Using the Placebo Effect as Addiction Treatment

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A placebo effect occurs when some form of ineffectual treatment (in research studies a placebo) is actually effective in reducing or treating the symptoms of a particular disease or other type of disorder. Placebo effects are typically strongest in situations where it is the subjective viewpoint of the person that plays an important role in the interpretation and severity of their symptoms, feelings and/or attitudes [1]. Placebo effects have been highly researched and a recent study demonstrated how the power of belief, an important component of the placebo effect, affects the areas of the brain that are considered to be activated during addictive behaviors [2].

The researchers set out to determine if smokers’ beliefs about nicotine would have a positive effect based on their expectations. The researchers performed a true experiment where one group of smokers were told that the cigarettes that they smoked were nicotine free, whereas the other group of smokers were told that the cigarettes they were smoking contained nicotine. In fact, both groups of the participants were actually smoking standard nicotine-containing cigarettes. Following smoking the cigarettes all of the participants underwent functional magnetic resonance imaging of their brains (fMRI). Interestingly, the participants who believed that they had smoked cigarettes with nicotine demonstrated much higher brain activity in their brain reward-learning pathways compared to those who believed that their cigarettes contain no nicotine, even though both groups smoked regular cigarettes [2].

The researchers believe that these findings may be useful in developing new treatments for addiction that manage the person’s belief system. This type of research is actually not new and other studies have similar type findings regarding how a person’s beliefs influence the brains of individuals with other addictions such as cocaine, alcohol, etc. [see #3 for a discussion]. Moreover, older research has even indicated that some individuals who were told they are drinking alcoholic beverages when in fact no alcohol was in them began to display symptoms of drunkenness [1]. Thus, a person’s beliefs can influence both their addictive behavior and their recovery. This type of research often stirs a debate that giving addicts placebos can be a treatment option.

Placebos as Treatments: Yes or No?

This writer has written quite a bit on the effects of placebos and how placebos stimulate the central nervous system [1]. Interestingly, while the aforementioned studies do not propose using placebos as treatments for anything, a common conclusion made by many is something to the effect of”Well, if placebos work like treatments for many conditions and placebos are basically safe because they are inert, then why don’t counselors and medical professionals give placebos as treatments?”In fact, this writer has had to debate this potential type of practice with certain uninformed medical professionals and several previous studies have indicated that some medical professionals and clinicians believe that it is ethical and advisable to administer placebos as treatments when no other alternative exists. However, this belief is not true.

While working on a person’s belief system is a fundamental component of any form of therapy including therapy for treating addiction, formally using a placebo as a treatment is unethical. First of all, the American Medical Association and the American Psychological Association consider the use of placebos as treatments unethical unless the person receiving the placebo is fully informed concerning what a placebo is and of its use and then after being fully informed agrees to receive the placebo in place of an actual treatment [4]. Most people upon learning about what placebos are would not pay a physician or other medical professional to treat them with one. Thus, the use of placebos is only justified in research such as clinical trials where the participants are informed that they might be getting a placebo instead of the treatment but are not told which one they are really getting.

The reader might ask themselves why using placebos is unethical. The reasons are quite simple. First, placebos are demonstrated through empirical evidence to have no real affects on the conditions that they are given for. If a clinician offers a placebo as a treatment without explaining to the patient that what they are getting is an inactive treatment this results in the use of deception and dishonesty by the clinical professional, especially if the placebo is used in the guise and effective treatment. Such a practice violates the ethical notion that clinicians must be frank and forthcoming regarding the types of treatments that they use with their patients.

Secondly, it is dishonest and unethical to charge someone for a treatment that the clinician knows is not established as being effective. Would you really pay a doctor to give you a placebo like a sugar pill after they told you that the pill had no real treatment benefit? Now you might say “What if the treatment provider does not charge me and gives me the placebo?” But think about that for a second. Do you really need to see a doctor or treatment provider to get a sugar pill? Does that even make sense? Why not just go take some sugar for your addiction or other ailment yourself (of course this won’t work because you don’t believe that it will). A big part of the placebo effect is the belief that one is receiving treatment.

Third, there is no way to predict whether a placebo will actually be effective with someone. Placebo effects vary widely with much more variation than actual treatment effects and are primarily effective when the complaint or symptom is subjective and subject to a person’s emotional state [1]. For instance, placebos have virtually no effect in helping people with physical diseases such as people who have cancerous tumors of their brain eliminate or shrink the tumor; however, placebos might help in lessening their pain (pain is a very subjective experience that is moderated by one’s emotions and there is no way to actually objectively measure a person’s pain; 1). Thus, placebo effects are often not strongly observed in research studies for diseases or conditions where the symptoms and their progression can be physically and/or objectively measured.

Finally, there is quite a difference between using or changing a person’s belief system in order to help them in recovery compared to administering placebos under the guise of offering a real treatment to an individual. Thus, the specific use of placebos by trained and licensed clinicians as actual treatments is both unethical and illegal; however, due to the nature of just being treated any individual in treatment may experience some level of placebo effects. What this means is that for many of the treatments that you use for problems that have a highly subjective component to them such as pain, your mood, and even your approach to recovery from addiction there is both a treatment effect and a potential placebo effect working in tandem. What qualifies many of these as actual clinical treatments is their ability to provide demonstrable benefits beyond the effects observed with placebos alone. Interestingly many of the alternative treatments you see advertised for many common ailments and conditions have a large placebo effect and little to no treatment effect.

Would you be willing to pay for treatment if you knew it was a placebo?

References

[1] Hatfield, R. C. (2013). The everything guide to the human brain. Avon, MA: Adams.

[2] Gu, X., Lohrenz, T., Salas, R., Baldwin, P. R., Soltani, A., Kirk, U., … & Montague, P. R. (2015). Belief about nicotine selectively modulates value and reward prediction error signals in smokers. Proceedings of the National Academy of Sciences, 112(8), 2539-2534.

[3] Volkow, N. D., & Baler, R. (2015). Beliefs modulate the effects of drugs on the human brain. Proceedings of the National Academy of Sciences, 112(8), 2301-2302.

[4] http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8083.page?


Dr. Hatfield is a clinical neuropsychologist with extensive experience assessing and treating neurological and psychiatric disorders. His areas of expertise include neurobiology, behavior, dementia, head injury, addiction, abnormal psychology, personality disorders, statistics, rehabilitation psychology and research methodology.

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