
A New Vaccine For Drinking Could Keep Alcoholics Sober - Spakman
http://www.fastcoexist.com/1681344/a-new-vaccine-for-drinking-could-keep-alcoholics-sober
======
phren0logy
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.

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

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

~~~
Falling3
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.

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

Is it?

------
lifeisstillgood
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 ...

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

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

------
nnq
> 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...

------
tomkinstinch
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...](http://www.captura.uchile.cl/bitstream/handle/2250/11147/Martinez_V.pdf?sequence=1)
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.

------
kqr2
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...](http://www.marketplace.org/topics/world/russia-rx/killer-cure-
alcoholism-russia)

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

------
biot
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?

~~~
ImprovedSilence
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."

~~~
evan_
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>

~~~
scott_s
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.

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

------
jostmey
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.

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

------
kibwen
_"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?

------
chrisgoodrich
> 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.

------
at-fates-hands
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.

~~~
nnq
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 :) )

~~~
at-fates-hands
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.

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

~~~
jtheory
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...](http://www.slate.com/articles/health_and_science/medical_examiner/2010/02/the_chemists_war.html)

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?).

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

~~~
jtheory
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).

------
cowpewter
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.

------
cron
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.

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

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

~~~
cron
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...](http://www.terrapinn.com/2013/world-vaccine-congress-
washington/speaker-juan-ASENJO.stm)

[2]
[http://www.ibtimes.co.uk/articles/430928/20130203/alcoholism...](http://www.ibtimes.co.uk/articles/430928/20130203/alcoholism-
cure-alcohol-hangover-antabuse-university-chile.htm) (unfortunately the
original source of this quote seems to be behind a paywall [3])

[3] [http://www.santiagotimes.cl/chile/science-
technology/25637-w...](http://www.santiagotimes.cl/chile/science-
technology/25637-worlds-first-alcoholism-vaccine-to-run-preclinical-trial-in-
chile)

------
matsiyatzy
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.

------
dreeves
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).

------
zellyn
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...

~~~
ta123987
They do: <https://www.23andme.com/health/Alcohol-Flush-Reaction/>

------
yekko
Basically, vaccine induced allergy.

~~~
carbocation
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.

------
macrael
Clockwork Orange

~~~
jlgreco
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.

------
MrBra
you need to cure the causes not the effects.

~~~
rmc
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.

~~~
jff
Crutch.

~~~
MrBra
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?

