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Flashcards in Addiction: Methods Of Modifying Deck (29):

What are the 2 Methods of Modifying Addiction.

1. Agonist + Antagonist Substances
2. Aversion Therapy


Describe a Agonist Substance.

- A chemical that binds to a postsynaptic receptor and activates that receptor to produce a response
- In medication, agonists are designed to imitate the action of another substance (e.g. heroine)
- Example = Methadone - used to treat addiction to opioid drugs + is produced synthetically to mimic same effects


What are the Uses of Methadone (Agonist Substances)?

- Aims to reduce cravings + to prevent withdrawal symptoms
- Similar effects of Heroine without high
- Dosage reduced over time until stopped completely


Describe the Dosage of Methadone (Agonist Substances)

- NICE suggest to give an initial dose of 10-40mg + increase by 10mg until no signs of withdrawal (60-120mg)
- Given orally
- Doctor checks patient everyday for first 3 months then once a week


Describe a Antagonist Substance.

- Binds to receptors + blocks usual function of particular substance
- Example = Naktrexone - used in abstinence stage of recovery - blocks euphoric + pleasurable effects associated with opioid (less rewarding)


What is the Usage of Naltrexone (Antagonist Substances)?

- Used for people who have stopped using opioids
- Given orally - available as an implant/injection in US + Russia
- Can be used for up to 6 months
- Can also be used for alcoholics
- NHMRC suggests it for problematic gamblers


Agonist + Antagonist Substances Evaluation
1. Effectiveness of Methadone

- NICE assessed 31 reviews of the effectiveness of Methadone (including 27 randomised controlled trials) - found higher levels of retention using Methadone than placebo/no treatment
-Providing that the Dosage is adequate the Methadone is an effective as a maintenance treatment


Agonist + Antagonist Substances Evaluation
2. Comparing Methadone + Buprenorphine

- Point to consider
- Alternative to Methadone = buprenorphine - milder + has agonist + Antagonist properties
- Less risk of overdose due to ceiling effect
- Marteau (2015) = analysed data for 5 years - 6X safer than Methadone
- Methadone still preferred treatment - higher rate in retaining patients in treatment because the addict prefers the feeling they get from taking Methadone so are more likely to continue taking it


Agonist + Antagonist Substances Evaluation
3. Effectiveness of Naltrexone

- NICE reviewed 17 studies concerning effectiveness of Naltrexone for heroine addiction - conflicting results - many randomised controlled trails showed no significant difference
-Naltrexone was associated with reduction in relapse rates particularly those were highly motivated
- Lahti (2011) = tested effectiveness of Naltrexone on sample of gamblers - instructed to take it before gambling + felt urge to gamble - found significant decrease in gambling levels - more research needed


Agonist + Antagonist Substances Evaluation
4. Issues with Effectiveness

- NICE identified problems with research in the effectiveness of Methadone + Naltrexone- studies from different countries are compared there may be differences in treatment protocol (e.g. dosage)
- Studies don’t follow up over a long period of time - common to relapse within months/years - researcher may not pick up on this - sample attrition is also common


Agonist + Antagonist Substances Evaluation
Ethical Issues
1. Ethical Criticisms of the Use of Methadone

- May interact with other drugs (e.g. alcohol+antidepressants) to cause respiratory problems
- Danger of overdose if addict combines methadone with other drugs
- Office for National Statistics reported that in 2013 methadone was responsible for 429 deaths in UK


Agonist + Antagonist Substances Evaluation
Ethical Issues
2. Side Effects of Naltrexone

- Greater risk of overdose if individual chooses to return to taking a drug they will need more to feel the same effects + more likely to overdose


Agonist + Antagonist Substances Evaluation
Social Implications
1. Financial Cost of Methadone to Society

- Centre for Policy Studies says prescribing methadone was an expensive failure - costs society money for methadone + 320000 drug users on benefits - greater success achieved through funding rehabilitation centre
- DrugScope claims report overestimated cost of prescribing methadone - National Audit Office described treatment as a good value for money (for tax payer) - addict able to function in society as makes addiction more manageable


Agonist + Antagonist Substances Evaluation
Social Implications
2. Methadone + Criminality

National Treatment Agency - treating heroine users with methadone has an immediate positive effect on society by reducing criminality - rates of offending are reduced by 1/2 when addicts are in treatment
- Setting up methadone programmes centered around a particular area - people worried about possible increased crime
- Boyd (2012) = treatment centres in Baltimore - crime rates were similar to surrounding area


What is Aversion Therapy?

- Helps individual to unlearn addictive behaviours by changing association
- Based on principles of classical conditioning
- Less popular as a treatment


What is the Equation for Aversion Therapy?

