Methods of Modifying Behaviour

Question 1

What is an agonist substitute?

Answer 1

An agonist binds to receptors in the brain and mimics other chemicals, causing a reaction that produces pleasure. It is useful for treating addiction and provides a comfortable detox.

Question 2

What an antagonist substitute?

Answer 2

An antagonist binds to receptors in the brain but blocks other chemicals from causing a pleasurable reaction. It is useful for treating addiction and provides a comfortable detox.

Question 3

What is the action of heroin and opioids on the receptors?

Answer 3

They mimic the brain’s natural opioids like endorphins. these then stimulate their receptors. because heroin stimulates more receptors than natural opioids, the result is a lot larger. this means that there would be a lot of opioid receptor activity.

Question 4

How do agonists imitate the action of other substances in the postsynaptic receptors?

Answer 4

An agonist drug binds and activates the postsynaptic receptor. They imitate and mimic another substance, e.g. heroin, in order to produce a response.

Question 5

What is Methadone?

Answer 5

• used to treat opioid drug addiction for drugs like heroin
• a synthetic substance that mimics the effects of heroin
• a substitute for heroin and will reduce the cravings experiences by heroin users and prevent withdrawal symptoms.
• has the same effect as heroin but does not give a ‘high’.

Question 6

How should Methadone be used?

Answer 6

• as part of a maintenance treatment

- should be reduced over time (detoxification) until the individual stops using it altogether (abstinence).

Question 7

Advantages of Methadone

Answer 7

• taken orally (minimises intravenous administration)
• long acting opiate agonist
• cheap
• easy to start
• well known and understood
• used in harm reduction
• minimises street purchasing / criminality
• easy to stabilise a user quickly

Question 8

Disadvantages of Methadone

Answer 8

• more addictive than heroin due to longer withdrawals
• much harder to come off
• if used with heroin can increase toxicity/tolerance
• toxic in overdose
• encourages stabilisation as opposed to abstinence
• high street value increases risk of trading.

Question 9

What is opioid agonist therapy?

Answer 9

OAT involves an addict taking the opioid agonists Methadone and Buprenorphine to prevent withdrawal and reduce the cravings they have for their addiction to opioid drugs such as heroin, Percocet ad oxycodone. this therapy helps to stabilise the lives of addicts and reduce the risk of harm to them that are associated with whatever opioid they are addicted to.

Question 10

How does opioid agonist therapy work?

Answer 10

Long-acting opioid drugs like Methadone replace the drugs that the addict is addicted to. Because they are long-acting, they work slowly for a long period of time to prevent cravings and withdrawal symptoms for the addiction. This works best when used with other forms of therapy, such as the addict going to support groups or individual counselling.

Question 11

What are the side-effects of opioid agonist therapy?

Answer 11

After initiating the treatment, the addict may feel lightheaded and tired, but a tolerance will quickly be built up against these effects. it works to reduce craving and prevent withdrawal symptoms, therefore does not get the addict high, but combats physical symptoms. OAT would help with salience, as it would allow the addict to focus on other aspects of their lives without constantly thinking about their addiction.

Question 12

How can OAT be administered?

Answer 12

Methadone is taken as a drink. the most common type of buprenorphine is Suboxone, which is in the form of a pill that is absorbed under the tongue. this includes Naloxone, which, if injected, can cause withdrawal. This is to prevent buprenorphine abuse. To begin OAT, the addict’s doctor will give the pharmacy a prescription. Initially, they will be asked to go to the pharmacy each day to take the medication. After about 2 months, when their life is more stable, they will be able to take the OAT home.

Question 13

Does OAT help with pain relief?

Answer 13

OAT will combat the pains caused by the withdrawal of the opioids. After taking it, it may relieve other pains for a few hours. Once the dose is stabilised, there should be no issues regarding pain. If there is, doctors may find other methods of improving pain control.

Question 14

What are the potential side effects of OAT?

Answer 14

• constipation
• excessive sweating
• dry mouth
• changes in sex drive
• drowsiness
• weight gain

Question 15

What are the health and safety issues surrounding OAT?

Answer 15

• children would be at risk of death
• risk of overdose is high
• mixing opioids with other drugs increases overdose risk
• any person taking opioids should have Naloxone on hand in case of overdose

Question 16

How long does someone have to continue to take an opioid agonist substitute?

