Addiction in our society

The relationship between humans and potentially addictive substances is complex, with both positive and negative aspects. Many substances now considered harmful have been used by communities around the world for medical purposes as well as for rituals and traditions. However, these same substances have also been used in the pursuit of pleasure or escape, and often have pharmacological properties that can lead to addiction. Addiction is considered a chronic affliction characterized by compulsive cravings, excessive behavior in the pursuit of drugs, and withdrawal symptoms when the substance is not consumed.

There are those who do not consider addiction to be a disease, arguing in part that this is too reductionist a definition, given the multiple social, cultural, and psychological factors surrounding it. However, while the linguistic definition of addiction may be open to debate, it is important to recognize that it is not simply a choice. Various studies have demonstrated the impact that addiction can have on the brain. For example, it has been discovered that the prefrontal cortex, an area closely linked to decision-making, is affected by drug use and may be one of the main culprits behind the loss of control in those struggling with addiction. Addiction can cause a great deal of harm to the family, the affected individual, and society at large. In fact, alcohol use accounts for more than 5% of the global burden of disease and injury. We must continue to work to reduce the stigma associated with addiction and foster a more complete understanding of this chronic affliction.

Not everyone has the same propensity to develop an addiction. Social and cultural factors, such as peer pressure or lack of economic opportunities, can influence the development of an addiction. Genetics can also play an important role in vulnerability to addiction. It has also been observed that childhood trauma, such as physical or emotional abuse, can increase the likelihood of developing an addiction in adulthood. Such trauma can affect brain development in areas important for emotional regulation and impulse control, which in turn can increase the likelihood of developing an addiction in the future. In addition, in recent years, there has been increased research on the gender perspective in addiction, and significant differences between women and men have been identified. Addiction tends to progress more rapidly in women, and there is a higher percentage of serious consequences. This may be due in part to social factors, such as greater stigma toward women with addiction, which means fewer women seek available treatment and a higher percentage of relapses.

There are many treatments for addiction, but unfortunately none of them have a high success rate. According to the National Institutes of Health (NIH), the relapse rate after treatment is between 40 and 60%. Behavioral therapies are most commonly found in rehabilitation centers, as well as group therapies and intervention programs such as the 12 steps. Eventually, those who seek treatment are often successful (75%), but it can take many years and therefore involve a great deal of suffering. It is an extremely difficult affliction to overcome and generally requires a long-term commitment and ongoing support from friends, family, and health professionals.

Given the variable and limited response, new avenues of treatment are being explored. Among these are therapies using psychedelic substances, such as ibogaine or ketamine. We will explore the existing evidence for the latter in a little more detail.

Ketamine has several modes of action in the body, many of which are not yet well understood. However, it is postulated that ketamine enhances brain plasticity, which is commonly reduced in patients with addiction. It also enhances the production of brain-derived neurotrophic factor (BDNF). This is a protein closely linked to cognitive functions and neurogenesis. Finally, ketamine has shown a significant impact in the treatment of depression and anxiety. Addiction, like many other disorders, is often comorbid with other diseases such as depression and, therefore, a reduction in these symptoms can facilitate recovery from addiction.

The evidence

A study recently published by Grabski and colleagues conducted an intervention program with a group of patients with alcohol addiction. All patients had to have been abstinent for at least 24 hours before the start of the study. They received three infusions of ketamine or a placebo. This was also accompanied by psychological treatment or, alternatively, educational sessions on alcohol addiction. The authors postulate that, in addition to the chemical and biological effects of the substance on the body, the subjective experience of ketamine may also facilitate the implementation of other therapies, such as mindfulness.

Follow-up was conducted after 3 and 6 months. It was found that those who received psychological therapy improved more than those who received educational sessions, although this difference was not significant. The number of days of abstinence was significantly higher for those who received ketamine treatment, both at 3 and 6 months. However, the percentage of relapses was not different for either group. Even so, this study shows great promise for the use of ketamine in the treatment of alcoholism. A greater number of days of abstinence is of great importance, as it allows more time for the implementation of new techniques and the reduction of physical symptoms associated with abstinence.

In addition, there are several studies that use ketamine in the treatment of other addictions, showing good results in the treatment of cocaine addiction (here, greater motivation to abstain from use was also found after ketamine sessions), heroin addiction, and even food addiction. Another positive aspect that studies have revealed is its usefulness in reducing opioid use in patients with both chronic pain and addiction. The altered state of consciousness created by ketamine and its dissociative effects allows individuals to see themselves and their problems from other perspectives, thus creating the possibility of contemplating a life without substance use.

In conclusion, current evidence points to ketamine as a possible treatment for addiction, although further studies are still needed to establish appropriate protocols and define the target population. In addition to helping increase the number of days of abstinence, the antidepressant and therapeutic properties of ketamine provide added value by reducing symptoms and stimulating neural and cognitive changes.

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