A New Vaccine For Drinking Could Keep Alcoholics Sober | Hacker News Reader

A New Vaccine For Drinking Could Keep Alcoholics Sober

fastcoexist.com

68 pointsSpakman73 comments

I'm a psychiatrist and I work with an addiction population. I think many of them would be glad to have this as an option. It's certainly not perfect, but it would provide an additional layer of protection to people who struggle to maintain sobriety. I think it's sad that the first reaction to this is to think of it as something from "dystopian" science fiction. The oral medication disulfram shares a similar mechanism of action, but it has to be taken every day. When a patient begins to struggle they often stop the antabuse, losing the benefit. At least gives them a few months of protection and if after that they choose not to resume it sounds like that's a possibility.

With proper informed consent, it's a welcome tool to a common and potentially devastating problem.

Thank you for sharing, my very first question was going to be about antabuse and how this would differ in mechanism.

From the article -- they're hoping the fully-developed vaccine would last 6 months to a year.

That's a big deal -- you decide "yes" once, and even when the going gets rough, you don't get to change your mind for many months yet... you'll have a much better chance to build better habits, etc. before you have to decide yes/no again.

Much, much better than something you have to take daily, or even weekly.

I hope you're right. I used to be a heavy smoker and even after I cut back I was still addicted to nicotine and unable to give it up completely. Eventually I was prescribed Chantix (which was still fairly new at the time) and took it in hope rather than expectation. It worked - to such an extent that it was like a time machine for my brain, unwinding it back to an earlier stage before I had overcome my dislike for the smell and taste of tobacco. Every day that I wake up without the taste of yesterday's cigarettes or draw a deep breath I feel grateful for it's availability; it was easily the best $400 I ever spent.

I hope this offers a similar benefit for people in the grip of alcohol addiction, a much heavier burden than the one I had to cope with.

...and then the alcoholics will turn to harder drugs for which they don't have intolerance. Great news! ...if you're a drug dealer.

So you're saying that you believe in 'gateway drugs'?

not really, but imagine that you're a drinker that also smokes pot occasionally. what do you do when alcohol no longer gives you any satisfaction? increase the consumption of the other, or if you're not using smth else, look for other stimulants or disinhibitors. it's not about gateway drugs, it's about addiction swapping!

Edit: + and it's not like if you're a pot smoker, you're gonna start doing heroin when pot is no longer enough for you, so I don't believe in gateway drugs.

I don't think there's necessarily an implication of the validity of "gateway drugs" there. The same idea crossed my mind, but only if this sort of treatment is not accompanied by anything else.

It's generally agreed that people abuse alcohol because of some sort of underlying problem. If you take the option of alcohol away and do nothing to address the problem, then it's reasonable to assume that they will look elsewhere.

> It's generally agreed that people abuse alcohol because of some sort of underlying problem.

Is it?

Its quite the jump going from, a trip to the corner store to grab your bottle of vodka, to hunting down a drug dealer so you can try "harder drugs".

Accessibility definitely plays a role here.

That argument also applies to people who stop drinking without help of a drug.

The article suggests that some people's addiction might manifest in other ways. That is, if you take away alcohol, an alcoholic will look for other inebriants. Is that actually correct? I thought alcoholism was largely a genetic disorder, which predispositions some people to abuse a particular drug. If someone with the disposition has one drink, he is then enticed to have 10 drinks. But if the same person smoked a joint, he wouldn't have any more interest in smoking more weed than a normal person.

If so, then this sounds like a fantastic tool for people with an physiological addition to alcohol.

There's a lot of individual variability on this point. Many people might have a higher susceptibility to similar substances (like heroin and oxycodone), then to a slightly lesser degree broader groups like "uppers" or "downers," and then finally some people will take anything they can get their hands on.

There are wrinkles to that general formula. Some people only want cocaine and have no affinity for amphetamines, but will take opiates or benzodiazepines without discrimination.

It's pretty messy, sorry I don't have a better answer but's that's how it is.

General question...

What kind of level of drinking or drugs do you think constitutes a real problem?

I know it varies, but what is the average. I assume that one drink a month is not a problem, but where is the middle amount of alcohol do you see an issue?

