Treatment of narcotic addiction by inhibition of craving: Contending with a cherished habit

The indefinitely repeated occurrence of powerful impulses to take drugs is the essence of drug addiction. These impulses are correlated with activity of the automatic nervous system. As early as 1941, Himmelsbach noted that the morphine abstinence syndrome (or craving) was “a disturbance affecting the autonomic division of the nervous system.”¹ The syndrome that results from repeated doses of narcotics has the features of a learned habit. Although narcotic habits always include motor acts that may have socially motivated components, treatment that concentrates on motor acts without attention to autonomic events inevitably misses the crux of the problem. The substantial failure of attempts to modify drug-taking behavior by measures directed at motor behaviors is exactly what was to have been expected.The evocations of the autonomic responses comprising the abstinence syndrome must be in response to some antecedent stimulus or stimuli. Lawrence Kolb, one of the earliest observers of addiction patterns stated: “… When we say a man relapses to drugs because he has a periodic craving …, we have stated only an end result and have left the primary cause of the craving undisclosed.”² Antecedent stimuli to craving may be in the external environment (exteroceptive),^2–11 or in a specific internal state (interoceptive).^2,5,6,12 In many cases, both external and internal antecedents can be identified.In this article we report our experiences in an experiment designed to weaken abstinence responses by systematically inhibiting them through the competition of aversive responses. The abstinence responses were induced by intravenous injections of naloxone and the aversive responses by electrical stimulation of the forearm. Our efforts achieved some success, but were largely thwarted by the subjects' almost universal disinterest in working towards change.