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Drug Therapy

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Drug Therapy

You’ve probably heard of people using nicotine patches to wean themselves off of cigarettes or methadone substitutions for those addicted to heroin. Typically, drug therapy aims to reduce the amount of substance the person uses over time through a process known as detoxing, which is a gradual process.

A variety of drug therapies exist that can help treat addiction, and they do so by altering the biological state of the body and the brain. Even addictions such as gambling can be treated with drug therapies, despite not physically consuming or taking a substance.

After all, addictions are more than just biological. Behavioural addictions, such as gambling, have been recently added into the DSM!

Inherently, addictions affect a person both mentally and physically, and drug therapies offer a potential solution to both issues.

Drug Therapy Addiction Pills StudySmarterDrug therapy for addiction, Flaticon

What are the types of drug therapy?

There are three main types of drug therapy used to treat addiction.

Aversives

Aversive drugs can treat substance abuse, such as alcoholism or drug addiction.

Aversive drug therapies treat substance abuse by creating a negative response to the substance.

For example, disulfiram can treat alcoholism by making the addict hypersensitive to alcohol and giving them severe hangovers minutes after drinking.

Addicts are then encouraged to give up their addiction to avoid the unpleasant outcome of taking substances such as alcohol or drugs. This concept is based on the theory of classical conditioning. At first, the substance is primarily associated with pleasurable feelings. They often induce a sense of relaxation, and some even instigate a state of euphoria (e.g., cocaine).

Removing this association and instead pairing it with a negative result discourages substance abuse.

Drug Therapy Alcoholism StudySmarterAlcoholism, Flaticon

Agonists

Agonists treat addictions by lessening the effects of withdrawal symptoms.

Agonists are less harmful drug substitutes, and they act as drug replacements by binding to neuron receptors and activating them in a similar way that the addictive substance does. Hence, the addict experiences a similar effect, which also reduces withdrawal symptoms.

Drug therapy examples include nicotine patches for someone addicted to smoking cigarettes, and methadone, for someone addicted to heroin.

Agonists are particularly popular as they allow addicts to essentially wean themselves off of a substance without suffering the uncomfortable (and often painful) effects of withdrawal. Depending on the severity, withdrawal is sometimes enough for a person to retake the drug, as the symptoms are pretty unpleasant. If a person is addicted to alcohol and without it, they have shaky hands, fevers, nausea and vomiting, it is understandable that they would want to avoid these symptoms. It is simpler to drink again, rather than suffer.

Agonists aid this process of detoxing.

Newman and Whitehill (1979) assessed the effectiveness of methadone in aiding the process of withdrawal from heroin addiction. Compared to a placebo drug, methadone proved to be more effective in assisting successful heroin treatment.

Antagonists

Antagonists work differently than agonists.

Antagonists bond and block receptor sites to stop the addict from feeling the pleasurable effects of their addiction (psychological dependence).

An example is Naltrexone, used to treat heroin addiction.

This process prevents the reinforcement that occurs, which fuels addiction. When a person takes a substance that gives pleasurable feelings, preventing this will directly affect the desire to retake the substance, as it’s not providing the same, intense effects.

However, antagonists are most valuable when used alongside other therapies, such as counselling.

Drugs Therapy Addiction StudySmarterA packet and bottle of drugs, flaticon.com/freepik

Drug therapy in practice

Different drug therapies exist to help treat specific issues.

Nicotine addiction: nicotine replacement therapy

Nicotine replacement therapy uses gum, inhalers, or patches to deliver nicotine in a less harmful way than traditional cigarettes. This therapy provides the addict with nicotine in a clean, controlled dose.

The brain responds in the same way as if the person had smoked a cigarette. The nicotine binds to the nicotinic acetylcholine receptors (nAChRs) in the mesolimbic pathway (where the brain responds to pleasure). It stimulates the release of dopamine (the pleasure hormone) in the nucleus accumbens (central to motivation and action, frequently associated with sexual, reward and drug behaviour).

Over time, smaller and smaller doses of nicotine are given, e.g., smaller patches. Withdrawal syndromes thus become a lot more manageable as there is no shock withdrawal.