Not to answer with a tautology, but it becomes a problem when it is a problem. For example, when you are missing work (or drunk/hungover at work leading to consequences), or it is causing problems in relationships, you spend an inordinate amount of time or money getting/using alcohol, etc. I would also add when you develop physical dependence as manifested by alcohol withdrawal symptoms, as alcohol withdrawal can be life threatening. People joke about "the DTs" (short for delirium tremens) but not many realize that you can die from them.

Check out the DSM for more detail about how addiction criteria are currently operationalized.

Still, I wish I had a number. I am sure there is a datapoint out there but I haven't seen it.

Even if it is, "on average a heavy drinker that claims to have a problem and registers with a psychiatrist says that they drink on average '10 drinks a week'".

The first thing that popped into my mind was a Tintin story - where Captain Haddock finds he can no longer bear the taste of whiskey. The professor had given him something akin to this.

http://en.wikipedia.org/wiki/Tintin_and_the_Picaros

Life is stranger than ...

Thundering typhoons! That's immediately what popped into my head as well.

Billions of blistering barnacles ! Another person who wasted / enlivened a childhood hiding under the bedcovers with a torch :-)

It made me think of a (more drastic) plot point in Neuromancer, but I guess Tintin far predates that. :)

But how about if that fiction was itself based on life?

Ibogaine, a hallucinogen from Africa, has been a folk remedy (with some medical evidence) for addiction for over a hundred years, and (appropriate for a Tintin reference) 1st came to European attention via French and Belgian explorers:

http://en.wikipedia.org/wiki/Ibogaine#History

> Normally, the liver breaks down alcohol into an enzyme that’s transformed into the compound acetaldehyde (responsible for that nasty hangover feeling), which in turn is degraded into another enzyme.

Replace 1st and 3rd "into" with "by", please: reading this makes my mind hurt and I'm sure it's the same for anyone with basic biochem knowledge...

So how does it work...

The second enzyme mentioned is one possessing acetaldehyde dehydrogenase activity, ALDH2 being the primary actor. This would not be a vaccine in the traditional sense since it would not cause ethanol to prompt an immunological response.

The closest paper I could find is this one from 2010, that describes the mechanism of action[1]:

"a long-term inhibition of ethanol consumption by reducing ALDH2 levels by the administration of vectors that code for anti-aldh2 antisense RNA molecules that inhibit aldh2 gene expression"

Pretty cool; they are using a viral vector to introduce complementary RNA that binds to the mRNA responsible for translation of ALDH2, directly down regulating expression of ALDH2. This reduces the number of ALDH2 enzyme molecules available to interact with acetaldehyde by reducing the number created (compared to disulfiram, which is a competitive inhibitor of ALDH2 itself). It seems the antisense RNA used targets the mitochonrial isoform of ALDH2, mimicking the effect of the "natural" mutation. I wonder if it has cross specificity adequate to inhibit expression of the cytosolic isoform as well.

Acetaldehyde is not the only substrate for ALDH2 however. Glyceryl trinitrate (nitroglycerin) and amyl nitrite are also metabolized by ALDH2, so this treatment might not be wise for those taking glyceryl trinitrate for a heart condition or amyl nitrite for cyanide poisoning/heart. It looks like the cells in coronary arteries mainly use cytosolic ALDH2 to metabolize glyceryl trinitrate[2] though, so if this "vaccine" only inhibits the mitochondrial isoform it may not interfere with the effectiveness of these other drugs.

1. (Martinez, et al.) http://www.captura.uchile.cl/bitstream/handle/2250/11147/Mar... Viral vectors for the treatment of alcoholism: Use of metabolic ﬂux analysis for cell cultivation and vector production.

2. (Beretta, et al.) http://www.ncbi.nlm.nih.gov/pubmed/22207712 Vascular bioactivation of nitroglycerin is catalyzed by cytosolic aldehyde dehydrogenase-2.

