The Rest of the Story

Hallucinogen may reduce alcohol cravings, reads one of the headlines on one of the sites that I go to regularly.  Hmmm.  Treat an alcohol problem by administering an hallucinogen?  Seems to not make sense.  Thinking that it must be a joke, but realizing that the site never publishes jokes, and also thinking that perhaps the headline was one of those that only makes sense when you know what the story is about, but which otherwise seems to mean something else, I satisfied my curiosity by clicking on the link.  It turns out that it is not a joke, and that the headline means exactly what it appears to mean. 

There are private clinics in the Caribbean and Mexico that use an hallucinogen to treat addictions.  It turns out, though, that the treatment is not really the point of the article.  Rather, the article is about the mechanism by which the drug acts, and how that might sometime lead to a treatment for addiction that is credible and clinically useful. 

Hallucinogen may reduce alcohol cravings
21 Jan 2005
Study findings suggest that ibogaine, a natural alkaloid, may be able to reverse behaviors associated with addiction, including alcoholism.

A team from the University of California in San Francisco, USA, says that the drug reduced cravings for alcohol in rats by triggering increased production of a brain protein known to affect alcohol consumption.

Ibogaine – derived from the West African shrub Tabernanthe iboga – is used as a recreational drug and its potential for neuronal toxicity has impeded research into ibogaine's use to fight addiction. However, some private addiction clinics in the Caribbean and Mexico use it to treat patients. [...]

The neurotoxicity may explain why it is not used in the United States.  Also, it is hard to imagine how it could be helpful to treat alcoholics with a recreational drug.  Personally, I think this is another one of those articles that describes an obscure kind of basic research, concluding with the observation that the study 'someday may lead to something that actually is useful.'  As we shall see, the prospects for that are rather dim.

However, that does not mean that the drug is useless; it means that any use it may have, is limited to the laboratory.  They elaborate:

To investigate ibogaine's properties further, Patricia Janak and colleagues describe how they induced rats to drink alcohol on a daily basis. Alcohol was then withheld for 2 weeks, which normally leads to increased alcohol consumption when it becomes available. But this craving appeared to subside in rats that had been given ibogaine.

"The discovery that ibogaine reduced binge drinking after a period of abstinence was an exciting finding for us because this is the type of behavior in alcoholics for which very few drugs exist," said Janak.

Examination showed that ibogaine appears to reduce the need for alcohol consumption by increasing production of glial cell line-derived neurotrophic factor (GDNF), the researchers report in the Journal of Neuroscience. This effect was confirmed in cell culture studies.

Why do I say that it is unlikely that GDNF ever would make a clinically-useful treatment?  This article describes what was done to use GDNF in an experiment regarding the treatment of Parkinson disease.  Note that the treatment involves the surgical implantation of a pump that delivers the substance directly into the brain.  GDNF cannot be given orally, or even by subcutaneous injection: it cannot pass from the bloodstream into the brain.  The authors point out that this would not be practical for an ongoing treatment.  Among other problems, the patients have to refill the pumps daily. 

Generally, it is considered to be a lousy idea to give a person, known to be prone to substance abuse, a way to administer drugs directly to the brain.

So, the study is important, but not in any practical sense.  Perhaps, someday, someone can figure out exactly what GDNF does in the brain. If they can figure out how that results in a reduction in craving, it might be possible to find some nontoxic, practical compound that does the same thing.  If so, it probably will take decades to figure out, then ten or fifteen more years to develop it to the point it could be marketed.  So while the headline is not a joke, it certainly is an exaggeration. 

The take-home messages are these: Always be skeptical of articles that conclude 'someday this may lead to something that actually is useful.'   Don't check in to a reputable detox center and expect to get hallucinogenic drugs; if you want to quit drinking, you're going to have to do it the old fashioned way. 

As they say, "there is no elevator to recovery; you have to take the steps."