You’ve probably heard of people using nicotine patches to wean themselves off of cigarettes or methadone substitutions for those addicted to heroin. Typically, drug therapy aims to reduce the amount of substance the person uses over time through a process known as detoxing, which is a gradual process.
- We are going to explore drug therapy in relation to reducing Addiction.
- First, we will discuss the drug therapy types.
- Then, we will delve into the various drug therapy psychology examples.
- Finally, we will discuss the effectiveness of drug therapy in psychology.
Fig. 1 - We can use drug therapies to tackle
Addiction.
Drug Therapy Types
A variety of drug therapies exist that can help treat addiction, and they do so by altering the biological state of the body and The Brain. Even addictions such as gambling can be treated with drug therapies, despite the addictive behaviour of not physically consuming or taking a substance.
After all, addictions are more than just biological. Behavioural addictions, such as gambling, have been recently added to the DSM. Inherently, addictions affect a person both mentally and physically, and drug therapies offer a potential solution to both issues.
There are three main types of drug therapy used to treat addiction.
- Aversives.
- Agonists.
- Antagonists.
Aversives
Aversive drugs can treat substance abuse, such as alcoholism or drug addiction.
Aversive drug therapies treat substance abuse by creating a negative response to the substance.
For example, cyanimide can treat alcoholism by making the addict have a severe reaction to drinking alcohol, resulting in tachycardia, and hypotension, to name a few consequences.
Niederhofer et al. (2021) investigated the efficacy and long-term treatment results of cyanamide use in alcoholism, using a double-blind, placebo-controlled study. They had 26 participants who were randomly allocated to cyanamide treatment or a placebo for 90 days. These participants were either chronic or episodic alcohol users.
They assessed participants at the start of treatment, 30 days into treatment, and 90 days into treatment. They found that the mean cumulative abstinence rate was significantly higher in the group taking cyanamide compared to the placebo group. Overall, the aversive drug seems to be an effective treatment alongside other potential therapies.
Addicts are encouraged to give up their addiction to avoid the unpleasant outcome of taking substances such as alcohol or drugs. Aversive therapy is based on the theory of classical conditioning.
At first, the substance is primarily associated with pleasurable feelings. They often induce a sense of relaxation, and some even instigate a state of euphoria (e.g., cocaine). Removing this association and instead pairing it with a negative result discourages substance abuse.
Agonists
Agonists treat addictions by lessening the effects of withdrawal symptoms.
Agonists are less harmful drug substitutes, and they act as drug replacements by binding to neurone receptors and activating them in a similar way that the addictive substance does. Hence, the addict experiences a similar effect, which also reduces withdrawal symptoms.
Drug therapy examples include nicotine patches for someone addicted to smoking cigarettes, and methadone, for someone addicted to heroin.
Agonists are particularly popular as they allow addicts to essentially wean themselves off of a substance without suffering the uncomfortable (and often painful) effects of withdrawal.
Depending on the severity, withdrawal is sometimes enough for a person to retake the drug, as the symptoms are pretty unpleasant. If a person is addicted to alcohol and without it, they have shaky hands, fevers, nausea and vomiting, it is understandable that they would want to avoid these symptoms. It is simpler to drink again, rather than suffer.
Agonists aid the process of detoxing. Newman and Whitehill (1979) assessed the effectiveness of methadone in aiding the process of withdrawal from heroin addiction. Compared to a placebo drug, methadone proved to be more effective in assisting successful heroin treatment.
Antagonists
Antagonists work differently than agonists.
Antagonists bond and block receptor sites to stop the addict from feeling the pleasurable effects of their addiction (psychological dependence).
An example is Naltrexone, used to treat heroin addiction.
Antagonists prevent the positive reinforcement that occurs, which fuels addiction. When a person takes a substance that gives pleasurable feelings, preventing this will directly affect the desire to retake the substance, as it’s not providing the same, intense effects.
However, antagonists are most valuable when used alongside other therapies, such as counselling.
Fig. 2 - Various drug therapies influence the effects of different addictive behaviours.
Drug Therapy Psychology Examples
Different drug therapies exist to help treat specific issues.
Nicotine Addiction: Nicotine Replacement Therapy
Nicotine replacement therapy (NRT) uses gum, inhalers, or patches to deliver nicotine in a less harmful way than traditional cigarettes. This therapy provides the addict with nicotine in a clean, controlled dose.
The Brain responds in the same way as if the person had smoked a cigarette. The nicotine binds to the nicotinic acetylcholine receptors (nAChRs) in the mesolimbic pathway (where The Brain responds to pleasure).
It stimulates the release of dopamine (the pleasure hormone) in the nucleus accumbens (central to motivation and action, frequently associated with sexual, reward and drug behaviour).
Over time, smaller and smaller doses of nicotine are given, e.g., smaller patches. Withdrawal syndromes thus become a lot more manageable as there is no shock withdrawal. Consider the following studies.
