week 8: Pharmacological and alternate approaches to addiction treatment Flashcards
Understand the role of medical detoxification in treating substance addiction;
Because withdrawal syndromes vary for each of the different classes of substances, withdrawal management is individually assessed and tailored. Withdrawal from some classes of substances requires close medical management (e.g. alcohol) whereas other classes of substances have less severe syndromes (e.g. cannabis). Additional assessment of medical and psychiatric comorbidities are also addressed in withdrawal management and interactions between these clinical syndromes and the severity of the presentation will determine which level of support is required.
Withdrawal may occur in a medical setting where a patient is admitted to receive medical care for an issue completely unrelated to their substance use. In these cases, hospitals have Consultation Liaison teams, made up of Registered Nurses with additional drug and alcohol expertise, who cover substance withdrawal management across the hospital. Alternatively, a client can access community based residential detoxification centers for a planned admission to undergo withdrawal.
Describe the major medications used in maintenance therapy, including methadone and buprenorphine;
n lay terms, maintenance pharmacotherapy involves substituting a less addictive opiate (e.g., methadone) for a more addictive one (e.g., heroin) and then tapering and maintaining the dosage of the substitution opiate over time.
Maintenance pharmacotherapies used in the treatment of opiate dependence include methadone (agonist) and buprenorphine (agonist/antagonist).
For example, methadone maintenance therapy has been shown to be an effective treatment for heroin addiction associated with a reduction in drug use, mortality, high risk behaviours related to drug-injecting, and criminal activity
Briefly describe the efficacy of antidepressants and mood stabilisers in treating pathological gambling;
Antidepressants were one of the first medications used in the treatment of pathological gambling due to the similarities identified between pathological gambling and a number of psychiatric disorders (Grant et al., 2012). The evidence is mixed as to the efficacy of antidepressants to treat pathological gambling (Bartley & Bloch, 2013; Grant et al., 2012). They are often prescribed when co-occurring depressive or anxiety symptoms are present.
Mood stabiliser medications including lithium and anticonvulsant medications such as valproate are sometimes used in the treatment of pathological gambling. There is very limited evidence of the efficacy of these medications in the treatment of pathological gambling (PGRTC, 2011; van den Brink, 2012). They are often prescribed when comorbid symptoms of subsyndromal hypomania or mania is present.
Opiate antagonists, including naltrexone and nalmefene, are the most commonly prescribed medications for the pharmacological treatment of pathological gambling. These drugs have been shown to reduce the intensity of gambling urges, gambling thoughts and gambling behaviours
Describe alternative treatments for substance use disorder including acupuncture and faith-based approaches
The clinical research to date suggests acupuncture alone is ineffective at reducing withdrawal symptoms and cravings, yet may be useful as an adjunct to more traditional pharmacological and psychological treatments (Ruiz & Strain, 2014; Yang, Lee & Sohn, 2008). Further well designed research studies with adequate sample sizes are needed.
Faith based approaches
Faith based addiction treatment approaches are non-professional, non-clinical community-based programs in which religious or spiritual content either implicitly or explicitly underlie program activities (Neff et al. 2006). While there is limited evidence of efficacy, many people turn to religion or spirituality in times of crisis, and this needs to be acknowledged within treatment programs and withdrawal management.
