Prescribing cognitive enhancing drugs as an addiction treatment strategy may seem counter-intuitive, but leaders in recovery research are increasingly supporting its use as a valuable tool in the struggle against substance abuse.
COGNITIVE ENHANCERS AND ADDICTION TREATMENT
As addiction severely compromises cognitive abilities, it has been theorised that the administration of cognitive enhancers can significantly improve both the efficiency and success of recovery.
Drugs such as Ritalin (methylphenidate), Concerta (an extended-release form of methylphenidate) Adderall (amphetamine and dextroamphetamine), and Provigil (modafinil), are well-known cognitive enhancers used primarily to treat the symptoms of attention deficit hyperactivity disorder (ADHD). They function by stimulating the prefrontal cortex of the brain, the area responsible for rationalising, exerting willpower, learning and motivation. Since this is the area of the brain that becomes compromised through substance abuse, it has been theorised that these drugs would support individuals in recovery to improve their cognitive functions, and therefore increase the rate of successful recovery.
SUBSTANCE ABUSE AND THE BRAIN
Numerous brain-imaging studies on addiction demonstrate that substances such as heroin and cocaine command the prefrontal cortex, areas of the brain used for reward, motivation and learning, until a substance abuser can no longer get pleasure from any activity but ingesting the addictive substance. The brain begins to prioritise drug-seeking behaviour over any other pleasurable activities, such as food and sex. Through these studies, it has been shown that addiction is not a lack of willpower, as was once believed, but the breakdown of the cognitive functions necessary to maintain an addiction-free life after continual use.
Catherine Cosgrove, founder of Sobriety Home, identifies drug addiction as primarily a learning failure: “addicts have learned to make self-destructive choices at the expense of healthier, more appropriate ones.” Since substance abuse severely impairs these cognitive functions, one of the most important steps towards recovery is to rebuild them.
COGNITIVE ENHANCERS AND FOCUS
Cognitive enhancers have been used not only for the medical treatment of ADHD symptoms, but also as a non-medical booster for tasks that require focus and learning- most notably studying. The casual use of cognitive enhancers as a study aid continues to rise for those in High School and University struggling under the pressure of maintaining good grades. In 2005, 7% of University students in the US admitted to the non-medical use of cognitive enhancers, and up to a quarter of students at certain elite schools. It has been proven to have beneficial results- many students have reported significantly improving their grades. The positive effects of cognitive enhancers on focus, learning and motivation are widely known. Even certain governments are investigating the use of these drugs for the general public, as even a small increase in productivity can lead to a significant boost in GDP.
Although the use of these drugs may boost productiveness in the short term, the uncontrolled use of amphetamines such as Adderall can become a problem. A recent article on the use of cognitive enhancers as a study drug, ‘Risky Rise of the Good-Grade Pill’ by Alan Schwarz, outlines some of the benefits and risks of the use of these drugs.
Since the prefrontal cortex of a teenager up until the early 20s is not yet fully developed- the abuse of ADHD drugs can compromise this area of the brain to act much like that of a substance abuser. Shwarz demonstrates how those who begin using ADHD drugs as a study aid at a young age are prone to presenting the side effects of unregulated use of these pills, such as depression, anxiety and high blood pressure.
The question remains whether these are acceptable risks-while there are inherent dangers with the uncontrolled and excessive use of any substance, it is becoming evident that the positive effects of these enhancers may the negative in the case of adult recovering addicts.
AN AID FOR COGNITIVE BEHAVIOURAL THERAPY?
Cognitive behaviour therapy is a central element of addiction treatment that supports individuals in recovery to ‘unlearn’ negative behaviours such as self-medicating with drugs or alcohol. At rehab centres like Sobriety Home and Searidge Foundation, residents learn new coping strategies that help them replace this self-medication with a healthier, and much more rewarding habit such as exercise, yoga or deep breathing. As cognitive functions improve, it becomes easier to exert willpower and resort to these coping strategies rather than the drug or alcohol of choice in a stressful circumstance.
There happens to be a high rate of substance abuse among those with ADHD symptoms. In theses circumstances the use of cognitive enhancers can not only support an individual with ADHD in recovery by treating the reasoning and motivation impeded by drug use, but can also treat the underlying impulsiveness that is a common symptom of ADHD.
Cognitive enhancers could support this recovery by radically improving focus and concentration, therefore boosting the rates of learning significantly. It is very likely that the use of cognitive enhancers as a tool for addiction treatment will become a reality.
THE FUTURE OF COGNITIVE ENHANCERS IN REHAB
In the safe and controlled setting of a rehab centre, these cognitive enhancers could be used to support addiction treatment therapies such as behaviour modification and psychotherapy, to significantly improve overall recovery rates. While more research remains to be done to investigate the side effects of such aids, there are compelling arguments for why they should be used in addiction treatment.