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Pavlov’s Dog And Pharmacological Extinction: A Cure For Addiction?

Who was Ivan Pavlov?

Pavlov was a Russian physiologist who studied classical conditioning in animals. In 1904, Pavlov was awarded the Nobel Prize. He was the first Russian to be awarded the Nobel Prize. His work with training animals to respond to a stimulus can be also applied to humans. This has led to many experiments in studying human behaviorism.

What does Pavlov’s dog have to do with addiction?

Ivan Pavlov performed a famous experiment in which he would ring a bell when providing food to a dog. The dog, smelling the food, would salivate. Pavlov trained the dog extensively, ringing the bell and giving the dog food. Each time, the dog would salivate as a response to smelling food. After a period of training, Pavlov would then ring the bell without giving the dog food. The dog would still salivate, just by hearing the bell! There are addiction experts who believe that addiction develops in a similar way. A person uses a drug repeatedly that provides them with pleasure. Their brain is then conditioned to associate the drug as being a necessity, just like food and water. When an addicted person sees or even thinks about their drug of choice, they immediately experience intense cravings for the drug. 

Can addiction be unconditioned?

Pavlovian conditioning, it turns out, works both ways. The dog that salivates when triggered by the ringing of a bell will eventually stop salivating when food is not given after many rings of the bell. The conditioning associated with drug and alcohol use is not so simple to reverse. Dr. John David Sinclair studied a process known as pharmacological extinction which is based on Pavlov’s work. His goal was to reverse the conditioning to alcohol in the alcoholic’s brain. He discovered that the human brain became dependent on alcohol due to reinforcement with endorphins being released to stimulate the opioid receptors. He was able to demonstrate that by suppressing this natural reward system using potent opioid receptor blockers, the alcoholic would gradually become less dependent on alcohol over time. 

How does The Sinclair Method compare to Pavlov’s dog exactly?

When Pavlov rang the bell, the dog was rewarded with food. The dog naturally craved the food and was triggered to salivate. When a person drinks alcohol and feels good from the effects of it, endorphins flood the central nervous system, rewarding the brain by activating opioid receptors. Alcohol, is in effect, hijacking the brain’s natural reward system that exists for the purpose of reinforcing life-promoting habits, such as eating food, exercising, and reproducing. By blocking this reward system chemically, with an opioid blocker such as naltrexone, for example, it has the same effect as Pavlov ringing the bell repeatedly but not giving the dog food anymore with the bell. This is pharmacological extinction. The learned behavior of craving alcohol is gradually extinguished.

Can this process of pharmacological extinction be applied to other addictions?

There is evidence that the same process that Dr. Sinclair developed for treating alcoholics may work for other addictions. Binge eating is one area that may respond well to this treatment. There have been studies using naloxone nasal spray, a short-acting opioid receptor blocker, to treat binge eating. There may also be an application of the process of treating cocaine and amphetamine addiction.  

What about opioid addiction?

If naltrexone works so well in extinguishing cravings to alcohol, what about opioids? With The Sinclair Method (TSM), the patient is instructed to take naltrexone an hour before having a drink. Should doctors tell heroin addicts to take naltrexone an hour before using heroin? No! The results would be disastrous. Where alcohol hijacks the brain’s reward system, heroin mounts an all-out direct assault by stimulating the opioid receptors directly, far more potently than our natural endorphins ever could.

What happens if you give naltrexone to a heroin user?

If you give naltrexone to an active heroin user, they will go into what is called precipitated withdrawal. Precipitated withdrawal is a very unpleasant experience. Yet, naltrexone is useful in treating opioid addiction. The way it works to treat opioid use disorder is to start the naltrexone 1-2 weeks after the last opioid use. This is ideal for residential rehabs where patients have been detoxed and kept opioid-free for at least 1-2 weeks. Surprisingly, few rehabs do this. It should be standard practice.

Saving lives with the sound of a bell.

Pavlovian conditioning seems like a basic concept to schoolchildren today. Over one hundred years after Pavlov did his research, it seems almost obvious now. The concept of conditioned response is routinely applied to animal training. It is also applied in human psychology. Hopefully, its use in treating addiction will also someday be better understood and commonplace. If Pavlov’s work can lead to a cure for addiction through pharmacological extinction, we will be even more grateful for his groundbreaking discoveries made at the turn of the 20th century.

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