In 2013, cocaine use accounted for almost six percent of all admissions to drug abuse treatment programs. Unlike the methadone or buprenorphine used in the treatment of heroin dependency, there are no medications to treat cocaine addiction. Treatment usually involves talk therapies such as cognitive behavioral therapy, although there are some medications that can be taken to curb certain side effects (sleeping pills for insomnia, for example.) Research on treating cocaine addiction has been focused on targeting dopamine receptors, which control pleasure and reward signals. Cocaine and other drugs highjack dopamine pathways and make the brain want to repeat the experience of taking drugs.
One interesting new possibility in cocaine addiction treatment is possibly the last thing you’d expect – stomach acid. In a paper published in July 2018 in PLOS Biology, researches explained that a certain bariatric (weight loss) surgery that increases systemic bile acids could cut down on cocaine cravings. The surgery causes some stomach bile to be diverted into the bloodstream, which was originally intended to reduce high fat intakes and reduce obesity. However, it turns out that in studies on addicted mice, this acid reduced cocaine cravings.
How can an acid from the digestive tract that breaks down fats influence the brain? Most bile acid does remain within the digestive system, where it passes from liver to gallbladder to small intestine. However, a small amount will make its way into the bloodstream and eventually to the brain. The acid can cross the blood-brain barrier, a semipermeable membrane that separates blood circulating in the body from the brain. Once it reaches the brain, the bile can interact with receptors and influence the way we think. The bile acids seem to interact with the dopamine reward system in our brains by dampening the response – meaning less enjoyment from whatever stimuli is used. Researchers gave the surgery to cocaine addicted rats, and afterward they found lower levels of dopamine present after a hit of cocaine.
Bile acids are already approved by the Food and Drug Administration for certain treatments. As indicated by the original purpose for the surgery, they can help with weight loss and other conditions that involve poor decision making by affecting dopamine levels. It’s not just the effect on dopamine that makes them helpful, either. In 2016, they approved a drug called Ocaliva (obeticholic acid) for the treatment of primary biliary cholangitis (PBC), a chronic liver disease that results from progressive destruction of the bile ducts in the liver. There’s even some evidence that bile acids can protect brain cells against diseases like Alzheimer’s, Parkinson’s and ALS by decreasing rates of cell death, although further studies are needed to understand exactly how bile acids work in the brain.
If you or a loved one need help with quitting drugs or alcohol, consider Asana Recovery. We offer medical detox, along with both residential and outpatient programs, and you’ll be supervised by a highly trained staff of medical professionals, counselors, and therapists. Call us any time at (949) 438-4504.
