TREATMENT OF ADDICTION

ZINBERG, (1984)

THEDRUG

THEPERSON

THEENVIRONMENT

Addiction is a complex interaction

QU. WHAT ARE THE CAUSES OF ADDICTION?

QU. WHAT ARE THE TREATMENTS FOR ADDICTION?

WEST (2006) - INTERACTIONIST MODEL

INITIATION

MAINTENANCE

CESSATION

Social factors

beliefs heldSusceptibility

Doctors help

Community support

Workplace rules

Clinical interventions

abstinenceSelf help

SOME CONSIDERATIONS IN TREATMENT;

Prevention is better than cure!

Once addicted, group & individual approaches used.

The more holistic approach = better recovery rate.

Addiction and mental health issues are interlinked and can affect appropriate treatments used.

Lots of research opportunities!

QU. READY TO WATCH A BBC FILM?

http://www.youtube.com/watch?v=GowvCVSnAfY&feature=player_embedded#!

QU. WHY DO WE GIVE PATIENTS DRUGS?Key brain pathways are involved

addictions.Prolonged addictive behaviours are

associated with changes in brain function

Brain changes demonstrated at molecular, cellular, structural and functional levels.

This evidence provides a rationale for medication-assisted treatment of addiction

DRUG TREATMENTS FOR NICOTINE?

Chantix™ (Varenicline)

Nicotine Replacement

NON-NICOTINE DRUG AIDS (VARENICLINE)

Nicotine attaches to brain receptors & sends a message to a different part of the brain to release dopamine = pleasure feeling for a short time.

This drug works by activating these receptors and blocking nicotine from attaching to them.

Thus smoking is not reinforcement or a reward for smokers (antagonist effect).

MEDICATIONS FOR TREATMENT OF ALCOHOLISM

Disulfiram (Antabuse)Naltrexone(and many more!)

ANTABUSE

Used to support the treatment of chronic alcohol abuse by producing an acute sensitivity to alcohol

Initial dose is 500 mg for 1 to 2 weeks, followed by a maintenance dose of 250 mg (range 125 mg - 500 mg) per day. The total daily dosage should not exceed 500 mg.

Should not be taken if alcohol has been consumed in the last 12 hours.

NALTREXONEBy blocking the opioid receptors, and weakens the rewarding effects of alcohol and reduces dopamine release and the inhibitory GABAergic output. (Blocks the “high” feeling)

Appears to promote reduction in drinking level

Dose: 50 mg per day.

METHADONE

Long lasting synthetic opiate administered orally to prevent withdrawal symptoms.

Methadone stimulates the same receptor sites as heroin but in a milder way.

It stops the craving for opiates but doesn’t get the user ‘high’.

Do they work?

SMOKING QUIT RATES* WITH DRUGS

CHANTIX 1 mg bid Zyban 150 mg bid Placebo

Gonzales et al (n=1025)

44.0%* 29.5%† 17.7%

Jorenby et al (n=1027)

43.9%* 29.8%‡ 17.6%

Quit Rates = Continuous abstinence (not even one puff of a cigarette) during weeks 9-12

C o p y r i g h t r e s t r i c t i o n s m a y a p p l y .

G a r b u t t , J . C . e t a l . J A M A 2 0 0 5 ; 2 9 3 : 1 6 1 7 - 1 6 2 5 .

M e d i a n H e a v y D r i n k i n g D a y s p e r M o n t h f o r E a c h T r e a t m e n t G r o u p O v e r a l l a n d b y S e x

Garbett et al, 2005

REDUCTION OF HEROIN USE BY DURATION OF METHADONE TREATMENT

8%

23%

97%

67%

0

20

40

60

80

100

120

Percent

Ball & Ross, 1991.

Pre-treatment

Admission:< 6 months

stay

AverageStay: 6 to54 months

Long-term:> 54 months

QU. ANY LIMITATION WITH DRUG TREATMENT?

The most frequently reported adverse events for nicotine drugs (>10%) were nausea, headache, insomnia and abnormal dreams.

Antabuse may cause liver toxicity.

Methadone?

RETURN TO I.V. DRUG USE FOLLOWING TERMINATION OF

METHADONE TREATMENT

28.9%

82.1%72.7%

57.6%

45.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

In Tx. 1 to 3 4 to 6 7 to 9 10 to 12

%

IV

USERS

Months Since Dropout

Primary Drug at Entry to Opiate Treatment, King County WA

Heroin

94.6

83.2

Rx Opiate

3.0

14.4

0.0

20.0

40.0

60.0

80.0

100.0

1999 2000 2001 2002 2003 2004 2005

%

QU. ANY OTHER LIMITATIONS?

MARK GRIFFITHS (2012)

Qu. Would they work for Behavioural

addictions?Such as

porn addictions

?Or food

addictions?