Answer 16

Depends on the time they need to deal with what led them to their addiction in the first place. This could be emotional, e.g. PTSD, or physical, e.g. dealing with an ongoing injury. It also depends on biology, as long-term opioid use has been shown to make irreparable changes to the brain that increase their dependence on the drug. there is a high risk of relapse and overdose for those who stop taking OAT before they are ready. Some continue on OAT for many years, whereas some choose to take it for 1/2 years.

Question 17

What is detoxification?

Answer 17

The process by which all traces of substances like alcohol and drugs are removed from the body after an addict has stopped taking it. When the substances are gradually reduced because of the withdrawal of the addiction, the brain will have to adjust to the sudden drop of the chemicals induced by the addiction.

Question 18

What are cravings?

Answer 18

A strong desire for something. In this case, it would be whatever substance the addict is addicted to. When beginning treatment, they will begin to crave the substance more, as their brain is receiving less of the chemicals it is dependent on.

Question 19

What is withdrawal?

Answer 19

The process the body goes through when the addict drops taking drugs. Continued exposure to the substance causes their body to adapt and depend on it. Therefore, it induces a lot of unpleasant “withdrawal” symptoms when the amount of the substance it receives is significantly reduced. These can be dangerous, and include things like: nausea, vomiting, diarrhoea, muscle/bone pain, fatigue, headaches, excessive sweating and heart palpitations. There are also psychological withdrawal symptoms, including: depression, anxiety, paranoia, insomnia, short term memory loss and irritability.

Question 20

How does opioid agonist substitution help with detoxification, cravings and withdrawal?

Answer 20

Methadone helps to eliminate withdrawal symptoms and relieve cravings by acting on the opioid receptors that the substances would have previously activated. This does not cause euphoria as it acts more slowly than heroin and other opioids.

Question 21

How can a heroin user get help in the UK? What help is available to them?

Answer 21

• See a GP
• Contact their local drug treatment service.
• Maintenance therapy (switching to a substitute)
• Detox (gradually withdrawing from the substitute)
• Inpatient detox
• Rehab
• Talking therapies (e.g. CBT)
• Support groups (e.g. Narcotics Anonymous)
• Support for family and carers
• Help to stay healthy
• Incentives (rewards for sticking with the programme)

Question 22

What will a heroin user’s first contact/analysis appointment look like and who would they be with?

Answer 22

The doctor or drugs worker will ask lots of questions, including:
- How much heroin they take
- Whether they are using drugs or alcohol
- What their physical and mental health are like
- What their personal circumstances are like (e.g. who they are living with & where)
- Whether they have had treatment for drugs before.
The addict will be asked for a urine sample, which will be tested to check the addicted substance. They will be put into contact with a key worker who will put together a treatment plan.

Question 23

What is the difference between maintenance and detoxification treatments?

Answer 23

Maintenance therapy is where the drug is switched for a substitute, e.g. methadone instead of heroin. This is increased gradually until the addict is on a stable dose to relieve withdrawal symptoms and cravings. Detoxification is where maintenance therapy is used and then the addict is gradually withdrawn from the substitute, so they are completely free from both heroin and methadone. This can take up to 12 weeks.

Question 24

What is Naltrexone?

Answer 24

A key part of the recovery from addiction - specifically, the abstinence stage. It can be taken as an oral medication, implant or depot injection (for slow release). It blocks any euphoric or pleasurable effects caused by the opioids, so that the addict no longer feels the high from them. Since the rewards from drug taking are significantly reduced, the addict is more likely to refrain from taking the drug. This should only be taken by people who have withdrawn from their opioid addiction and are motivated to stay clean. Naltrexone has only been approved for treatment in USA and Russia.

Question 25

How can Naltrexone be used as a treatment for gambling and alcohol addiction?

Answer 25

Alcoholics can use Naltrexone to help with their treatment. This should be offered alongside other treatments; not as a stand-alone. For this to be effective, it should be taken after the addict has withdrawn from the alcohol. Naltrexone can be used for up to 6 months and users should be monitored to ensure that they have not relapsed. This can also be used for gambling addictions, according to The National Health and Medical Research Council in Australia.