MONTREAL — the urge to satisfy an addiction is said to be one of the most powerful cravings known to man. Addict’s brains wire around burning desires that override reason, and even family. the cliche that someone would sell their own grandmother is not actually a cliche. Many addicts have stolen from their own grandmothers and worse.
What’s amazing to me as someone who has worked in a rehab centre is this: Take people off their substance and, after detox, they quickly become upstanding citizens — considerate, responsible and good-natured. put them back on the drugs or alcohol and the madness begins anew.
It’s clear to me addiction is not a moral quality but more a neurochemical one, probably capable of distorting just about anyone. Actor Gary Busey once famously snorted cocaine off his dog, which had rolled in the drug after Busey dropped it on the floor. Keith Richards snorted his dead father’s ashes mixed with cocaine. Whitney Houston demolished a fabulous life with addiction. Worse still, many addictive personalities, like the late singer Amy Winehouse, move toward a terminal finale.
But solving addiction is one of the most intractable issues in science, with many addicts doomed to cycles of relapse. the CBC’s Nature of Things reported on Nov. 10 that traditional Canadian rehab programs have a success rate of only eight per cent. but a research project initiated in Quebec may offer something new. Montreal’s Douglas Hospital in association with McGill University is currently recruiting test subjects for a pilot approach to treating addiction based on a successful treatment for post-traumatic stress disorder.
But aren’t PTSD and addiction two completely different things? Sure. but they have one thing in common — they’re both driven by powerful memories. and scientists now say they can get into your brain and alter those memories.
PTSD, traditionally known as shell shock, is an often-debilitating condition related to trauma usually caused by having experienced or witnessed violence, atrocities or abuse. PTSD sufferers can be haunted and crippled by the intense emotions triggered by a trauma that may be many years behind them. but there is now a way to "dampen" the charge of once-potent PTSD memories. and it’s possible scientists might be able to do the same thing with the powerful triggers that drive addiction.
"the reason we think that people suffer from addiction is because of cravings," said McGill psychologist Alain Brunet, one of the world’s leading trauma researchers who heads the project. "A craving is a form of emotional memory — it’s a fond memory, but it’s a memory that’s very strong. but once things around you remind you of your drug use it triggers your cravings, and you very much want to use. What we found a few years ago that emotional memories, be they positive or negative, can be turned down or dampened."
Brunet, along with a team at Harvard and McGill universities, developed a revolutionary way to treat PTSD lauded as one of Quebec Science magazine’s Top 10 Scientific Discoveries of 2008. Brunet’s work is based on the "memory consolidation theory," which identified a peculiar aspect of human memory. when a powerful memory is remembered, it also has to be packed away or re-consolidated into the brain. During that process there is a short time frame when that memory, even a potent habitual one, is vulnerable and malleable. with proper timing, powerful unhealthy brain patterns, even habits, could be disrupted.
While PTSD is itself a factor in addiction, Brunet’s pilot project focuses on the cravings in addiction, because, he says, the pilot project must focus on a single variable.
Brunet’s PTSD treatment, the subject of international publicity, is deceptively simple — in effect, treating PTSD with a pill. the process goes like this: the subjects are asked to write the troubling memory down on a small piece of paper. one such story might read: "He held the gun against my head. I heard my heart beating. I thought I was going to die."
Test patients are given a pill containing propranolol. Propranolol is actually a mild blood pressure drug, which happens to have an extraordinary effect on memories active while the drug is in the subject’s system — it dampens or de-intensifies them.
The subject then holds up the paper with the memory on it and reads the difficult sentences five times. Why five times?
"it was just an educated guess," said Brunet. but the act of going over a difficult, troubling memory, saying it out loud, has a measurable and surprising effect. it brings the memory back to life inside the brain, something science can actually see with brain scans. the person’s heart starts to beat, sometimes their eyes tear up. At this moment, the troubling memory is hot and vulnerable.
