Would it make sense to induce a coma in someone who is an addict (any substance)? While in a coma, their body would be detoxed and given time to recover. With all of the physical trauma of withdrawal gone unnoticed by them, would it, then, be easier to address the mental/emotional factors of their addiction? I don’t even know enough about this to know whether or not this is an extremely stupid/naive idea, but I’m just really curious about this. Thanks!
IANAD, but, just from observing the process of a prolonged, induced coma in my father while he was recovering from septic shock, I would guess it would be too dangerous and the level of care required would be too costly.
I suppose that all the chemicals and crap that addicts tend to have in their systems are too much of an unknown factor to take the risk. Also, many of them will be in poor health, which is not the best way to enter a coma, induced or not.
It isn’t a totally crackpot idea but I am not not sure what the benefit is supposed to be. The process of detoxing also includes some rehab and information about what is going on plus a scare factor. I am a recovering alcoholic who went through three in-patient detoxes before getting better. People with drug and alcohol addictions are masters of finding loopholes and the easy way out and it probably isn’t a great idea to create more on purpose. OTOH, I did read a story a little while back about a doctor that invented a way to do rapid detoxes (like 24 hours) and catered to the rich and famous. However, detoxes done in a hospital setting are carefully managed by doctors and while they aren’t fun, the staff doesn’t usually let patients be in too much pain. Medications can blunt withdrawal and make it safe.
This is actually done by some addiction treatment centers, at least for addictions to opioids like heroin, morphine, oxy- or hydro-codone, etc. It’s called Ultra-Rapid Opioid Detox, or UROD; they put you under general anesthesia for 24-48 hours and pump you full of naloxone during that time. Ordinarily naloxone kicks an addict into extremely uncomfortable full-blown withdrawal immediately, but since they’re unconscious, it doesn’t matter. Supposedly, once the procedure is done, you’re already past the worst of the physical symptoms and only have to deal with the cravings.
In reality, it doesn’t seem to work very well (the rates of relapse are pretty high), and it’s so expensive that the majority of addicts can’t afford it anyway (I’ve seen prices from $3,000 to $15,000, though it’s been a while since I checked). Plus it apparently reduces your tolerance quite a bit, so there are reports that addicts often undergo the treatment with the full intention of remaining addicts, just so they can feel the euphoria again instead of just keeping themselves from feeling sick.
Also, it probably wouldn’t work very well for longer-acting opioids like methadone, where the physical symptoms of withdrawal can last for weeks instead of a couple days.
It probably would help for somebody who was a very recent addict and just wanted to get past the discomfort. I remember George Clooney’s character performed the procedure on a baby that was born addicted to methadone, and whose mother kept stealing his methadone for herself, in the … um … fifth season of ER, I think it was. I wondered at the time why they would bother when the baby would probably still feel bad for weeks after that, but whatever.
I can’t vouch for the efficacy or safety of The Waismann Method, but it is a so-called “rapix detox” treatment that involves general anesthesia.
The small community I live in has restricted the prescribing of pain medication to grievous wounds and terminal patients, and the doctors refer chronic pain patients to pain clinics in Anchorage. A few years ago a person I have known for many years was deeply hooked to morphine and oxy. She went up to Anchorage and was put into an induced coma to detox her. The only problem was that when it was time for her to “wake up”, she didn’t. For several weeks it was touch and go if she was going to live before she finally was brought back to consciousness. However she is all kinds of messed up, her cognitive abilities are toast, she is on oxygen, she isn’t ambulatory, etc. and she is only in her 40’s. She is an Alaska Native and this procedure was through Native Services, so I do not believe she paid anything.
Me? I decided to just quit morphine cold. Not the best idea I have ever had, but I survived, and I handle my pain with, well, I deal with it.
Here’s a story from Wired about the aforementioned-and-linked Waismann Method.
Ah yes, the “softer, easier way” of detoxing. It’s generally not appropriate for most opiate detoxification, which is, in and of itself, not life-threatening. For reasons already pointed out above.
Experiencing the psychological and physical withdrawal from opiates does have a distinct therapeutic benefit for opiate addicts. In my opinion. And I’ve detoxed several dozen opiate addicts in my career, via a variety of methods (but not the Waismann method). I’ve also gone thru opiate withdrawal myself via a variety of methods (again, not the Waismann method.)
http://en.wikipedia.org/wiki/Waismann_Method is pretty similar to coma induced detox
I want to say a couple of words about ibogaine, since you seem to be asking indirectly about painless withdrawal/detox treatments. Ibogaine has been known to completely halt opioid withdrawal symptoms in humans in as few as 3 hours, with effects lasting 2 to 6 months. A strongly skeptical response is normal at this point, so before responding that this is impossible, please help yourself to some cites.
