

They were not only used for religious purposes, Opium from the poppy plant has a long history of use as a pain medication. Homer mentions its use in the Odyssey. Laudanum was used extensively in the 19^th Century and German psychiatrist Griesinger (1817-1868) prescribed opium to his patients (Crocq, 2007). No history speaks of when alcohol or drugs were first used. However, there are plenty of modern videos that show animals choosing to eat ripe fruit and getting drunk, so it was probably pre-homo-sapiens (google). Ethiopian tradition has priests roasting and brewing coffee to stay awake for all-night prayer(Crocq, 2007). This sort of usage is not considered addiction.

In the 17^th Century, the basis for modern concepts of dependency, and loss of control when using, began to be formulated. Under this concept, there are differing viewpoints: is drug addiction a moral failing to be treated with prayer, or an illness to be physicked? In the late 18^th Century, the physician Benjamin Rush began a form of medical treatment for alcohol dependency, creating what he termed ‘sober houses’. In 1870, six managers of these houses to treat ‘inebriates’ joined together to form The Association for the Cure of Inebriation, in an attempt to label addiction as a disease rather than a moral failing. Most treatments involved a stay in the hostels, either short- or long-term, while the drugs cleared from the body. The doctors believed that the addict needed to be removed from society to get well. Unfortunately, they used other psychotropic drugs to ease withdrawal symptoms, such as cannabis and cocaine, leading to another addiction (Henninger, 2014).

More Modern Approaches

Moving on to the early 20^th Century, drug addiction abruptly became a crime. With the passing of the Dangerous Drugs Act in 1920 the UK made possessing drugs illegal (Lancet Ed., 2016). Even earlier, in 1909, the US passed the Smoking Opium Exclusion Act, though it still allowed Opium for medicinal use. 1914 saw the regulation of cocaine, and of course, 1919 brought in the total Prohibition of Intoxicating Substances (History.com Ed., 2019).

Non-medical

Despite the criminalization, doctors still attempted to help their patients. Several non-medical treatments were devised to return the patient to health. These included bathing in sunlight, electric shock therapy, and massages along with the regular religious and moral teaching and counseling of the past. With the advent of criminalization, however, these therapies went out of use in favor of jail time. When this did not cure the addiction, other methods arrived such as the 12-step program espoused by Alcohol Anonymous and the Minnesota Model. These remain the basis of non-pharmaceutical treatments for addiction of any sort (Henninger, 2014).

Medical

While non-pharmacological methods work for some people, others need a little more help. For everything, people want a quick-fix pill, whether it’s dieting or causing mood changes. For drug addiction this came in the form of miracle cures peddled in magazines and provided by mail order, promising a cure without the expense of a long stay in an institution. In the clinics, an effective treatment involved gradually reducing the dose of the drug. However, researchers in Germany came up with the non-psychoactive treatment for opiates that we now know as Methadone. This supports the addict through withdrawal, while the body makes the necessary metabolic changes for recovery. A less popular version of medical intervention is using Antagonists. These drugs block the uptake of drugs but do nothing to smooth over withdrawal as methadone does. Used in conjunction with non-medical methods, pharmacological intervention can be successful in helping overcome dependency (Henninger, 2014).

So What’s in the Future for Treatment of Drug Addiction?

Research into helping the recovery of drug addiction is ongoing. A truly effective medication according to Dr Kyle Chapman, director of the Charles O’Brien Center for Drug Addiction, requires three actions.

“You want it to take away withdrawal symptoms, you want it to reduce craving and you want it to block the high.” (American Addiction Centers Ed.,2023)

Unfortunately, none of the medications in current use can perform all three actions.

Researchers hope to create a vaccine of monoclonal antibodies to block the effects of illicit drugs.

In the 1970s they developed a formulation to help block such drugs in monkeys, it did not advance to human testing because the advent of methadone took interest away from the research. At present time, the effect of the antibodies would block the drugs, but not prevent withdrawal, in a similar action to the Antagonists mentioned earlier (Ovalle, 2023). Research took off again in the 1990s, as they still hope to create a vaccine to block the high, and thus would prevent any cravings and withdrawal symptoms. The main problem with vaccines is the molecules to which the antibodies need to bind are very small and can hide from the immune syste,. Other issues that researchers have found are that the vaccines they have in production and testing do not last very long, and require constant boosters, and as with other methods, they only effectively work for people who want to quit. Acquiring the funding for drug addiction research is a challenge in itself as many people still believe that addiction is a moral failing, not a disease that requires care and treatment (American Addiction Centers Ed.,2023).

Conclusion

It is not often that my two disciplines of forensic science and medical biochemistry coincide, but drug addiction is both a crime (by law) and a medical condition that requires intervention. The Care and Treatment of Drug Addiction has come a long way since prayer and fasting for a moral failing and we can hope researchers will arrive at new methods to provide a brighter future for those in the grip of drugs, and break them free of the criminal side.

References

Henninger, A. and Sung, H. (2014). History of Substance Abuse Treatment. 10.1007/978-1-4614-5690-2_278.

WHO. (2024) Drugs (Psychoactive). World Health Organisation. https://www.who.int/health-topics/drugs-psychoactive#tab=tab_1

NIH. Psychoactive Substance. National Cancer Institute. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/psychoactive-substance

Transform Drug Policy Foundation. Understanding UK Drug Law. https://transformdrugs.org/drug-policy/uk-drug-policy#:~:text=Inevitably%2C%20this%20definition%20also%20covered,substances%2C%20including%20alcohol%20and%20nicotine

Crocq, M. A. (2007). Historical and cultural aspects of man’s relationship with addictive drugs. Dialogues in clinical neuroscience, 9(4), 355–361. https://doi.org/10.31887/DCNS.2007.9.4/macrocq

Google Search. Animals Drunk. https://www.google.com/search?client=opera&q=animals+drunk&sourceid=opera&ie=UTF-8&oe=UTF-8

Lancet Ed. (2016) Drug Policy: Getting Over the 20^th Century. The Lancet. February 18. DOI: https://doi.org/10.1016/S2215-0366(16)00047-X

History.com Ed. (2019) War on Drugs. A&E Television Networks. https://www.history.com/topics/crime/the-war-on-drugs

American Addiction Centers Editorial Staff. (2023) Drugabuse.com. Aug 7. https://drugabuse.com/blog/why-dont-we-have-addiction-vaccines/

Ovalle, D. (2023) The Hunt Quickens for Vaccines and Antibody Therapies against Opiates. The Washington Post. November 5^th. https://www.washingtonpost.com/health/2023/11/04/opioid-fentanyl-vaccine-antibody/