"Propranolol will target the memories that will be activated while it’s in the system," said Brunet. "the drug deadens that memory."
Any memories coming alive during the few hours that the drug is active are likely to be "dampened."
"you don’t want to think about your wedding day," said Brunet. "I’m saying this half-jokingly."
Only half, as the procedure might dampen any memory that becomes hot during the process, including happy ones. but Brunet believes the process is harmless because only memories systematically targeted over several weeks are affected.
Using the process, PTSD sufferers have reported an uncanny change. A memory of a shocking trauma seems to deflate and lose its power. it doesn’t disappear, but becomes a distant memory like so many others.
The parallel to addiction is intriguing. in both scenarios, people are victims of the powerful effect of memory essentially gone amok. Because they often represent lethal danger, our brains make PTSD memories impossible to forget and, when triggered, these memories can push people into states of panic and anxiety. Similarly, the brain is convinced that addictive cravings are necessary and tied to relieving powerful anxieties, and won’t let them go.
Instead of writing down their traumas, the addicts isolate and write down the core memory that drives them to reach for the substance.
Most addicts will usually describe a specific trigger or feeling. here are the first few lines of one addict’s story: "It’s Friday morning. I wake up feeling depressed, lethargic, and tense all over. All I can think is ‘I would feel so much better if I had some coke.’ I make plans with my friends for drinks after work; an excuse to use. It’s all I can think of during my work day. as soon as I get home, I call my dealer, and wait for him to arrive. the anticipation of his arrival is overwhelming."
The addict also gets a pill, a dose of propranolol, and about 75 minutes later, the story is also read five times. After several sessions and a few weeks, the hope is that the powerful memory of using becomes a trivial, distant memory.
It’s tempting to see this treatment as wishful thinking. Are addicts really driven by one single memory? maybe. Although an addict could have multiple triggers or reminders of their use, "they may all be variations on a theme," says Brunet.
Could the treatment destroy valuable parts of a person’s memory?
"My answer is no," said Brunet. "Memories never disappear, their effective force can be reduced. We’ve been doing the PTSD memory work since 2004, we’ve never heard anyone say, ‘Doctor I’ve forgotten something important to me.’ "
According to Brunet, most memories "are generally not active but a few carry a huge, powerful emotional charge." If those memories are controlling someone, dampening them might actually have a natural, healthy effect. A person who was hit by car shouldn’t spend the rest of their lives being unable to cross a street. A person who enjoyed a glass of wine shouldn’t be destined to to never put a bottle down.
Brunet doesn’t yet see this treatment as a cure by itself.
"this is an adjunct to treatment currently," he said, meaning addicts should be still be getting counselling and therapy while undergoing this experiment.
Catherine Cosgrove, who runs the Heritage Home treatment centre in Huntingdon, Que., is hopeful that the approach might evolve into a full, effective treatment. Cosgrove, a psychotherapist specializing in addiction, was instrumental in helping to get the Douglas pilot project off the ground by suggesting to Brunet his treatment could be applied to addiction. She says she was motivated by the high relapse rate among addicts, and a sense that there has to be a better way.
Cosgrove believes the new approach could be used at both ends of addiction.
"the new research is really suggesting what makes addicts different form the rest of us is usually trauma," she said. "There really is a PTSD connection with addiction in that most addicts have some kind of recognized or unrecognized PTSD."
That PTSD, says Cosgrove, drives its victims to high states of anxiety, and that person eventually finds something to sedate them, sending them down the road to addiction.
Cosgrove says the ultimate application of this approach is to use the method to dampen both PTSD as addiction’s source and de-intensify the result of addiction — drug craving memories. Together, the new approaches could pack a memorable punch.
— Albert Nerenberg has done occasional workshops — in laughter therapy for addiction — for Heritage Home.
For more information on the pilot project, contact Michelle Lonergan: m_lonerg(at)live.concordia.ca; 514-761-6131, Local 3472; or visit info-trauma.org.
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