MOM addiction Flashcards
what is the first method of modifying addictive behaviour
agonist and antagonist substances is a way of modifying addictive behaviour
what do agonist and antagonist substances do
work to treat addiction by either mimicking or blocking the effects of substances in the brain
one example of an agonist substance
methadone
what is methadone used for
to treat addiction to opioid drugs like heroin, by binding to a postsynaptic receptor and activate it to produce a response (imitate heroin)
what is methadone used as part of
a maintenance treatment, it reduces cravings and prevents withdrawal symptoms. has the same effects as heroin without the high. it is used until abstinence from the drug
dosage of methadone
initial dosage of 10-40mg each day which is increased by up to 10mg daily until no withdrawal symptoms are seen. an individual will reach a maintenance dose of 60-120mg a day
how is methadone usually given
orally as a green liquid to avoid risk associated with needle usage and injections. a nurse or doctor will see the patient each day for the first three months until they can continue without supervision
what is also given with methadone
to ensure people don’t take multiple doses or sell on their methadone, this treatment is given alongside psychological support
an example of an antagonist drug
naltrexone, it works binding to a receptor and blocking the usual function of a substance. nalextrone blocks euphoric and pleasurable effects associated with opioids/makes them less rewarding.
who should nalextrone be used for
according to NICE guidelines, nalextrone should be used by people who have stopped using opioids and have proven they are highly motivated to stay free from drugs. it is given as an oral medication
who else can nalextrone also be used for
might also be offered in cases of alcohol addiction. it is recommended alongside psychological intervention and should be used after withdrawal symptoms from alcohol have occurred
dosage of nalextrone
can be used for up to 6 months and users should be supervised to ensure they haven’t started to drink again
who is nalextrone said to also possible be able to help
problem gamblers although more research is needed
what is the second method of modifying addictive behaviour
aversion therapy
what is aversion therapy based on
the principles of classical conditioning, where a naturally unpleasant stimulus (unconditioned stimulus) produces a negative response (UCR) the UCS is then paired with the addictive behaviour (NS) and a conditioned response is learned. the individual associated the addictive behaviour (CS) with the negative CR rather than previous pleasure they would experience
first type of aversion therapy
antabuse
describe how antabuse works
by affecting how the body metabolises alcohol. alcohol is normally briken down to a compound called acetaldehyde and then further broken down by an enzyme in the liver called aldehyde dehydrogenase. antabuse causes a disulfiram reaction, stops the enzyme from working, causing a build-up of acetaldehyde in the bloodstream
what can antabuse cause
unpleasant sysmptoms (sweating, heart palpitations, headaches, nausea/vomiting)
what are the NICE guidlines around ANTABUSE use
antabuse can begin after individuals has undergone withdrawal, they are given a dose of 40mg daily but this may be increased if the reaction with alcohol is not aversive enough
what is the second form of aversion therapy
rapid smoking
what is rapid smoking
used to help smokers overcome their addiction, smokers sit in a closed room and take a puff on a cigarette every six seconds until they’ve finished a specific number of cigarettes or they feel sick
theory is the smoker will associate this unpleasant feeling with smoking and develop an aversion to it. this might be repeated over several sessions to try and make the association stronger
how popular is this treatment today
it is used much less often now since the development of other therapies
evaluate the effectiveness of methadone as a method of modifying addiction
NICE assessed 31 reviews of the effectiveness of methadone, including 27 randomised controlled trials. found higher levels of retention for people using methadone than placebo or no treatment and lower rates of illicit opioid use. one meta-analysis of studies into the effectiveness of a range of treatments concluded that as long as the dosage is adequate then methadone is effective as a maintenance treatment
effectiveness of naltrexone
NICE reviewed 17 studies concerning the effectiveness of naltrexone for heroin addiction. overall they found conflicting results, and many showed no significant difference between naltrexone and a control treatment for retention on the treatment programme. however they did find naltrexone was associated with a reduction in relapse rate especially in those who were highly motivated
evidence to support the effectiveness of naltrexone
Lahti tested the effectiveness of naltrexone on a small sample of gamblers who were instructed to take it before gambling or when they felt the urge to. they found significant decreases in gambling levels, although they highlight further research is needed
issues with studies of effectiveness
methods of modifying agonist/antagonist.
