Addiction- Methods of modifying Flashcards
What are the two methods of modifying criminal behaviour?
1- Agonist and Antagonist substitution
2- Aversion Therapy
What do Antagonist and agonist drugs do?
Common treatment is medication
- drugs work at the level of this synapse to alter behaviour
- act on specific biological processes
- either mimic or block the effects of particular substances on the brain
What is the Agonist drug called?
Methadone
What does methadone do?
Maintenance treatment, occupies dopamine receptors
-mimics effects of heroine without high
- activates receptors, reduces symptoms of withdrawal
- not uncontrolled or impulsive
- detoxification then abstinence
What is the recommended dosage for methadone (agonist drug)?
NICE- 10-40mg increased until there is no sign of withdrawal/intoxication
- maintenance dose 60-120mg a day
- see pharmacist each day for 3 months until they can continue without supervision
- alongside other psychosocial support
Why do addict have to o to the pharmacist every day to collect their dosage?
Methadone is still addictive
- may take more than one or sell it
Why is methadone given orally rather than an injection?
The blood concentration of methadone will rise and fall slowly, compared to the rush and crash of heroine which is injected
- digested differently
What is the Agonist substitution drug?
Naltrexone
What does naltrexone do?
Commonly used in the treatment of opioid addiction
- while methadone is used to manage the symptoms of withdrawal, naltrexone is used for addicts on recovery to prevent relapse
What is the biological action of the antagonist drug naltrexone?
- What is happening at the synapse?
It blocks europhic and pleasurable effect associated with opioids by blocking receptor sites, makes them less rewarding
What effect de naltrexone have on feelings produced by the drug?
Do no feel anything as it is made less rewarding
Who is given naltrexone as a treatment?
NICE- people who have stopped using opioids and have demonstrated they are highly motivated to stay free from drugs
How is naltrexone given?
Oral medication- available as an implant or depot injection (released lowly over a couple of weeks)
How can naltrexone be used for an alcohol addiction?
- offered alongside a psychological intervention
- after withdrawal has occurred, kept under supervision
- ensure they haven’t started drinking again
How can naltrexone be used for gambling?
more research needed but could be sued
Evaluation effectiveness: Substitution drugs
Research for Methadone
31 reviews on effectiveness of methadone
- 27 randomised controlled trials
(2+ conditions, single blind, Ps unaware of condition)
- higher levels pf retention for people using methadone compared to placebo/no treatment, lower rates of illicit drug use
- scientific methodology
- credible evidence
- more effective than placebo and no treatment
Evaluation effectiveness: Substitution drugs
What did Van de brink and Hassan’s meta-analysis find?
Large scale- effectiveness of a range of treatments concluding that as long as dosage is adequate then methadone is effective as a maintenance treatment
Evaluation effectiveness: Substitution drugs
X Comparing methadone to buprenorphine
B- milder medication, both agonist and antagonist properties
Ag- partially activated the D receptors, reducing withdrawal symptoms
Ant- blocks the receptors, preventing euphoria associated with opioids
B- much reduced chance of overdose
- ceiling effect, taking larger quantities will not produce a greater effect
Evaluation effectiveness: Substitution drugs
X Comparing methadone to buprenorphine
Marteau
Analysed data over a 5 year period and concluded that it was 6 times safer than methadone
Evaluation effectiveness: Substitution drugs
X Comparing methadone to buprenorphine
Whelan and Remski
Methadone is preferred, more effective in retaining patients
- person with addiction may prefer the feeling they get from methadone, more likely to continue with the treatment
- lower abstinence rate
Evaluation effectiveness: Substitution drugs
X Naltrexone, NICE
Nice reviewed17 studies concerning effectiveness of naltrexone for heroine addiction
x found conflicting results
x many of randomised control trials showed no significant difference between N and control treatment for retention
-N associated with reduction in relapse rates, highly motivated Ps, where they are closely monitored and offered support
Evaluation effectiveness: Substitution drugs
- Naltrexone, Lahti
Tested effectiveness of N on a small sample of gamblers, instructed to take N before gambling or when they felt the urge to
- significant decrease in gambling levels
X further research needed with placebo for comparison
Evaluation effectiveness: Substitution drugs
X Naltrexone, Gowing
NOT appropriate for all drug users
x completely stopped taking heroine as withdrawal symptoms may occur
x right attitude towards recovery, highly motivated to quit
x not as useful on those less motivated
Evaluation effectiveness: Substitution drugs
X Attrition rates
Drop outs are not reflected in the final results
x only show it works for those who are still in the study
x highly motivated to quit
x those not will have dropped out, may not have worked for them
Evaluation Ethical: Substitution drugs
Side effects
Confusion, dizziness, nausea, tremors, seizures
Evaluation Ethical: Substitution drugs
Side effects
X dangers of methadone
May interact with other drugs
- alcohol and antidepressants = respiratory problems
- danger of overdose
2023- 709 deaths
- struggle to make detoxification and abstinence, on for 20+ year
- transfer addiction, unethical
Evaluation Ethical: Substitution drugs
Side effects
X Risks of Naltrexone
Monitor liver function
x if opioid dependant, withdrawal symptoms
x displace opioids still in system from receptors
Evaluation Social: Social Implications
X social problems
x strain on NHS
x waiting times A n E, doctors
x impact on police
x high crime and unemployment rates
x less tax money collected
x more claims on universal credit
Evaluation Social: Social Implications
Social effect of methadone
- The National treatment agency
Treating heroine users with methadone has an immediate positive effect on society by reducing their criminality
- rates of offending half when they are in treatment
Evaluation Social: Social Implications
Social effect of methadone
X Gynell
Drug-relating reoffending has continued to rise despite methadone
Evaluation Social: Social Implications
Findings from Advisory Council of drug misuse
Those in poorer areas receive less help and due to deprivation are more likely to engage in drug use from an earlier age
Evaluation Social: Social Implications
Cost effectiveness of methadone
X Gynell
Prescribing methadone was an expensive failure and costs society money, not just for methadone but for 320,000 problem drug users on benefits
Evaluation Social: Social Implications
Cost effectiveness of methadone
- Doward
Charity DrugScope has disputed claims saying that the report overestimated the cost of prescribing methadone
- is cost effective
What is the 2nd method of modifying?