Disulfiram has been known to cause acute sensitivity to alcohol since 1948 and has been used to treat chronic alcoholism:

http://en.wikipedia.org/wiki/Disulfiram

  Disulfiram is absorbed slowly through the digestive tract
  and eliminated slowly by the body the effects may last 
  for up to two weeks after the initial intake

An interesting podcast from NPR on its use in Russia:

http://www.marketplace.org/topics/world/russia-rx/killer-cur...

The vaccine will (if it works as planned) last 6 months to a year.

It's a pet peeve of mine when articles quote their own paragraphs in big bold headings immediately below the paragraph itself.

  "It's a pet peeve of mine when articles 
   quote their own paragraphs"

After all, didn't I just read that?

I agree, yet this tactic pops up all the time. I suspect it keeps those with short attention spans (who can't be bothered to get through an entire page of writing) glued in better to the article. Anyone know what this "literary device" is called?

"yet this tactic pops up all the time."

It's called a Pull Quote. It's used in newspapers and magazines to draw you into an article as you leaf through the pages, I guess it serves basically the same purpose in blogs.

http://en.wikipedia.org/wiki/Pull_quote

It works far better in print media, in my opinion... you don't leaf through the pages of a blog.

But some people do scroll down fast, somewhat like skimming...

It works best in magazines or newspaper layouts where the pull-quote exists outside of the normal eye-path when reading the article. Then you avoid the "Hey, I just read that" moment, but still pull people in who are leafing through.

But, web pages are not typically laid out in such a way to allow for that.

It would probably work better as a side bar in this case, since the blog layout has all that wasted space on the left.

If I understand what is being proposed, the recipients of the treatment will essentially suffer from Asian flush (many people of Asian descent have a mutation that makes them less capable of breaking down alcohol and its byproducts). This may discourage the recipient from drinking in the future by essentially preventing the body from protecting itself from the ravaging effects of alcohol. Perhaps there is a better way to set up this vaccine.

About 20% of jews have the same gene mutation: http://www.ncbi.nlm.nih.gov/pubmed/12351924

There is not a better way on the market. If you invent one, untold riches can be yours.

"So far, the vaccine has been tested successfully on alcoholic mice."

How does one raise a mouse to be alcoholic? How would you even diagnose it in mice? Is there a genetic strain, or is it environmental?

> But with the biological piece of the disease taken care of, a big part of the battle is already won.

I completely disagree. IMO biology is responsible for a very very small part of the problem of addiction. As somebody who lost his mother to liver disease stemming from her addictions, these types of treatments lead to even more dangerous outcomes.

A week in rehab will remove the biological dependence of alcohol.

My mom's addictions started as a teenager with food. Food was her indulgence of choice. After years of trying to rid herself of the consequences of that addiction by dieting, she turned to weight loss surgery to help. Sure, she lost a lot of weight but this merely relieved the symptoms of her disease and did nothing the disease itself.

Years later she no longer possessed the biological ability to be addicted to food so she turned to alcohol instead. The weight loss surgery combined with only 4 years of alcohol abuse (with several stints of sobriety) was enough to ruin her liver to a point of no return.

I don't dispute that this drug could be effective for the newly sober individuals who need a little extra push to remain sober. A doctor that administers this vaccine without careful followup and psychological treatment is doing the patient a disservice.

Let's not kid ourselves, this "vaccine" does nothing but mask the symptoms of the disease leaving the patient troubled, alone and without help.

Addiction is a lifelong disease and it needs to be treated as such. Without proper treatment (psychological help), the disease will morph and before you know it have ahold of your life once again.

I remember a roommate of my in college who was a heavy smoker and was trying to quit. Friend of his was in Equinox (the multi-level marketing scheme) and gave him some of these "no smoke" tablets to cure him of his smoking habit.

He said all it did was give him intolerable diarrhea for a week and then he threw the rest of the tablets away. I would imagine most people would do the same thing with the oral medication if the effects were so drastic.

I can't imagine what on earth could have such an effect when reacting with nicotine or other comps from cigarette smoke. Do you have any reference to those "no smoke" tablets? I'm really interested in the pharma/toxycology of such a thing... (In case they were not just laxatives :) )

I don't know if this will help, but at least it might give you a lead on something. . .

http://www.equinox-products.com/masterformulas.htm#No Smoking Nutrition

if you really want to, you could order a bottle and do some tests on what exactly is in it. I'd be interested to see what they put in these things.

