Fighting Fire With Fire

Does an unproven treatment that combats drug addiction with drugs promise more than it can deliver?

His nightly transformation began with a twinge. Then, gnawing and relentless, it consumed him.

At 45, "Steve" was a hard-charging sales manager who'd snagged two promotions in three years. After work one spring day in 2006, he picked up his infant and toddler from day care, had dinner with his family and retired to his office in their spacious Plano home.

His wife assumed he was wrapping up the day's projects. As he thought about her lying in bed downstairs, trying to calm the agonizing headaches that had plagued her since she'd delivered their second daughter the year before, he felt like a terrible husband and father.

Dr. Bryon Adinoff, distinguished professor of alcohol and drug abuse research at UT Southwestern Medical Center at Dallas, is doing experiments to identify the causes of relapse and pave the way for medical treatments that could prevent it.  He's concerned Prometa promises too much too soon.
Morrey Taylor
Dr. Bryon Adinoff, distinguished professor of alcohol and drug abuse research at UT Southwestern Medical Center at Dallas, is doing experiments to identify the causes of relapse and pave the way for medical treatments that could prevent it. He's concerned Prometa promises too much too soon.
Dr. Bryon Adinoff is concerned Prometa promises too much too soon.
Morrey Taylor
Dr. Bryon Adinoff is concerned Prometa promises too much too soon.

But as always, on the heels of guilt and resistance came desire, as though Daytime Steve, with his down-home East Texas upbringing and frequent workouts, his upscale job, polo shirts and fancy house, just disappeared. In his skin, The Addict emerged, a neurological creation as real as a tumor and just as dangerous.

It's fine, The Addict argued, trotting out the usual rationalizations: He was doing everything he was supposed to do—working hard and caring for the girls when his wife didn't feel well, which was most of the time. Doing all that without a little help was impossible. What was the big deal?

He opened the desk drawer and pulled out a pipe. Then he placed a small, crystallized rock of methamphetamine into the bowl, heated it and inhaled. He felt a rush of relief, the rare combination of focus, drive and sweet calm that kept him coming back. As he eased into his reverie—literally a new state of mind—the office door opened.

His wife stood in the doorway. She wore a bathrobe and the pained expression that signaled pounding between her temples. Her eyes rested on the pipe. She yelled, knocked a piece of art from the wall and swiped the stacks of papers off his desk. "How could you?" she screamed.

"I'm sorry," he said lamely. They'd been through this before. He'd gone to therapy and quit for five months. But then the stress had returned and, with it, the craving. It existed only in his head, deep within loops of nerve and tissue, but it was overpowering.

Papers sailed through the air, and Steve watched his wife's mouth moving furiously, forming words he didn't want to hear. Suddenly, from somewhere behind The Addict's foggy gaze, Daytime Steve came back. He awoke with a jolt to see the life he'd spent decades building in mid-implosion. The Addict had beaten and cajoled him into defeat.

Steve agreed to move out of the couple's five-bedroom house and into a condo. "I didn't deserve to be there," he would later say. In the following weeks, while he was wracked by loss and shame and withdrawal, his wife recommended he try a controversial new medical program tailored to treat addiction. It was called the Prometa Protocol, an experimental combination of medication and counseling that has stirred excited anticipation, criticism and open conflict in the treatment community.

Hythiam Inc., the biotech firm that markets and sells Prometa, is based in Los Angeles, but Dallas has emerged as a crucial base for the treatment's clinical research trials and home to the company's first managed-care reimbursement deal with locally based Cigna Healthcare.

After reviewing the Prometa Web site and seeing local clinics that provided the treatment, Steve figured he'd test its promise to do what his willpower could not: beat back The Addict by targeting the chemical compounds that his brain kept unleashing on him.

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Unlike the heart, lungs or stomach, the brain doesn't beat, inflate or gurgle. If you were to shrink and climb into it like Slim Goodbody, who in the '80s donned a bodysuit and gave guided tours of the human body on PBS, the brain would offer little action. Weighing three pounds and home to billions of neurons, it's one of the least visually dynamic organs but certainly the most complex, an exasperating biological riddle that scientists have been striving to unravel for centuries.

Thanks to the advent of new scanning technologies such as fMRI—a device that measures blood flow and neural activity, lighting up colors in images on a computer screen to show where the brain is most active—the last two decades have brought an explosion in scientists' understanding of addiction and the brain. Researchers in labs across the country have discovered how substance abuse affects different parts of the organ and why addicts' neurology may be unique to begin with. They've identified the flood of neurotransmitters that lulls users into ever-deeper levels of dependency, found genetic variants that make some people more vulnerable to addiction than others and determined that the impulse to take a drink or snort a line originates in specific parts of the brain.

Researchers have learned that while the brain holds specific receptors for various types of drugs, there are also basic brain patterns that all addicts share, no matter their substance of choice. This newfound knowledge has set the stage for treatments—on the market already or in development—with the potential to halt the cascade of chemical reactions that leads an addict from his first sip of beer at 15 to passing out in front of his kids at 40.

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