- Maity et al. (2014): In this review, they analysed three agents known to be partial agonists to nicotine receptors: Varenicline, Cytisine, and Dianicline.
Nicotine interacts with neuronal nicotinic acetylcholine receptors (nAChRs), which release neurotransmitters such as dopamine and noradrenaline upon activation.
The three partial agonists activate the nAChR receptors at lower concentrations than pure agonists, by which we mean nicotine. They help reduce addiction to smoking by maintaining dopamine levels to reduce withdrawal symptoms when a person quits smoking. They found that these partial agonists were the most promising drug therapy for reducing and stopping smoking, with one study on Vernicline showing that around 46.4% of people on Varenicline could stop smoking by the end of treatment (Wang et al. 2013).
Issues exist with cost, although Cytisine appears to be cheaper than Varenicline.
Gambling Addiction: Opioid Antagonists
Although there are no official drug therapies for gambling addiction, some are being trialled, and opioid antagonists are the front runners. Naltrexone, a drug conventionally used to treat heroin addiction, has been used because of the similarities between gambling and substance addiction recognised in the DSM 5.
Drug addiction is similar to gambling because the dopamine reward system responds to gambling the same way as it would to drugs such as heroin.
- Opioid antagonists reduce dopamine release in the nucleus accumbens by increasing the release of another neurotransmitter called GABA. This process effectively reduces cravings associated with gambling.
Fig. 3 - Drug therapies can also treat gambling as they affect the reward pathways.
Evaluating the Effectiveness of Drug Therapy Treatments in Psychology: Addiction
Each therapy has its strengths and weaknesses. Let's explore the advantages and disadvantages of drug therapy use in reducing addiction.
Strengths of Drug Therapy Treatments
There is quite a bit of research support for the effectiveness of drug therapy. Stead et al. (2012) conducted a meta-analysis of 150 high-quality studies into the efficacy of nicotine replacement therapy (NRT). They concluded that all forms of NRT are significantly more effective than placebos/no treatment to help smokers quit.
The nasal spray was the most effective form of nicotine delivery. NRT users were 70% more likely to abstain from smoking six months after quitting.
NRT is also safer than smoking and does not encourage dependence, giving it validity as a treatment for Nicotine Addiction.
The use of drug treatments to treat addiction removes stigma as it encourages people to view addictions as medical issues. This erodes the view that addictions result from some moral or psychological weakness. Removing this stigma could lead to more research and more people seeking help.
An advantage of drug therapy is its convenience. It is easy to take a pill every day and not work on your thought processes or make behavioural changes.
Weaknesses of Drug Therapy Treatments
Both NRT and opioid antagonists can have severe side effects. The side effects of NRT include dizziness, gastrointestinal problems, sleep disturbance, and headaches.
However, it must be considered that the patient would experience these effects from nicotine if they continued smoking anyway. Opioid antagonists, on the other hand, create severe side effects. They require a much higher dose of the drug to treat gambling than drug addiction.
Correspondingly, the side effects are much worse. These include tiredness, anxiety, headaches, joint and muscle pains, cramps, and nausea.
- Side effects are a negative of drug therapy because they are hard on the patient and inhibit people from completing the entire course of treatment.
Drug therapy is a limited treatment. Some addictions make addicts disorganised and unmotivated, i.e., they might forget to take their medication, making the treatment less effective.
There are also individual differences that could affect the effectiveness of drug treatments.
For instance, small genetic variations like the presence of a single gene (mu-opioid receptor gene) can affect Naltrexone. Alcoholics with one variant of this gene responded much better to the drug than those that didn’t.
- Chung et al. (2012) suggest that drug treatments need to become more tailored to individual genetic profiles before they can be consistently effective.
Ethical issues also exist with using certain drug therapies to treat addictions. Aversive drugs induce uncomfortable and unpleasant side effects. Drug therapies are often best used in conjunction with other therapies, such as Cognitive Behavioural Therapy.
Drug therapies also have issues with reductionism.
Drug therapy - Key takeaways
- Drug therapies are biological treatments that help reduce addiction, and they do so by altering the biological state of the body and the brain. There are three types of drug therapies.
- Aversive drug therapies treat substance abuse by creating a negative response to the substance. Examples of aversive drug therapies include cyanimide and disulfiram.
- Agonists are less harmful drug substitutes, and they act as drug replacements by binding to neurone receptors and activating them in a similar way that the addictive substance does, so the addict experiences a similar effect.
- Examples include nicotine patches for someone addicted to smoking cigarettes, and methadone, for someone addicted to heroin.
- Antagonists bond and block receptor sites to stop the addict from feeling the pleasurable effects of their addiction (psychological dependence). An example is Naltrexone, used to treat heroin addiction and alcoholism.
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