Learn More About Addiction Research Studies

What Are Addiction Research Studies and Their Clinical Trials?

The term addiction is not just related to the use of psychoactive substances but other types of behavior as well. While many efforts are being made to understand the biological and neurological basis of substance addiction, it is still often untreated and undiagnosed. Part of this negligence can be attributed to physicians' unawareness or lack of willingness to treat such patients.

According to PubMed, addiction is described as the psychological dependence on substance use without tolerance and withdrawal. It is also uncontrolled and compulsive behavior despite social, physical, and psychological consequences.

The classification of addiction not just covers the use of psychoactive substances like sedatives, opioids, and stimulants but behavioral addictions as well. Certain types of behavior, like gambling, compulsive stealing, sexual behavior, and internet use, have been categorized under the umbrella of behavioral addictions. The inability to stop taking part in such activities is what leads to the compulsive behavior of the addict.

It is a common concept that those people with substance or behavioral addictions lack moral principles and don't have the willpower to 'choose' not to indulge in such activities. However, many people fail to understand that 'drug addiction is a complicated disease, and quitting uncontrolled and compulsive behavior and substance use is more than just a 'strong will.'

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, lists the following substances that are related to substance addiction.

• Caffeine
• Alcohol
• Cannabis
• Inhalants
• Hallucinogens
• Sedatives
• Stimulants
• Opioids
• Anxiolytics
• Tobacco
• Hypnotics

These drugs alter the brain function and change it, making quitting hard and impossible, even if the patient wants to do so. Addiction is a complex chronic disease, and even though the initial choice of taking these drugs is voluntary, repeated and uncontrollable use often interacts with brain neurotransmitters, which challenges the person's willpower and self-control. In this way, the patient is unable to resist the psychological dependence and the urge to take these substances.

Addiction is a relapsing disease, which means that people recovering from drug use are at risk of returning to old habits even after years of resisting them. According to scientists and researchers, certain neurophysiologic processes define compulsive behaviors related to the addicted state. These brain changes are hard-wired and revolve around reward, pleasure, and addiction, which makes the transition from casual drug use to addictive drug use.

The two major neurological pathways that are involved in addiction are:

Mesolimbic Dopamine Pathway

Dopamine is the chief neurotransmitter that is involved in the brain reward pathway. The mesolimbic dopamine pathway is also known as the 'reward circuit.' Repeated exposure to drugs and stimuli leads to a hypodopaminergic state, and the following distress is one of the hallmarks of exacerbation during drug withdrawal. In short, the mesolimbic dopamine pathway is altered, resulting in irresistible cravings.

Prefrontal Cortex

The dysfunction of the prefrontal cortex leads to a loss of control over behavioral addiction and drug intake. The prefrontal cortex has a key involvement in decision-making and other high-order executive functions like self-control and awareness. Drug abuse alters the prefrontal cortex, which in turn fails to suppress reward response, resulting in uncontrolled drug use due to impaired 'stop' signals.

Why Is addiction Being Studied Through Clinical Trials?

According to UN Office on Drugs and Crime World Drug Report 2022, about 284 million people in the world between the ages of 15 and 64 use drugs. This report shows how the drug has seen a 26% increase compared to the previous decade. In America, people aged 35 and under are the majority of people being treated for drug use and addiction. Almost 11.2 million people around the world are injecting drugs, and half of these people are suffering from Hepatitis C, HIV, or both.

Addiction is not just a devastating disease for patients; it leads to severe social consequences and a high death rate worldwide.

Just like other chronic diseases like asthma, diabetes, and heart disease, drug addiction, too, doesn't have a cure. However, the disease is treatable and manageable, and many people are suffering from addiction are going for therapies and treatment medicines to manage their substance use.

It is to be noted that addiction is a relapsing disorder, which means that the people recovering from the disease are at risk for relapse for many years or their whole lives.

Researchers agree that when addiction treatment medicines are combined with behavioral therapies, there is a huge chance of success for the treatment of patients and management of this disease. The treatment plan and therapies are tailored according to individual patient's needs, drug use patterns, and other mental or social problems.

Nowadays, addiction and drug use are being prevented through certain programs involving families, communities, school, and media, and all these efforts show effectiveness in reducing and preventing drug use.

Many clinical trials and addiction research studies are being conducted to study how drug use causes brain changes that lead to addiction. The research studies will help in the development of better treatments for addiction and enhance the effectiveness of the standard treatments. Scientists are studying the potential of vaccines against these psychoactive substances, which will prevent the drugs from entering the brain.

