Can We Prevent Relapse with Drugs We Used to Hate?

Addicts relapse for a reason. Its not just that they want to get high again, but because it is profoundly stressful to live in a world where they're constantly triggered by reminders of past drug use. One of the biggest causes of relapse is memories and the stress reaction they can evoke. Its the kind of stress that cues drug cravings and impulsive behavior in an addict.

In addiction recovery, some self-regulation can be accomplished through certain medications and psychological interventions such as mindfulness and neurofeedback. The memory technique of prospection is also helpful because it allows people to create a mental representation of possible future outcomes and to envision the advantages of a healthier life.

Researchers have been looking for new ways to address memories that drive relapse and, to the surprise of many, have found promise in a few drugs we used to hate. Ketamine, psilocybin and GHB drugs that pose clear addiction risks when used recreationally may provide a mechanism for stopping memories from triggering a relapse when used therapeutically under close medical supervision.

Understanding Stress Cues and Memory Retrieval

Stress cues are different for addicts than for people who have not faced addiction. Anyone can have a neutral stress reaction. If someone comes into work and the boss yells at them, it is likely they will have a stress reaction. Wed see increased cortisol and norepinephrine levels, and it would be measurable in galvanic skin response. People who use drugs, and those who never have, may have a similar response. Everyone gets stressed when the boss gets mad. Its normal.

A drug cue looks more like this: A man is sitting at a bus stop and the bus is late. He looks around and happens to notice there's a bar behind him. For the alcoholic, especially in early recovery, noticing the bar evokes the same intensity of stress reaction as being yelled at by the boss for the average person. He may be overcome by a powerful urge to drink. By contrast, a non-addict will just be annoyed at the bus delay.

For people who abuse alcohol or other drugs, the brain's wiring changes over time and becomes highly sensitized to drug cues. Seeing a beer bottle, hearing a champagne cork pop or watching someone drink on television can trigger an overwhelming drive to use drugs again. These cue-induced stress responses soar in the first few weeks after someone begins treatment and stops using alcohol or other drugs and peak somewhere between six and 12 weeks. This means that around the time people are typically sent home from residential drug treatment when they most need stability cue-induced stress reactions are getting worse.

Memory-Interrupting Drugs to Aid Addiction Recovery

Memories are more malleable and robust than once thought. Researchers have found they can be altered long after their acquisition, and that the brain may be able to rescue lost memories and bury bad ones. These findings may have useful applications for addiction recovery. For example, researchers have found that certain drugs may play a role in interrupting the memories that lead to relapse. Some of these approaches are a long way from being viable medical options in the U.S., but the fact that they are being studied is a step in the direction of acknowledging the need for a medical solution. Some of the drugs being studied include:

1. GHB (Gamma Hydroxybutyrate Acid). Known as a club drug and date rape drug, GHB has a reputation on the street as being non-habit-forming, but is in fact an addictive substance that can have severe withdrawal symptoms. It has been tested more widely in Europe, especially in Italy, where it has been approved for use in alcohol dependency and is viewed by some as a valid pharmacological treatment tool for alcohol addiction and withdrawal. It has also been approved for this use in Austria.

Researchers believe GHB affects memory reconsolidation the process by which memories are re-stabilized after retrieval and consolidated memories may be erased after retrieval. Clearing the memory from the brain through small daily doses of GHB may reduce the stress reaction. But use of GHB is not without risks , including the risk of addiction, though researchers have studied combining it with other medications, such as naltrexone, to cut down on its addictive potential.

1. Psilocybin. This naturally occurring hallucinogenic substance, more commonly known as magic mushrooms, is illegal and is classified by the Drug Enforcement Administration as carrying a high risk of addiction. Recent studies have found that it may help to relieve stress and anxiety in end-of-life cancer patients and it is being tested in ongoing nicotine and alcohol addiction studies in humans. Initial small trials indicate further studies are needed. Findings show psilocybin's chemical structure is similar to serotonin, a natural chemical in the brain that impacts the addicts stress reaction. In recent studies , participants taking psilocybin reported decreased stress reactions, increased control over emotions, and relief from persistent negative thoughts and feelings. Even under close medical supervision, the drug has potential to cause acute adverse reactions, including panic, anxiety and low mood.

1. Ketamine. This powerful animal tranquilizer, also known as the illegal club drug Special K, has been studied for use with treatment-resistant depression with promising results. It is also being studied for use in alcohol treatment because it interacts in the brain in such a way that can potentially erase memories that trigger relapse. Addicts, especially in the earlier stages of recovery, are vulnerable to simple triggers. Once triggered, the brain retrieves a memory and in that moment neural connections that encode it are temporarily destabilized. Ketamine may, in that moment of instability, weaken or dismantle unhelpful memories. Researchers are also looking at ketamine therapy as an adjunct to more established treatments. There are still potential side effects and it is dangerous when used recreationally.

None of these drugs are a panacea for people in recovery. Under rigorous study and medical scrutiny, we may find that some of these drugs can help reduce trigger memories that can lead to relapse. But until these drugs and their long-term effects are better understood, their medical use remains an interesting possibility rather than a go-to strategy for recovery.

David Sack, MD, is board certified in psychiatry, addiction psychiatry and addiction medicine. As chief medical officer of Elements Behavioral Health, he oversees a network of addiction treatment centers that includes Promises Treatment Centers and The Right Step Texas drug rehabs .