Rehearsing Abstinence

First there was methadone. Then came bupropion, naltrexone, acamprosate, varenicline and a host of other promising drugs. But the latest anti-addiction medication doesn’t come in a pill; it runs on your PC. ScienceDaily reports on two interesting studies that attempt to help addicts using computer software. Both rely on cognitive behavior therapy, the psychological technique that involves identifying and modifying dysfunctional thought processes that lead to unwanted behaviors.

In the first study, researchers created a virtual reality environment in which alcoholic patients could be exposed to the same cues and stimuli that normally elicit cravings.

[The] VR environments, developed with a company called Virtually Better, feature different scenarios that an addict may find challenging: a bar with imbibing patrons, a house party with guests drinking and smoking, a convenient store with cigarettes and alcoholic beverages within reach, a designated smoking section outside of a building or a room with an arguing couple. The environments use actors in each scene as opposed to computer-generated characters. In addition, the study added another layer of realism. A device sprayed the air with scents the participant may encounter in the various scenarios–cigarette smoke, alcoholic beverages, pizza or aromas associated with the outdoors.

In the second study, researchers developed a computer program that places patients in hypothetical situations and coaches them on how to avoid relapse.

Those assigned to computer-assisted training were exposed to six lessons, or modules, that they accessed from a computer located at the treatment program. Each module included a brief movie that presented a particular challenge to the subjects’ ability to resist substance use — such as the offer of drugs from a dealer. The narrator of the module then presented different skills and strategies to avoid drug use and also show videotapes of individuals employing those strategies.

Unlike the first study, the second scored participants for successful abstinence. Researchers found that subjects who received computer training had fewer positive drug tests compared to traditional counseling alone.

One problem with pharmaceutical interventions like varenicline or naltrexone is the way in which they shift responsibility away from the patient (It’s not me, it’s my brain!). By conceptualizing addiction as purely biological, patients may lose faith in their own willpower. Emerging computer-based interventions are promising because they encourage addicts to take control of their own cravings. Some combination of these approaches may prove most useful in the long run.

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One response to “Rehearsing Abstinence

  1. Addictions have both a neurochemical and behavioral component and successful treatment involves extinguishing both. Medications like naltrexone were specifically developed to protect patients who were detoxed in residential program and were going home to a cue-rich environment which could easily reinstate the addiction (Pavlovian Conditioning). Similarly patients taking veranicline are encouraged to smoke on the medication for several days to extinguish the craving for nicotine. The major evolution of the newer medications like naltrexone, acamprosate, veranicline etc. is that these medications are non-addicting, allowing behavioral therapies and exposures to a myriad of cues and triggers to extinguish the classical conditioning. These are exciting times in our field making integrated treatment more effective and improving outcomes.

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