Consider the following studies:

  • Maity et al. (2014): In this review, they analysed three agents known to be partial agonists to nicotine receptors: Varenicline, Cytisine, and Dianicline. Nicotine interacts with neuronal nicotinic acetylcholine receptors (nAChRs), which releases neurotransmitters such as dopamine and noradrenaline upon activation.
  • The three partial agonists activate the nAChR receptors at lower concentrations than pure agonists, by which we mean nicotine. They help reduce addiction to smoking by maintaining dopamine levels to reduce withdrawal symptoms when a person quits smoking.
  • They found that these partial agonists were the most promising drug therapy for reducing and stopping smoking, with one study on Vernicline showing that around 46.4% of people on Varenicline could stop smoking by the end of treatment (Wang et al. 2013). Issues exist with cost, although Cytisine appears to be cheaper than Varenicline.

Gambling addiction: opioid antagonists

Although there are no official drug therapies for gambling addiction, some are being trailed, and opioid antagonists are the front runners. Naltrexone, a drug conventionally used to treat heroin addiction, has been used because of the similarities between gambling and substance addiction recognised in the DSM 5.

DSM Addiction Criteria Gambling Drug Therapy StudySmarterA chart showing the DSM characteristics of gambling and drug addictions, Yzabelle Bostyn, StudySmarter Originals

Drug addiction is similar to gambling because the dopamine reward system responds to gambling the same way as it would to drugs such as heroin. Opioid antagonists reduce dopamine release in the nucleus accumbens by increasing the release of another neurotransmitter called GABA. This process effectively reduces cravings associated with gambling.

Evaluating the effectiveness of drug therapy treatments of addiction

Each therapy has its strengths and weaknesses.

Strengths of drug therapy treatments

  • Effectiveness of drug therapy, research support: Stead et al. (2012) conducted a meta-analysis of 150 high-quality studies into the efficacy of NRT. They concluded that all forms of NRT are significantly more effective than placebos/no treatment to help smokers quit. The nasal spray was the most effective form of nicotine delivery. NRT users were 70% more likely to abstain from smoking six months after quitting. NRT is also safer than smoking and does not encourage dependence, giving it validity as a treatment for nicotine addiction.

  • Removal of stigma: The use of drug treatments to treat addiction removes stigma as it encourages people to view addictions as medical issues. This erodes the view that addictions result from some moral or psychological weakness. Removing this stigma could lead to more research and more people seeking help.

  • Convenience: An advantage of drug therapy is its convenience. It is easy to take a pill every day and not work on your thought processes or make behavioural changes.

Weaknesses of drug therapy treatments

  • Side effects: Both NRT and opioid antagonists can have severe side effects. The side effects of NRT include dizziness, gastrointestinal problems, sleep disturbance, and headaches. However, it must be considered that the patient would experience these effects from nicotine if they continued smoking anyway.

  • Opioid antagonists, on the other hand, create severe side effects. This is because it requires a much higher dose of the drug to treat gambling than drug addiction. Correspondingly, the side effects are much worse. These include tiredness, anxiety, headaches, joint and muscle pains, cramps, and nausea.

  • Side effects are a negative of drug therapy because they are hard on the patient and inhibit people from completing the entire course of treatment.

  • Limited treatment/individual differences: Drug therapy is a limited treatment. Some addictions make addicts disorganised and unmotivated, i.e., they might forget to take their medication, making the treatment less effective.

  • There are also individual differences that could affect the effectiveness of drug treatments. For instance, small genetic variations like the presence of a single gene can affect Naltrexone. Alcoholics with one variant of this gene responded much better to the drug than those that didn’t. Chung et al. (2012) suggest that drug treatments need to become more tailored to individual genetic profiles before they can be consistently effective.