Unpleasant Stimulus ------------> Negative Response(NR) Unconditioned Stimulus ------> Unconditioned Response

Unpleasent Stimulus + Addictive Behavior ------------> NR
US + NS ------------> UR

Addictive Behaviour ---------------> Negative Response
Conditioned Stimulus ----------> Conditioned Response


Describe Antabuse (Disulfiram)

- Treatment used for alcohol
- Acts as an aversive stimulus
- Motivation needs to be there to take drug in the first place
- Treatment can begin after individual has undergone withdrawal


How Does Antabuse Work?

- Works by affecting how the body metabolites alcohol
- Causes a disulfiram reaction which prevents acetaldehyde being broken by aldehyde dehydrogrease + causes a build up in the bloodstream which causes unpleasant symptoms
- Occurs within 10 minutes + lasts for several hours


Describe the Equations for Antabuse

During Leanring
Antabuse + Alcohol -----> Feeling unwell/anxiety/vomiting
US + NS -----> UR
After Learning
Alcohol ---------------------> Feeling unwell/anxiety/vomiting
CS ---------------------> CR


What is the Dose for Antabuse

- 200mg a day
- May increase if reaction with alcohol is not adverse enough
- Individual remains under supervision every 2 weeks for first two months - then once a month for following four months


What is Rapid Smoking?
(Describe Process)

- Helps smokers overcome addiction
- Smoker sits in closed room + takes a puff of fag every 6 seconds until they finish a certain number of cigarettes/feel ill
- Unconditioned stimulus = Intensive smoking
- Unconditioned Responce = Disgust/feeling sick
- Smoker will associate unpleasant feeling with smoking + develop a aversion to it
- Very popular in the 1970s


How can CBT be Used With Aversion Therapy to Treat an Addiction?

- Focuses on coping strategies for when individual thinks they might relapse
- Example = Gambling
-Cognitive = focuses on correcting/challenging any cognitive biases felt at breaking individual about their habit (e.g. Overconfidence)
- Behavioral = looks at breaking any associations between behavior + cues in environment
- CBT has a range of benefits for gambling
- Studies criticised for small sample + not fully investigating long-term effects


Aversion Therapy Evaluation
1. Effectiveness Of Antabuse

- Niederhofer + Staffen (2003) = compared anatbuse + placebo, assessed participants using self-report + screening for 90 days - Antabuse patients had significantly greater abstinence duration
Jorgensen (2011) = those treated with antabuse had more days until relapse + fewer drinking days
- Studies looking a effectiveness of antabuse in long term studies are rare + lack scientific rigor as they're not fully randomised controlled trials
- There are fewer comparison studies between antabuse + other treatments for alcoholism + often take place on small sample


Aversion Therapy Evaluation
2. Effectiveness Of Rapid Smoking

- NEGATIVE/POSITIVE (G boi loves you, keep on revisin!)
- Limited research - less popular
- McRobbie (2007) = compared 100 smokers going through rapid smoking + control group - found that rapid smoking significantly decreased in urge to smoke 24 hrs + week after sessions - 4 weeks later difference no longer significant


Aversion Therapy Evaluation
3. Eliminates the Behavior Not the Problem

- Only treats behaviour rather than cause
- Individual feelings towards the specific behaviours may remain after a period of time but underlying problem that caused addiction then it won't be addressed
- Individual may simply switch focus of addiction to another problem
- CBT may be needed to address deeper issues


Aversion Therapy Evaluation
Ethical Issues
1. Risk of Harm

- Taking antabuse can cause negative side effects when alcohol is consumed + rapid smoking is a very unpleasant experience
- This is why the treatment is designed + those taking it have given valid consent
- Harmful effects also create an issue with compliance as individual can choose to pull out of treatment - this creates problem with effectiveness studies


Aversion Therapy Evaluation
Ethical Issues
2. More Ethical Alternatives

- More ethical ways of achieving the same associations by using covert desensitisation
- Kraft (2005) = presents a series of case studies highlighting the despite it not being used often it can be quick + highly effective


Aversion Therapy Evaluation
Social Implications
1. Financial Implications

- 2008 = NHS spent under £2.25 mil on medication for alcoholism (up form 1.08 mil in 1998)
- Alcohol concern responded saying this was a small amount compared with money spent on treating alcholism + related illnesses on NHS
- Treatment + prevention saves NHS money in the long term


Aversion Therapy Evaluation
Social Implications
2. Social Cost of Not Treating Addiction

- Alcoholism costs tax payers £21 billion a year
- Addiction leads to unemployment + claiming benefits
- Effect of addiction costs NHS £35 billion a year
- can cause breakdown of families/homelessness/debt/crime
- Benefits outweigh the Costs