Dr. James Halikas Finds That a Pill Made for Seizures May Help Cocaine Addicts to Just Say No
Like most drug addictions, the craving for cocaine is extremely difficult to curb. Despite good intentions and their best efforts, about 80 percent of cocaine addicts who try to kick the habit fail. But Dr. James Halikas, 48, a professor of psychiatry and director of the chemical dependency treatment program at the University of Minnesota, believes he may have found a medication for cocaine addiction that, coupled with group therapy, makes it easier for the addict to break his habit. Building on his two decades of research in drug and alcohol problems and on recent findings about the brain, Dr. Halikas in 1986 began to study how carbamazepine or CBZ—an anticonvulsant widely prescribed for epileptic seizures—affects cocaine craving in addicts. His results have been so promising that New York's Sen. Daniel Moynihan has called the drug researcher "inspired—indeed, inspiring." Says Dr. David E. Smith, founder and medical director of San Francisco's Haight Ashbury Free Clinics: "James Halikas presents an innovative treatment strategy based on new understanding of how cocaine affects the brain." Dr. Halikas, who lives with his family outside St. Paul, spoke to PEOPLE reporter Nancy Stesin about his experiments with CBZ.
What are the results of your initial studies?
We began with hard-core cocaine addicts. On average, this group had failed four previous treatment attempts, had used drugs for 17 years, including an average of seven years each on cocaine, and had been arrested nine times apiece, serving 18 months in jail. Of those first 26 patients, 10 took the pill regularly and on average cut their cocaine use from 69 days out of 100 down to about 1.2 days. Some have now stopped completely, for up to 18 months. Another 10 took CBZ periodically and cut their use by two-thirds. The rest dropped out in less than one week.
How does CBZ affect a cocaine addict?
The use of cocaine causes the cells in the brain's pleasure center, within the limbic system, to become more sensitive by a process known as "kindling." These supersensitive cells are likely to fire electrical impulses prematurely, like a hot spark plug, starting a chain reaction that spreads to the neighbor cells, which also become more sensitive. Kindling, then, is like a cellular memory of cocaine, which causes the intense craving. We believe CBZ, whose brand name is Tegretol, can eliminate or significantly reduce kindling, curbing the craving for cocaine.
Is this true for cocaine's smokable form, crack?
Yes. Crack is even more of a problem because the craving is almost uncontrollable. The addict wakes up thinking about getting high, and the craving comes and goes throughout the day. It is triggered by many things—memories, smells, having a wad of cash, powdering a baby with talcum. The wave of craving, lasting from five minutes to an hour, will overwhelm the addict. Our preliminary data show that crack patients respond well to CBZ.
Is the recognition of kindling new?
No. In 1929, it was shown that if you inject a rat with cocaine, he is bouncy and happy. But after several weeks of the same daily dose, the rat becomes more and more sensitive and begins to have seizures, caused by late-stage kindling. Other drugs such as smokable methamphetamine—known on the street as "ice"—also cause kindling in lab animals.
Why is the reduction of craving critical?
Because it gives responsibility back to the individual. With his craving curbed, and by involving himself in therapy groups, the recovering addict can begin to control his cocaine use. Group therapy and counseling are of course critical, because you must address the reasons why someone becomes an addict.
How is CBZ given?
In pill form, ideally twice a day, with increases over the first two weeks. The dose is typically l/3 to½ less than that prescribed for epileptic seizures. The most common side effects are drowsiness and sometimes dizziness, but they usually disappear quickly.
How long must the patient be treated?
It's too early to know for sure, but so far patients seem to need the medication for three months to as long as a year.
Is CBZ anything like methadone for heroin addicts?
Absolutely not. Methadone is a narcotic that is a substitute for another narcotic. CBZ is not addicting. It's a specific antidote to cocaine craving in the brain.
What can you say about your program's future?
We've just begun a second study of street cocaine users at a Twin Cities hospital, which will involve a control group receiving a placebo. Thus far we have grounds for cautious optimism, but until more studies are done elsewhere, we can only say we are very hopeful.
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