Aversion therapy
What are the key principles of aversion therapy?
- principle of classical conditioning
- associate addiction with unpleasant stimulus
- unpleasant response rather than pleasure
- no longer deriving pleasure- they stop taking substance/engaging in behaviour
> practical, ethical, safety- only used for alcohol
What drug is used in aversion therapy?
Antabuse
(disalfiram)
How does Antabuse (disulfiram) work?
Drug Antabuse acts as a aversive (unconditioned) stimulus
- affects how the body metabolizes alcohol
- causes a disulfiram reaction, stops enzyme from working
- leads to a build up of toxins in the bloodstream
What does Antabuse cause and how does this modify addiction?
Range of unpleasant symptoms
- sweating, heart palpitations, headaches, vomiting
- occurs within 10 minutes of consuming alcohol and can last for hours
- once association has been made, the person will try and avoid contact with behaviour and triggers associated with the addiction
e.g. pubs
Classical conditioning schedule for Antabuse
Before :
UCS - UCR
(Antabuse) (sickness)
NS
(alcohol) - nothing
During:
NS + UCS - UCR
(alcohol) (Antabuse) (sickness)
After:
CS - CR
(alcohol) (avoidance)
What do NICE guidelines suggest about Antabuse?
- begin after individual has undergone withdrawal
- daily dose of 200mg, increased if the reaction to alcohol is not aversive enough
- remain under supervision every 2 weeks for the first 2 months then monthly for the next 4 months
- must be careful about alcohol in other substances such as food or mouthwash, may contain enough alcohol to cause an unpleasant reaction
What is Rapid smoking?
A second, less common form of aversion therapy, there is no additional medication required
How does Rapid smoking work?
Smokers sit in a closed room and take a puff on a cigarette every 6 seconds until they finish a specific number of cigarettes or feel sick
- US is not a drug, something unpleasant
- intensive smoking creates UCR of feeling disgust or sick
- associate unpleasant feeling with smoking and develop an aversion for it
- repeated over several sessions to make it stronger
Evaluation effectiveness: Aversion Therapy
- Research for Antabuse
STAFFEN
- compared Antabuse to placebo and found a significantly greater abstinence duration than the placebo group
- shows effective, increases validity
Jorgensen
- found that people treated with A had more days until relapse and fewer drinking days
- external reliability (consistency)
How can we Criticise research for Antabuse?
X no long-term studies
X lack scientific rigour
X not full randomised controlled trials
X few comparisons between A and other treatments for alcoholism
X often take place on small samples
X hard to carry out placebo studies as patients will be aware which condition the are in if they drink and no adverse effects are experienced
Evaluation effectiveness: Aversion Therapy
- Research for Rapid Smoking
McRobbie
cessation clinic, 100 smokers, control watched video about giving up
- RS showed a significant decrease in urge to smoke in 24hrs/week after procedure
X at 4 weeks the difference between groups were no longer significant, impact of RS on long-term abstinence remains unclear
- reducing urge in early period may be useful in kick-starting the process and then other techniques can be employed
Evaluation: Aversion Therapy
X Practical issues
X limited research as it is less popular now
X does not tackle the root causes- not remove bigger issues
X only treats the behaviour, not the underlying cause
X aversion remains, underlying problem (cog bias) not addressed
X may switch the focus of their addiction- gambling
Evaluation Ethics: Aversion Therapy
X Side effects
X long term health problems from RS
X lung damage, increased risk of cancer
X rash, nausea, headaches, unpleasant
- addicts cannot be legally forced to undergo AT, voluntarily, choice and free will
Evaluation Ethics: Aversion Therapy
X Antabuse implants
Insert into lower abdomen- George Best died
X drank again not long after the implants were fitted
X lack of research on long term effects
X not available on the NHS
X interferes with the right to withdraw
Evaluation Ethics: Aversion Therapy
- Covert sensitisation
Encouraged to imagine feelings of being sick and vomiting when they have the urge to drink
KRAFT- series of case studies highlighting that although this technique is not common, it is quick and effective
Evaluation: Aversion therapy
X social implications
Both smoking and drinking cost the UK economy a lot of money
X any treatment that is able to reduce the rates of these addictions may also be able to prevent lot the harm caused, my be able to save money
Evaluation Social: Aversion therapy
X Devlin
Dramatic increase on spending on Antabuse/other drugs to treat alcoholism
2008 NHS- £2.25mil
1998 NHS- £1.08mil
Evaluation Social: Aversion therapy
- Alcohol concern
Small amount compared with the money spent on treating alcoholism and related problems on NHS
- investing in treatment and prevention saves NHS more in the long run