In addition to opioid dependence, studies in rats and anecdotal reports in humans suggest it is helpful for alcohol and cocaine as well. The downside is that it is an extremely potent, long-acting hallucinogen with a body load that some find quite uncomfortable. A treatment at a reputable facility costs $2000-$4000 and lasts 3 to 7 days, as it can be a shock to the system. It is illegal in the US but there are reputable clinics in Canada, Mexico, Europe, Asia, Africa, and South America. In fact Canadian National Health is currently funding a study of ibogaine’s efficacy in treating addiction. It works for many people, but not everyone, particularly lifelong addicts of advanced age in poor health.
This having been said, no matter whether your healing journey takes hours or years, curing the physical symptoms is only half the battle (if even that). If you don’t gain self-awareness of the issues and circumstances that contributed to your addiction, you’ll be likely to slide back into it as soon as life takes a downturn and temptation presents itself.
Addiction treatment is still trying to find the most effective way to get people to stay abstinent. I’ve been in addiction treatment (provider, not customer) for 5 years and there are general things that apply across the board but each treatment is very individual. Detox does indeed have some therapeutic benefit as Qadgop said. My personal working theory for addiction treatment is that the customer needs both the stick and the carrot. They need to feel the pain of addiction and be tempted by the benefits of recovery. Like I said, general things apply. I don’t think there is a magic bullet to “cure” addiction. Oh, and Kaiwik, damn! Withdrawal, I know just plain sucks, but to go cold turkey. You are sir/mam, are a rare bird indeed.
In Australia most people would think of deep sleep therapy. Note the discouraging death rate.
Are there any scientific studies that indicate pain is necessary for addiction recovery? I think this is just due to our societal bias toward treating everything as a conditioning problem and unconscious notion that addiction is somehow an offense that requires punishing to correct.
Aren’t you familiar at all with ibogaine? Please read my post above.
My SIL went into a coma due to alcoholism. She was out for a month (and nearly died), which was perfect for detox purposes, but when she woke up, she still had the habit and the craving, so it didn’t help in the long-term. If all you had to do was go to sleep for an extended period, alcoholism would be erraidicated. The problem is much more complex than that.
I’ve read the literature put out by the proponents and the skeptics regarding ibogaine therapy, including the recent article: Ibogaine Therapy: A ‘Vast, Uncontrolled Experiment’ By Brian Vastag, in Science 15 April 2005.
(sorry, I couldn’t find a free copy on the net)
We need more study.
Not familiar with ibogaine and I will read your link as soon as possible. Scientific studies about the need for pain? I’m not talking about pain. You can look up Transtheortical Change Theory and Motivational Interviewing. The basic premise is that there are 5 stages of change. Without going into to much detail, whenever we (humans) change we start from not considering change then move to thinking about it, then planning for it, then doing it. Often times, it takes several or one really significant adverse event for the substance dependent individual to consider change.
Just to clarify, I’m not suggesting nor do I condone “punishing” people who are addicted. Just letting them experience the natural consequences of their drug/alcohol abuse. My personal approach is to assist them with identifying the rewards of recovery. Get them excited about staying clean and sober. The idea of the “stick” is to keep them from moving backwards. I would prefer to never have to use it. Just keep following the carrot but if you stop, I’ll tap you to remind you.
In reality, continued use of substances in an addictive fashion will result in incarceration or other legal problems. Take the legal question out of it and the person still has to deal with loss of a job, disintegrating relationships, loss of dignity, etc. So far, according the theories I mentioned above, the most effective treatment for substance abuse is increasing self-efficacy and establishing a trusting relationship.
My thoughts about the need for “the stick” are rooted in the belief that if I continue to enable your addiction, what reason do you have to stop. Personally, if your pattern of substance use is working for you, go right ahead. Unfortunately, drug and alcohol use is so powerfully rewarding that most people will continue to use it in an addictive fashion until something really bad happens (e.g., DUI, Incarceration, OD, getting fired).
Since it’s the topic of discussion and I wouldn’t be posting full issues, I feel that posting the article someplace for others to read falls under fair use. If someone can tell me how and where to post it I will.
Brain Wreck, I checked out the link on Ibogaine. Looks risky, but what the hell, whatever works. It seems like it was being used for detox and at therapeutic doses, the side effects didn’t seem pleasant.
Recovery from addiction requires more than just detox. There are a lot of behavioral components to treating addictions. The addicted person has permanently altered his/her brain. The reward system was likely already compromised (yes, addiction is heriditary) and then further corrupted by the drugs. Addiction is a brain disorder, and so requires a holistic approach to treatment. This requires some behavior and cognitive restructuring.
I’m all for harm reduction and believe in the therapeutic effects of methadone and buprenophine even more so.
The mods would of course have to be the ones to rule on this, but I seriously doubt that it could be considered fair use.
RR