For more than 25 years, scientists have been hard at work formulating vaccines for nicotine, cocaine and other addictions. Growing recognition of addiction as a brain disease has spurred renewed interest in medical solutions such as vaccines.
Despite a number of close calls, success has been elusive as the vaccines have yet to produce consistent results in humans during clinical trials. Still, there is a great deal of motivation and passion behind developing an addiction vaccine, with some experts predicting an FDA-approved product within the next five years. But would an addiction vaccine really work?
The vaccines under development offer hope to people struggling with devastating consequences of addiction, particularly at the earliest stage of recovery, but there are a number of limitations that could keep the vaccines from being a “magic bullet.”
How the Addiction Vaccine Works
Vaccines are different from other medication strategies for addiction that try to undo or counteract the damage drugs have caused in the brain. For example, the cocaine vaccine works by preventing cocaine from reaching the brain. How is this done?
Like shots for other diseases, the vaccine tricks the immune system into thinking that cocaine is an invading bacteria. Large immune proteins bind to the cocaine molecules and trap them in the peripheral circulation. If the person tries to use cocaine, they will not get high since the cocaine never reaches the reward system in the brain. As a result, they would theoretically lose interest in wasting their money on ineffectual drugs.
Problems with the Addiction Vaccine
We are in the earliest stages of studying vaccines for addiction, and none has been approved for treatment. Although the vaccine does not alter brain chemistry and is not addictive like certain other medications currently used to treat addiction, there are a few obvious limitations.
1. Each vaccine is specific to a particular drug.
For example, the cocaine vaccine won’t protect from amphetamines. We know that anyone with drug or alcohol addiction is 10 times more likely than the general population to become addicted to another drug. One concern, then, is that if you block the high from cocaine with a vaccine, then the addict will choose to get high on another drug. Addiction is a disease that drives people to find workarounds, doing whatever it takes to get the next high.
Scientists acknowledge that no vaccine can “cure” addiction for someone deep in denial and lacking the motivation to change. Vaccines are intended to be “a crutch for people wanting to go into abstinence,” Dr. Kim D. Janda, a professor at the Scripps Research Institute who has spent the past 27 years working on addiction vaccines, told The New York Times. “The whole thing with addicts is you have to want to get off the drug, or it’s not going to happen.”
2. The immunity created by drug vaccines is time limited, lasting only several months.
Even if the vaccine is effective, an individual who chooses not to get re-vaccinated will no longer be protected. While the vaccine buys the addict time to get treatment and build their motivation to stay clean, there is no guarantee with a chronic, relapsing disease that the addict will continue a regimen of vaccines.
3. A vaccine has no impact on habits, lifestyle or mental illness.
Even if an addict no longer gets physically high as a result of the vaccine, psychological dependence remains. The drug use rituals, including the triggers to use prompted by certain people, places and things, can be as difficult to give up as the drug itself.
Cross-addictions will remain a significant threat, potentially leading the drug addict to turn to gambling, food, sex or some other outlet for their next high. In addition to a vaccine, addicts must learn healthier coping mechanisms, develop social support networks, and address underlying mental health disorders such as depression, anxiety and trauma, to truly recover from addiction.
Hope, Tempered by Realism
Even with these limitations the addiction vaccine, if proven successful, could be useful in treating addiction. The estimated 22 million drug abusers and their families are clamoring for answers to a problem that has destroyed their lives and for which other treatments so often end in relapse.
At present, a majority of cocaine addicts who enter treatment never make it through the first week. By comparison, three months would allow time for drug rehab treatment and therapy to bring about needed emotional and psychological changes.
Recovering from addiction is no simple task – and will likely never be “easy” even if an addiction vaccine becomes widely available. But the more tools we have to combat this chronic, progressive brain disease, the more lives we can save.
David Sack, M.D., is a board-certified addiction psychiatrist and CEO of Elements Behavioral Health which offers residential addiction treatment at Promises Treatment Centers and The Ranch at Nunnelly.