IX. Give the gist of the article and formulate its key idea.

X. Comment on the headline.

XI. Points for discussion.

1. Why is beating an addiction tough?

2. Is drug dependency a failure of will or a miscarriage of brain chemistry?

3. Do people need mild drugs like buprenorphine?

4. Do you agree with the journalist that addiction affects every aspect of an individual’s interaction with the world?

5. How do you find the approaches aimed at beating addiction? Which of them is the most effective?

6. Why is medication only one step towards recovery?

7. Are weak- or strong-willed people become addicts?

A shot of sanity

Vaccine shows promise against cocaine addiction

You know the feeling. It sends you running to the store for chips, makes you down a pint of ice cream in sec­onds, destroys your promise to lay off the caffeine and cigarettes. An out-of-control craving, a mindless compul­sion, an irrepressible urge.

Drug abusers call it Jonesing.

But experienced addicts will tell you that you don’t re­ally know what jonesing is all about until you’ve tried crack.

Smoked cocaine is probably the most addictive sub­stance used by humankind. Its effects are so potent and immediate – crack reaches the brain within 20 heartbeats of inhalation – that a single hit can hook you.

And once you’re hooked, you’re cooked. There’s no approved medical treatment for cocaine addiction, no ther­apeutic equivalent of the methadone dose, the Antabuse pill or the nicotine patch. Instead, there are rehab centers, Narcotics Anonymous meetings, a shrink in the afternoon, group therapy at night.

And the success rates of these programs are sobering in themselves. Most people in talk therapy for cocaine addiction, for example, are still using. At a typical long-term treatment center, only 25 of every 100 residents are still completely clean three to five years after they leave.

To beat those odds, the U.S. National Institute on Drug Abuse has made developing an effective treatment for cocaine addiction a top priority.

At Daytop, a residential treatment facility run by the Apt Foundation in Newtown, Conn., the institute is test­ing a time-honored approach to controlling disease: vac­cination.

Several dozen addicts housed in Daytop’s gloomy brick barracks on the aban­doned grounds of a state mental hospital have pledged to forgo their co­caine habit and shoot up an experimental vaccine in­stead.

The cocaine vaccine works the same way other vaccines do: by stimulating the immune system to produce antibodies that bind to a foreign entity, preventing it from entering the brain or otherwise interacting with the body’s organs and tissues.

In this case, the foreigner isn’t a virus like polio or a tox­in like the one that causes lockjaw. It’s another drug.

The vaccine’s developers – chemists at ImmuLogic Pharmaceutical in Waltham, Mass. – don’t plan to vacci­nate the masses to prevent cocaine addiction. Their goal instead is to help people who are already addicted.

Cocaine itself escapes the body’s defenses because its molecule is too small to activate the immune system.

The vaccine couples a piece of the cocaine molecule to chemical carriers that slow its release into the blood­stream and make it large enough to be recognized.

Once the immune system is thus primed, the use of co­caine – via nose, lung or vein – should prompt legions of antibodies to enter the bloodstream and ambush the drug.

In theory, the vaccinated user will no longer get a co­caine high. And in practice, vaccinated users do seem to lose all interest in their habit. But so far, those users are cocaine-addicted rats.

“It’s not something that will be a panacea for all (cocaine) addicts,” says John Shields, senior vice president of research at Cantab Pharmaceuticals, a British company that recently bought ImmuLogic’s vaccine program. “It’s only going to be useful if an individual actually wants to give it up.”

That’s because there’s a catch to the treatment the rats can’t tell you about: The vaccine doesn’t reduce the jonesing.

Drug craving is thought to be created by as-yet-uniden­tified changes in the function and perhaps even the struc­ture of the brain. And it’s the craving – the compulsion to use the drug despite its adverse consequences – that’s the essence of addiction. Whether using or not, an addict who’s craving isn’t cured.

Shields and his colleagues emphasize that the vaccine would only be suitable for people determined to stay clean and confront the psychological and behavioral aspects of addiction.

Because the initial injections are unlikely to confer life­long immunity, patients would have to be motivated, enough to continue getting boosters, probably at least once a year.

“I think the vaccine will be very helpful for people who have a desire to stop using, so that if they slip and use once they won’t get much out of it,” says Tom Kosten, a professor of psychiatry at the Yale School of Medicine and head of the vaccine trials.

Relapses are the reason most treatment programs fail, he says, because a single, brief exposure to a disavowed drug ignites a compulsion in addicts more powerful than that engendered by continual use.

The biology of addiction is not entirely understood, but it seems that the faster a drug’s effects build and di­minish, the more compul­sion it creates. That’s why crack cocaine is more addictive than snorted cocaine: Inhaling into the lungs’ large surface area rather than the mucous membranes of the nose gets the drug into the bloodstream much faster. In fact, the speed and potency of cocaine’s assault on the body could pose a major challenge to the vaccine ap­proach.

It took researchers years to learn how to build an an­tibody response that could counter the drug, and even a strongly fortified immune system may not defeat it com­pletely.

Alan Leshner, head of the National Institute on Drug Abuse, agrees.

“You can’t compare this directly with, you know, the polio vaccine. Nobody wants polio, so you’re not trying to override the vaccine. But people love cocaine. We don’t know what will happen if you take six times the amount you’d usually use to try to get high.”

But one trial participant says he does know. He left Daytop after receiving all three shots and immediately started injecting megabits of cocaine with a lady friend over the course of a weekend – to no avail.

This report is, of course, what scientists call anecdotal evidence from an unreliable source. And the current trials are measuring the vaccine’s safety at different dosages, not its effectiveness.

Nevertheless, in subsequent stages of testing, subjective accounts will become a crucial part of the clinical data.

Karen Wright

/Discover magazine, №27, 2000/