ADHD Drug Tested as Treatment for Crack Addiction. Atomoxitine, a nonaddictive medication used for ADHD, may be enough of a mild mimic of the pharmacological effects of cocaine in the CNS that it might substitute for it, the reasoning goes. When used in cocaine rehab, however, patients often relapse. So the efffects and dangers of mixing atomoxetine and cocaine were investigated in a study to be published in Drug and Alcohol Dependence but available online in pre-print. The verdict was that there was mild additive cardiovascular danger and no consistent blockade of the pleasurable effects of the cocaine. In other words, the combination was “safe but of questionable effectiveness”, investigators concluded.
This illustrates a longstanding fallacy in the treatment of drug addiction, IMHO. All too often, no matter what the drug is, addicts are given a medication that produces a mild version of the pharmacological effects of their drug of choice in hopes it will satisfy their cravings or block the stronger effects of the drug and make it less rewarding. Examples include another medication, the antidepressant bupropion, for cocaine; and buprenorphine for opiate addiction. Similar (but even more thoughtless) is the medically contraindicated but widespread practice of maintaining ex-alcohol abusers on tranquilizers for sleep or anxiety. I have rarely seen these work and usually see users begin using their drug of abuse again while still on the supposed treatment, with additive effects. The fallacy lies in the reductionistic pharmacological materialism that equates the reward of the drug entirely with its (poorly-characterized) physiological effects in the CNS. This ignores the psychological needs the drug and its use provide. The habitual and compulsive nature of drug abuse comes from its being a powerful reinforcer in far more ways than just its stimulation of the “pleasure center” of the CNS, as it has become fashionable to describe it. From this point of view, it is not puzzling that patients will revert to their drug of abuse instead of, or on top of, the supposed relapse-preventing medication therapy.
A related phenomenon occurs when other drugs which themselves have abuse potential are used to substitute for the supposedly more damaging street drug, as in the case of methadone for opiate addicts. I’m not arguing about the merits of legalizing addiction here, but if that is what we are doing, let us be honest about it. Not only is there a street trade in diverted methadone itself (as well as suboxone) — more to get high than to self-detox — but the methadone clinics are often vehicles to maintain or even enhance clients’ addictions, in effect diverting addicts’ payments from the drug dealers into the clinic coffers. Call me cynical, but few of the methadone clinics I have seen do what would be medically prudent: (a) carefully assess the patient’s level of tolerance and maintenance need; (b) place the patient on a dose of methadone at or slightly below that level; (c) and embark on a medically prudent and tolerable but inexorably progressive taper of the methadone.