What Are The Types of Treatments Available for addiction?

Different treatments and medications are being developed to help manage and treat addiction and its related consequences. Patients need long-term care that will help them stop drug use and recover the normal functions of their lives. The three basic goals of addiction treatment are:

• Helping the patient to stop taking drugs.
• Helping the patients to stay drug-free in the future.
• Encouraging them to be productive and play their role at work, in society, and in their families.

Addiction research studies since the mid-1970s have resulted in the following regimen that forms the basis of any treatment against addiction.

• One treatment is not right for all patients.
• Effective treatment also covers other needs of the patients apart from drug use.
• Counseling therapies are effective as a form of treatment.
• Medications must be combined with behavioral therapies for better treatment.

Considering the above points, the following treatment options have been successful in treating addiction:

Medication for detoxification

Medications are used for detoxification and relapse prevention in patients. Medical detoxification is the first step toward further treatment. The Food and Drug Administration granted the use of NSS-2 Bridge in 2017, an electronic stimulation device used to reduce post-operative opioid withdrawal symptoms.

In May 2018, FDA approved the first non-opioid medicine, lofexidine, for the management and reduction of opioid withdrawal symptoms in adults.

Relapse Prevention

Scientists are developing medications that will help patients reestablish brain function and reduce their cravings. Such medications are already available for opioid, tobacco, and alcohol addiction, and research is underway for cannabis and cocaine addiction.

Opioid addiction

Buprenorphine, naltrexone, and Methadone are currently being used for opioid addiction.

Tobacco addiction

FDA has approved bupropion and varenicline as prescription medications.

Other medications

Treating co-occurring conditions like depression and anxiety may help treat a person's addiction.

What Are Some Recent Breakthrough Clinical Trials For addiction?

2014: Center for Psychedelic and Consciousness Research, Johns Hopkins, is researching the potential of Psilocybin as a promising treatment for neuropsychiatry-related conditions. Experts recognize the potential of this chemical to help patients break their addictive dependencies on opioid substances. Psilocybin is being explored to treat addiction problems ranging from anorexia, alcoholism, and depression to Alzheimer's. The data gives an opportunity into the neuroscience of the effect of psychedelic drugs on brain activity and breaking the pattern of addiction.

2021: The Accelerated Development of Additive Pharmacotherapy Treatment, or ADAPT-2 study, which is conducted by the National Institute on Drug Abuse, has made a breakthrough in addiction research studies and the long search for the medication for methamphetamine use. The clinical trial demonstrated the effectiveness of the use of naltrexone with bupropion in the treatment of methamphetamine use disorder. This study is significant as contingency management for stimulant use disorders is underutilized, and there were no severe adverse effects of this medication combination, which resulted in adherence of the patients to this treatment.

2022: Orexin, which is also known as hypocretins, are neuropeptides that are involved in energy metabolism, stress response, sleep, arousal, and reward. The involvement of the orexin system in highly motivated behavior and other brain mechanisms is being targeted for addiction research studies. This approach can result in promising strategies in the future to mitigate relapse, reduce drug intake and restore physiological functions in the patient.

Who Are Some Of The Key Opinion Leaders / Researchers / Institutions Conducting addiction Clinical Trial Research?

National Institute on Drug Abuse (NIDA)

NIDA is leading the research studies and advanced trials for the consequences of drug use and causes of addiction. From detecting the drug abuse trends, responding to the drug's work in the brain, and developing new approaches for better treatment of addiction, NIDA is supporting several addiction research studies.

Johns Hopkins Institute of Basic Biomedical Sciences

The drug abuse and addiction research studies at IBBS focus on the lasting changes in the brain as a result of psychoactive drugs, which lead to addiction. Current addiction research studies use a combination of slow weaning, counseling, and drug replacement to control physical cravings and reverse the changes in the brain that were caused by drug use.

National Institutes of Health (NIH)

The National Institutes of Health (NIH) is a medical research agency in the US that is funding many research studies for a better understanding of addiction treatment and substance abuse. NIH plays a critical role in the understanding of all chronic diseases, and its funded research is critical for the development of future lifesaving treatment protocols.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is a part of the US Department of Health and Human Services (HHS) and focuses on the behavioral health of Americans. SAMHSA connects with those families whose loved ones have succumbed to addiction and gives a better understanding of the effects that addiction disorders and substance abuse have on the whole country.