Reducing addiction

how do drugs work

interact with receptors and enzymes in the brain to reduce cravings for a drug or the desire to engage in a particular behaviour

what are the three basic types of drug treatments

Aversives
Agonists
Antagonists

which one of the drugs prevents withdrawal symptoms

Agonists

Those receiving Aversive or Antagonists drugs may require additional treatments to alleviate these unpleasant symptoms eg anxiolytics to reduce anxiety

How do aversives work

produce unpleasant consequences eg vomiting and nausea if taken with specific drugs
Eg is people drink alcohol while taking disulfiram an atabuse drug they experience nausea, vomiting, dizzines, and severe headaches

they work on the principle of counter conditioning by replacing pleasant associations with unpleasant ones

how do agonists work

drug substitutes

act as a less harmful replacement for the drug on which people are dependent- fewer side effects and are ‘cleaner’ as they are administered medically rather than being delt on the streets

bind to the same neuron receptors as addictive drugs and produce similar effects

allow gradual and controlled withdrawal from a substance

one example is methadone for the treatment of heroine addiction

how do antagonists work

block the neural receptor sites, preventing the drug having its usual effects

however other interventions eg counselling should be used alongside drug therapy to tackle the psychological causes of the addiction

how can drug therapy be used to reduce nicotine addiction

by nicotine replacement therapies eg patches spray and gum

use of pharmacological interventions

how does Nicotine replacement therapy (NRT) work

works as an agonist, gradually releasing nicotine into the blood stream at lower levels than a cigarette and without all the harmful chemicals found in cigarette smoke

stimulates nicotinic receptors causing dopamine release in the nucleus accumbens

reduces cravings for a cigarette, improves mood, helps prevent relapse

over time the patches/lozenges/sprays are reduced in strength so the person can gradually withdraw over a period of 2-3 months

what other drugs have been NHS approved for nicotine addiction

Varenicline (champix)

Bupropion (zyban)

nicotine free pills that reduce cravings and help with withdrawal symptoms
have different mechanisms of action in the brain, but both help prevent relapse in people trying to quit

how does varenicline (champix) work

attaches to many of the nicotine receptors in a smokers brain (partial agonist)

causes continual release of dopamine at a lower intensity than a cigarette but spread out across the day

if the person does have a cigarette the effects are blocked so there is no rewarding effect

how does Bupropion (zyban) work

originally developed as an antidepressant

inhibits the reuptake of dopamine

found to be effective as a smoking cessation drug

how can drugs be used to treat gambling addiction

no drug has been approved in the UK to treat gambling addiction

research into several candidates including opioid antagonists such as naltrexone

reduces urges and cravings to gamble and can reduce depression or anxiety which may trigger continued gambling

how do opioid antagonists like naltrexone work

enhances the release of GABA to reduce the release of dopamine in the nucleus accumbens

Kim et al 12 week double blind placebo controlled trial for 45 addicts

naltrexone was effective in reducing frequency and intensity of gambling urges and gambling behaviour

how do antidepressants (SSRIs) work to reduce gambling addiction

evidence supports serotonin dysfunction in pathological gambling

research suggests gamblers treated with SSRIs to increase serotonin levels show improvement

SSRIs reduce depression and anxiety which may trigger gambling

impulsivity is linked to low serotonin levels so increasing serotonin should reduce impulsivity

AO3 for drug therapy

research supports the effectiveness of NRT in the treatment of nicotine addiction

A problem with the use of opioid antagonists concerns its basic mechanism- it works by blocking the brains reward system when the person engages in gambling behaviour

Research provides support for the claim that SSRIS, which raise serotonin activity in the brain, reduce gambling behaviour

Although there is some evidence to suggest that gambling addiction can be reduced by drug treatment, there are methodological criticisms of research in this area

Drug treatment for reducing addiction is cheaper than other forms of treatment, such as CBT, as it requires only prescription and medical supervision. However, a limitation is side effects

a strength of drug therapy to reduce addiction is that addiction becomes less stigmatised through its association with drug therapies

Research supports the effectiveness of NRT in the treatment of nicotine addiction

Hartmann-Boyce et al conducted a meta analysis of 136 high quality research studies into the effectiveness of NRT (almost 65,000 participants) and concluded that all forms of NRT were significantly more effective in helping smokers quit than placebo and no therapy at all. NRT products increased the rate of quitting by up to 60%. The research also indicated that NRT does not appear to foster dependence

Therefore, NRT is an effective therapy for nicotine addiction which may save lives and reduce costs to the NHS in treating smoking related health issues
However it may be that there is a publication bias towards studies with positive results

a problem with the use of opioid antagonists such as naltrexone concerns its basic mechanism- this being that it works by blocking the brains reward system when the person engages in gambling behaviour

unfortunately, this mechanism is a fairly general one, in that by reducing the release of dopamine in the nucleus accumbens (normally makes activities feel good) it can cause patients to lose pleasure in other areas of their life too eg playing sports or partaking in hobbies while they are taking the drug

this tendency to make fun activities seem uninspiring is a downside of naltrexone for many addicts, and one reason why some choose not to continue their treatment

research provides support for the claim that ssris which raise serotonin activity in the brain, reduce gambling behaviour

Grant and Potenza gave 13 gambling addicts an SSRI for 3 months. at the end of the 3 months, some of the individuals who had improved (eg gambled less and had fewer anxiety symptoms) were randomly assigned to continue with the SSRI or to receive a placebo. Of the 3 who recieved the SSRI, improvement continued for the next 3 moths, while the person who received the placebo had gambling symptoms and anxiety return within just 4 weeks
This demonstrates that the improvements in the first part of the study were due to the effects of the SSRI rather than potential confounding variables

however there is a limitation of a small sample size

Although there is some evidence to suggest that gambling addiction can be reduced by drug treatment, there are methodological limitations of research in this area

Blaszxzynski and Nower claim that research studies are characterised by small sample sizes, high dropout rates, and low numbers of women, Many studies fail to include control groups or randomly assign gamblers to different treatment conditions. Moreover, they argue, research has generally failed to address the impact of comorbidity (presence of other psychiatric or medical conditions on treatment response)

what is the aim of CBT

to change faulty ways of thinking that lead to people using drugs or engaging in behaviours

what are the 2 elements of a CBT programme

1. CBT identifies and tackles the cognitive distortions that underlie addictions, replacing them with more adaptive ways of thinking (functional analysis)

2. Skills training to help the client develop coping behaviours to avoid high risk situations that usually trigger addiction related behaviour

what is the first part of functional analysis

starts with the client and therapist identifying high risk situations

the therapist reflects on the clients thinking before, during, and after a situation

what should the relationship between the therapist and patient be

warm, collaborative, and responsive but not cosy

the therapist must challenge the distorted cognitions and not merely accept them

what is important about functional analysis

it is not a one off occurrence but an ongoing process- valuable in early phases but also later in working out circumstances in which they are still having problems in coping

why is skills training important

addicted people often have only one way of coping with their problems- through the addictive behaviour

CBT helps the client to replace this strategy