Transcript Treatments for Addiction

TREATMENT OF ADDICTION
QU. WHAT ARE THE CAUSES OF ADDICTION?
ZINBERG, (1984)
THE
DRUG
Addiction is
a complex
interaction
THE
PERSON
THE
ENVIRONMENT
QU. WHAT ARE THE TREATMENTS FOR ADDICTION?
WEST (2006) - INTERACTIONIST MODEL
Susceptibility
INITIATION
Social
factors
beliefs held
MAINTENANCE
Doctors help
Clinical
interventions
CESSATION
abstinence
Self help
Community
support
Workplace
rules
SOME CONSIDERATIONS IN TREATMENT;
 Prevention
 Once
is better than cure!
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&feat
ure=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 medicationassisted 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.
NALTREXONE
 By
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
 Dose:
to promote reduction in drinking level
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
Quit Rates = Continuous abstinence (not even one puff of a cigarette) during weeks 9-12
CHANTIX 1 mg bid Zyban 150 mg bid Placebo
Gonzales et al 44.0%*
(n=1025)
29.5%†
17.7%
Jorenby et al
(n=1027)
29.8%‡
17.6%
43.9%*
Median Heavy Drinking Days per Month for Each Treatment Group Overall and by Sex
Garbett et al, 2005
Garbutt, J. C. et al. JAMA 2005;293:1617-1625.
Copyright restrictions may apply.
REDUCTION OF HEROIN USE BY DURATION
OF METHADONE TREATMENT Ball & Ross, 1991.
120
100
97%
P
e 80
r
c 60
e
n 40
t
67%
23%
20
0
8%
Pretreatment
Admission:
< 6 months
stay
Average
Stay: 6 to
54 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
90%
80%
%
I
V
82.1%
70%
72.7%
60%
57.6%
50%
U
S
E
R
S
40%
45.5%
30%
20%
28.9%
10%
0%
In Tx.
1 to 3
4 to 6
Months Since Dropout
7 to 9
10 to 12
Primary Drug at Entry to Opiate Treatment,
King County WA
100.0
94.6
Heroin
80.0
83.2
60.0
%
40.0
20.0
14.4
Rx Opiate
3.0
0.0
1999
2000
2001
2002
2003
2004
2005
QU. ANY OTHER LIMITATIONS?
Qu. Would they work for
Behavioural addictions?
Such as porn
addictions?
Or food
addictions?
MARK GRIFFITHS (2012)