Drug therapy - Key takeaways

  • Aversive drug therapies treat substance abuse by creating a negative response to the substance. For example, disulfiram can treat alcoholism by making the addict hypersensitive to alcohol and giving them severe hangovers minutes after drinking.
  • Agonists are less harmful drug substitutes, and they act as drug replacements by binding to neuron receptors and activating them in a similar way that the addictive substance does, so the addict experiences a similar effect. This also reduces withdrawal symptoms.
  • Examples include nicotine patches for someone addicted to smoking cigarettes, and methadone, for someone addicted to heroin.
  • Antagonists bond and block receptor sites to stop the addict from feeling the pleasurable effects of their addiction (psychological dependence).
  • An example is Naltrexone, used to treat heroin addiction and alcoholism.
  • Drug addiction is similar to gambling addiction because the dopamine reward system responds to gambling the same way as it would to drugs such as heroin.
  • Drug therapy has proven effectiveness, especially when paired with counselling such as cognitive behavioural therapy. However, it can be expensive and may cause side effects. They often ignore individual differences, too.

Frequently Asked Questions about Drug Therapy

There are three main types of drugs used in drug therapy. These are aversives, agonists, and antagonists.

Other interventions such as aversion therapy can be very unpleasant; therefore, drug therapy is a much easier alternative as you don’t have to engage in long periods of uncomfortable therapy.

Drug therapy can be used to treat several addictions, from nicotine to gambling addiction.

It can help remove stigma towards addiction, encouraging people to view it as a mental illness. Stead et al. (2012) research also supports drug therapy.

Although there is no blanket ‘success rate’, specific drug therapies such as NRT are highly successful, with 70% of NRT users abstaining six months after quitting.

Final Drug Therapy Quiz

Question

What is drug therapy for addiction?

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Answer

It is a way of treating addiction using medication.

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Question

What are the three types of drugs used in drug therapy?

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Answer

Aversive, agonist, and antagonist.

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Question

Give an example of aversive drug treatment.

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Answer

Disulfiram is often used to treat alcoholism by making the addict hypersensitive to alcohol and giving them severe hangovers minutes after drinking.

Show question

Question

Give an example of an agonist drug treatment.

Show answer

Answer

Nicotine patches.

Show question

Question

Give an example of an antagonist drug treatment. 

Show answer

Answer

Naltrexone.

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Question

What is aversive drug treatment?

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Answer

Aversive drugs are used with substance abuse, such as alcoholism or drug addiction. This is because they create a negative response to the substance.

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Question

What is an agonist drug treatment?

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Answer

Agonists are essentially drug substitutes. To do this, they bind to neuron receptors and activate them so that the addict experiences a similar effect to the addictive drug.

Show question

Question

What is an antagonist drug treatment?

Show answer

Answer

Antagonists bond and block receptor sites to stop the addict from feeling the pleasurable effects of their addiction (psychological dependence).

Show question

Question

What type of drug therapy is used to treat nicotine addiction?

Show answer

Answer

Agonist, in the form of nicotine replacement therapy.

Show question

Question

What is nicotine replacement therapy?

Show answer

Answer

Nicotine replacement therapy uses gum, inhalers, or patches to deliver nicotine in a less harmful way than traditional cigarettes. This therapy provides the addict with nicotine in a clean, controlled dose. The brain responds in the same way as if the person had smoked a cigarette. The nicotine binds to the nicotinic acetylcholine receptors in the mesolimbic pathway and stimulates dopamine release in the nucleus accumbens. Over time, smaller and smaller doses of nicotine are given, e.g., smaller patches. This means that withdrawal syndrome becomes more manageable as there is no shock withdrawal.

Show question

Question

What type of drug therapy is used to treat gambling addiction?

Show answer

Answer

Antagonist, in the form of opioid antagonists, such as naltrexone.

Show question

Question

How does Naltrexone treat gambling addiction?

Show answer

Answer

Naltrexone, conventionally used to treat heroin addiction, has been used because of the similarities between gambling and substance addiction recognised in the DSM 5.

Show question

Question

What is the positive of using drugs to treat addiction?

Show answer

Answer

They help remove stigma around addiction by treating it as a medical issue.

Show question

Question

What did Stead et al. (2012) find?

Show answer

Answer

They concluded that all forms of NRT are significantly more effective than placebos/no treatment to help smokers quit. The nasal spray was the most effective form of nicotine delivery. NRT users were 70% more likely to still abstain from smoking six months after quitting.

Show question

Question

What is the negative of using drugs to treat addiction? 

Show answer

Answer

There are severe side effects of using naltrexone and NRT, including dizziness, headaches, tiredness, and muscle aches.

Show question

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