Things you buy from MLMs are generally overpriced, worthless, or both. Usually both.

Generalize much? The same could be said for retail stores I guess.

It's overpriced by the definition of MLM. Normal retail: the store buys from a wholesaler and sells to you. MLM: Some guy buys from the wholesaler, and sells it to his downstreams, who sell it to their downstreams, through however many levels of the pyramid it takes to reach you, the sucker^Wcustomer. Of course, they don't really want to sell items to customers, the point of MLM is to get new vendors who will buy their stocks from you.

As for crap, well, most of them sell "health products". So sometimes you're getting homeopathic "cures" (read: water), sometimes it's just $30/bottle fruit juice (Monavie).

MLM is a scourge on people with low incomes who just want to get ahead. They use cult-like techniques to make victims believe they'll get rich if they can just recruit enough people, and make sure the victims ignore any advice or warnings from outside. The only people making money here are the ones who created the thing.

Good thing this didn't exist in the 20's.

as in "It would have been put in the water along with flouride" I suppose?

Something like that.

No, bad thing.

Because this didn't exist in the 20's, the government started adding poison to alcohol not intended for drinking -- because people were drinking it, predictably, and bootleggers were reselling it to be consumed -- and killed thousands of people in the process.

http://www.slate.com/articles/health_and_science/medical_exa...

Denatured alcohol still does nasty things to people who are ignorant and/or desperate enough to try not-for-consumption alcohol... fortunately it's not so deadly nowadays (I think?).

If something is labeled "do not drink this - poisonous" then whose fault is it that you drink it?

Blame doesn't rest in one location only, does it?

Obviously the people drinking alcohol in liquids not meant for consumption aren't in normal rational states of mind; but yes, they're doing something really stupid. But suppose when you're "denaturing" the alcohol in your product, you have the choice to use a substance that will make it taste very bad and cause vomiting; or a substance that will make people die, or at least go blind. Which should you choose?

Next, suppose that the alcohol was stolen and resold by a bootlegger and thus has no warning (beyond the government's warnings that buying illegal alcohol is dangerous, which had already been going on for some time).

This is still done today. Acetaminophen s added to Vicodin specifically to make it destroy your liver if you take too much. http://www.psychologytoday.com/blog/archevore/201103/tylenol...

I am 1/4 Japanese, and have the "natural" genetic version of this. It does not stop me from drinking, though I naturally drink a lot less frequently than my peers because it is unpleasant. I don't drink casually, because the pleasure of a slight buzz is overwhelmed with the discomfort of having a hot face/chest and difficulty breathing (feels a lot like a mild asthma attack - like something heavy is sitting on your chest and making it hard to take a full breath). But at a special event or a party or something, yeah, I can and will still get drunk.

Also, as almost anyone of Asian descent can tell you, you can take a Pepcid AC (or the generic equiv) around 30-45 minutes before drinking and it slows the conversion of alcohol into acetaldehyde, making drinking with this condition more tolerable.

For someone with an actual, problematic addiction to alcohol, I don't know if the side-effects of an acetaldehyde dehydrogenase deficiency will be enough to stop drinking.

Could someone explain to me how this is a vaccine? In school we were taught inoculations boost immunity and a vaccine is a form of inoculation which works by introducing enough of a bacteria or virus to make a person build antibodies.

> Could someone explain to me how this is a vaccine?

It's a metaphor; an analogy. It might not be a very good one.

So a bit of internet sleuthing later...

The creator, Dr. Juan Asenjo, is speaking at the World Vaccine Congress and Expo [1]. He also refers to the drug as a vaccine [2].

[1] http://www.terrapinn.com/2013/world-vaccine-congress-washing...

[2] http://www.ibtimes.co.uk/articles/430928/20130203/alcoholism... (unfortunately the original source of this quote seems to be behind a paywall [3])

[3] http://www.santiagotimes.cl/chile/science-technology/25637-w...

Well, we've had similar drugs (though not vaccines) for a while I believe, and they don't always work as they should.

