I was interested to see recently that the National Institute on Drug Abuse (NIDA) announced progress with a new, vaccine-like approach to treating cocaine addiction.

The treatment works in a way similar to vaccination by stimulating the body’s immune system to produce antibodies that prevent the cocaine from entering the brain and central nervous system and producing its euphoric effects. I find that this development is promising for a number of reasons, both for its direct potential impact on cocaine addicts and its broader implications for the mindset of the treatment and recovery community. As Dr. Nora Volkow, Director of NIDA, "By targeting [addiction] as a medical disease as opposed to a moral dilemma, we're likely to come up with solutions that have a much longer impact.”

Furthermore, this vaccine-like approach demonstrates increasing acceptance of addiction treatment that moves beyond rigid 12 Step-based programs to better address the reality of the disease process. These more holistic, integrated approaches place less focus on short-term, acute recovery and abstinence, instead emphasizing harm-reduction and longer term recovery processes. This is a model much more analogous to other medical diseases, such as diabetes or lupus, which are chronic, remitting, and relapsing in nature, and thus require a mix of clinical treatment and behavior modification in order to maintain disease remission.

A holistic approach integrating both clinical and medical treatment with recovery principles also better addresses the reality that many cocaine addicts, like persons addicted to other behaviors and substances, frequently suffer from undiagnosed or undertreated co-occurring disorders. When present, these psychiatric conditions are usually tightly interconnected with the addictive disease process. Over the course of my career I have worked with numerous patients who had previously failed to maintain abstinence because of their reliance on addictive behavior to manage the side effects from co-occurring disorders.

A few of the conditions with the greatest potential to impact addiction treatment and impede long-term recovery include:

- Depression
- Bipolar disorder
- Schizophrenia
- Post-traumatic stress disorder
- Obsessive compulsive disorder
- Borderline personality disorder
- Panic and anxiety disorders

The NIDA study leaves unanswered some important questions, such as how to achieve higher antibody levels in more of the participants and how frequently the vaccine will need to be administered. Also, using the vaccine alone as the sole treatment will most likely lead to people developing other addictions (such as with food, other drugs, sex, or gambling) if the underlying emotional, social, and spiritual issues are left unaddressed. We see this with people who have food addictions and receive gastric bypass surgery with little to no emotional or spiritual treatment. It is not uncommon for some of them to develop alcoholism or other addictive disorders, even anorexia.

Patients I have treated with co-occurring disorders tend to have more severe symptoms of addiction and a higher potential for relapse. However the cocaine vaccine holds out the promise of being a valuable tool as part of a comprehensive treatment program that can assist the patient in the withdrawal effort, increase her success with treatment, and start her down the path of long-term recovery. I will be watching developments on this front closely, and I hope to be able to bring you further updates in the not too distant future.

Dr. Dennis