EDITORIAL COMMENT: Hyperkatifeia

On Friday 05 April, the Annual ASAM Scientific Conference included two plenary sessions titled, “Big Ideas.”  At the latter of these were Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA); and Dr. George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).  Both provided brief presentations to serve as take-off points for a colloquium hosted by Dr. Kelly Clark, then President of ASAM.

George Koob’s presentation centered on “hyperkatifeia”*, a coinage that he introduced in 2010** with Joseph Shurman and Howard Gutstein, as “…the increased intensity of negative emotional/motivational symptoms and signs observed during withdrawal from abused drugs.”  It’s a lovely word with a grim portent.  As he went on to note, it represents “…the increases in emotional distress and emotional pain experienced by individuals with addiction during abstinence.” 

The presentations, the discussions, and the questions that followed revolved elliptically around the two points of how best to induce abstinence and how best to maintain it – by no means the same thing.   And in the course of listening, I heard echoes of several voices.  One was Ed Khantzian, advocating the Self-Medication Hypothesis; a concept that used to annoy me because it seemed a mis-appropriation of the word “medication”.  It annoys me less now, as science and experience merge to produce a view of symptom-suppressing drugs as useful, sometimes essential allies in the long view of addiction treatment; a statement which will doubtless get me in trouble with several camps.

But the voices that called to me loudest were those whom I have heard, in meetings and in offices, almost weekly for many decades, declaring something along these lines: “I always felt off-balance, not quite comfortable, somehow not in step with my friends and others.  And then I had my first drink (dose, blunt, huff, etc.).  And suddenly I felt the way I had believed ‘normal’ was supposed to feel.  I was home. …Years later, when I stopped, the same bad, off-balance feelings came back, worse than ever, and seemed impossible to shake.  Shake them I did, but it took months (years, decades, forever).” 

(A case will follow in a subsequent issue.)

*- Gr., “katifeia” for dejection or negative emotional state

** - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907890/pdf/nihms218055.pdf

- Editor-in-Chief: William Haning, MD, DFAPA, DFASAM