when studies from different countries are compared there may be differences in this treatment protocol, such as the methadone dosage and how much support and monitoring is given.
another problem is studies don’t always follow up over a long period of time, common for relapses to occur months or even years after a person has become clear the research didn’t pick it up
ethical criticisms of the use of methadone
agonist/antagonist
there are side effects that need to be taken into consideration. methadone may interact with other drugs such as alcohol and antidepressants to cause respiratory problems. also a danger of overdose if an addict combines methadone with other drugs
the office for national statistics reported that in 2013 methadone was responsible for 429 deaths in the UK
ethical issues of naltrexone
agonist/antagonist
side effects, there is a greater risk of overdose. if the individual chooses to return to taking a drug they will need more of it to feel the same effects and are then more likely to overdose
people taking naltrexone will also need to be carefully monitored for issues with liver function and if they are still opioid dependent it can cause withdrawal symptoms
social implications
financial cost of methadone to society
a report by Gyngell said that prescribing methadone was a ‘expensive failure’ and cost society money, for both the methadone and the 320,000 problem drug users on benefits. it suggested that greater success would be achieved by funding rehabilitation units encouraging abstinence.
PB point of the financial cost of methadone to society
antagonist/agonist
the charity DrugScope has disputed the claims in this report. saying that they overestimated the cost of prescribing methadone, they described trug treatment as good value for money for taxpayers as people taking methadone become able to function in society
effectiveness strength of antabuse
Niederhofer and Staffen compared antabuse to a placebo and assessed their participants using a self-report method and screening for 90 days. the antabuse patients had significantly greater abstinence duration than the placebo group
Jorgensen found that those treated with antabuse had more days until relapse and fewer drinking days.
effectiveness weakness of antabuse
studies that look at the long term effectiveness of antabuse are rare and they tend to lack scientific rigour as they are not full randomised controlled trials. there are also few comparisons studies between antabuse and other treatments for alcoholism and are often over small samples.
weakness effectiveness of rapid smoking
although when rapid smoking is compared with a control condition of watching a video about giving up smoking. the rapid smoking showed a significant decrease in their urge to smoke in the 24 hours and week after the procedure. but at 4 weeks the difference between the groups was no longer significant and therefore the effectiveness of the use of rapid smoking on a long-term basis is unclear
weakness of aversion therapy as a MOM
a key issue is that it is only treating the behaviour and not the underlying cause. the aversion towards the specific behaviour may remain but if there is an underlying problem like cognitive bias then it will not be addressed. it is even possible that the individual will engage in other addictive behaviour e.g. gambling. individuals may need something like CBT to properly address the issues
evaluation ethical issues of aversion theraoy
taking antabuse can clearly cause very negative effects to an individual if they drink alcohol while on the medication. rapid smoking is also an unpleasant experience. however those taking the treatment would have given valid consent based on information provided to them by a professional therefore reducing the risk of harm
evaluation
what can potential harm lead to
could also create an issue with compliance as individuals can simply choose not to take the antabuse or engage in the rapid smoking, therefore creating problems with effectiveness as people may drop out
evaluation
more ethical alternatives of aversion therapy
the use of covert sensitisation. individuals may be encouraged to imagine feelings of being sick and vomiting when they have the urge to drink. it is much more ethical than using a drug like antabuse to induce such an unpleasant reaction
aversion therapy
financial implications
there has been a dramatic increase in spending on antabuse and other drugs to treat alcoholism, however it is argued that this money is a small amount compared with the money spent on treating alcoholism and related problems on the NHS. investing in treatment and prevention saves the NHS money in the long run.
evaluation:social implications
aversion therapy
there is a social cost of addiction, alcohol abuse costs the taxpayer £21 billion a year. e.g an addiction can lead to unemployment which may lead to the individual clamining benefits. the effects of addiciton on the physical health will also cost the NHS money
addiction also causes the breakdown of families, homelessness, debt and crime. therefore it is important that the right treatment decisions are made, aversion therapy could be one option to be considered, the benefits of the treatment to society may outweigh any potential costs (ethical or financial)