A guy I worked with was a recovering alcoholic on a "return-to-work" program. As a part of this program he had to take antabuse to stop him from drinking again. He died from a fatal heart attack within a month after he started working. It turns out he'd secretly still continued to drink even while on antabuse, which put an immense strain on his heart (antabuse gives tachycardia on consuming alcohol), causing the heart attack. Sad story.

Alcholics have a really strong urge to drink, even though it causes discomfort.

This is a beautiful example of a strong commitment device! I've been collecting examples of commitment devices at http://blog.beeminder.com/akrasia/#AUG (my startup, Beeminder, is also an example of a commitment device).

Anyone know (a) whether 23andme will pick up the natural genetic mutation mentioned, and (b) whether you can have varying degress of this condition?

Just curious: 60% of the time, alcohol makes me feel terrible every time...

They do: https://www.23andme.com/health/Alcohol-Flush-Reaction/

Basically, vaccine induced allergy.

Just for educational purposes, you should know that this flush in no way resembles allergic reaction. It's an important distinction because drug toxicity can often be worked around by changing the dose, etc, while true allergy is highly dangerous as it can lead to anaphylaxis.

Clockwork Orange

It is not uncommon that the line between ethical and exciting and unethical and dystopic is drawn at "voluntary".

Imagine if we gave gastric bypasses to fat people against their will. Horrible, right? We don't do that though, so we have few ethical issues with the procedure.

you need to cure the causes not the effects.

Yeah, give my dad this and he'll just up his consumption of Klonopin.

It's a lot harder to cure the causes than the effects.

Really? :)

I absolutely agree, but I believe it may be easier to cure the causes of alcoholism during periods of sobriety.

There is nothing wrong with a temporary clutch. After all, and actually clutch doesn't cure someone's broken leg, but you wouldn't take it away from someone with a broke leg. A clutch gives people time to heal. This can do that too.

Crutch.

Damn you auto correct

What I am saying is that if you coerce someone into getting out of an addiction that he got into because he has been having some frustrations with his emotional/social life, then you are just pushing the frustration relief that alchool has been giving him so far, into something else (another drug addiction, over-eating violence, ...).

You can't automagically fix the brain. We live by feelings, which are the world most powerfull "things", in both positive and negative sense.

If an alchoolist had by himself the means to rationalize why he is an alchoolist and what to fix in his life or mindset to not be one, then he would have stopped himself immediately.

But he got into this in the first place and because he has not stopped yet, it means that he has not yet achieved these understandings.

I am no psychologist here, just a random guy who, from time to time has been experiencing some time frames of deep demotivation and feelings of social inadequateness due to some parents relationship issues and probably a bit of over-sensitivity. In those time frames alchool consumption got higher than average (but didn't reach an alchoolist level).

So I am just elaborating on what at that time would have meant to me to make me hate my only stress relief (which also worked to me as a little mood-booster to push me to have a bit more social life). Where would I find another stress-relief ? Inside myself ? I was not ready to understand myself, and sometime you just don't have around you the right friends or people who will help you doing that. So I would have probably stuck to some other substance.

As for everything (and as we say many times for IT), when you don't know something, you don't even know what you don't know about it, and so wheter or not and where you need to search for help.

It's only now that I can rationally understand what was going on. But at the time I'd probably told you that I had no issues, and that anyway, I was following a "right" path.

If I was a totally-alone person, if you had fed me that pill and wash your hands afterwards (which is exactly how modern-world government & health care systems would manage it) then you would have basically got me lost in some other psychologically wrong behaviour.

Not everyone is like me, I know, but I think that: magic pill + hand washing = streets are clear from drunken people -> governent & lucky people are happier -> general society applaudes on itself for being able to defeat alchoolism plague -> unlucky people are just struggling somewhere else with other dangerous stress relief: bad habits, behaviours or substances.

At least alchoolism is visible, it's not hidden like some hard to see pathology with subtle or no symptoms at all, so let's use this evident symptomatology to cure the cause, and not the effects, let's just not hide them !

Clear now?

This means that one slip-up won't become the slippery slope. That's a big deal.

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