Preventing Relapse in Patients Addicted to Cocaine

relapseRelapse is of high-risk for individuals who suffer from all addictions, even those who have been sober for months or years.[1] In fact, the National Institute on Drug Abuse estimates that between 40 and 60 percent of individuals with addiction will relapse at some point in their lives.1 Within six months of receiving treatment, the rate is at its highest of 80 percent.1 Although some relapse triggers can be avoided, others are related to the brain’s reward system and may be impossible to avoid.1

Researchers at Penn Medicine’s Center for Studies of Addiction have found that the drug baclofen, which is commonly used to prevent spasms in patients with spinal cord injuries, can help to block the impact of the brain’s response to unconscious drug triggers before conscious craving occurs.1 Researchers state that this drug has the potential to prevent cocaine relapse, specifically.1

“The study was inspired by patients who had been experiencing moments of ‘volcanic craving,’ being suddenly overcome by the extreme desire for cocaine but without a trigger that they could put their finger on,” said senior author Anna Rose Childress, PhD. “The sights, sounds, smells, and memories of the drug could activate the brain’s reward circuit. Now we wanted to understand whether a medication could inhibit these early brain responses.”1

The study tested the drug baclofen, which was FDA approved for spasm in 1977.1 They had 23 cocaine-dependent participants: all male, ages 18 to 55.1 Each participant reported using cocaine at least eight of the 30 days prior to screening.1 The study required them to stay in a supervised inpatient drug treatment facility for 10 days, to not be on any mediation affecting dopamine or neurotransmitter response, and to have no history of psychosis, seizures, or brain syndromes unrelated to cocaine use.1

When admitted, patients were randomized to receive either baclofen or placebo.1 Over the first six days, patients who were randomized to receive baclofen received the medication in increasing dosages until 60mg.1 After that, all of the patients were placed in an fMRI and shown photos to measure their neural responses to ultra-brief images of cocaine and other comparison pictures.1 Each of the pictures of cocaine were followed by a longer view of a picture of non-drug objects or scenes.1 Therefore, the participants were aware of the longer pictures, while the pictures of cocaine remained outside of their conscious awareness.1

“We wanted to present the key stimulus: images of drug use and preparation, sexual images, and other aversive images in a way such that the brain could not consciously process them, but so that we could measure their earliest, subconscious effect on the brain,” said Childress.1

The researchers found that the patients who were treated with the baclofen showed a significantly lower response in the reward and motivational circuits when shown the subliminal cocaine pictures, compared to those who were not on baclofen.1 Also, no differences were seen in the baclofen and placebo group when shown pictures of sexual and aversive cues, showing that the effects of baclofen were specific to drug cues.1

“These finding suggest that the brain response to drug cues presented outside of awareness can be pharmacologically inhibited, providing a mechanism for baclofen’s potential benefit in addiction,” said Young. “Further studies will show whether the prevention of these early brain responses is associated with reduced rates of craving and relapse in cocaine-dependent patients.”1

[1] Perelman School of Medicine at the University of Pennsylvania. (2014, April 1). Preventing relapse in cocaine-addicted patients with new methods. ScienceDaily. Retrieved April 9, 2014 from www.sciencedaily.com/releases/2014/04/140401172914.htm

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