addiction part 4
addiction part 4 NROSCI 0081
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This 7 page Bundle was uploaded by Arielle Reiner on Friday October 2, 2015. The Bundle belongs to NROSCI 0081 at University of Pittsburgh taught by Fanselow,Erika in Summer 2015. Since its upload, it has received 18 views. For similar materials see DRUGS AND BEHAVIOR in Neuroscience at University of Pittsburgh.
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Date Created: 10/02/15
Addiction part 4 10022015 2 types of drug dependence 0 physical dependence de ned by the occurrence of withdrawal syndrome 0 withdrawal syndrome set of de ned symptoms associated with a decrease in the blood levels of a particular drug 0 symptoms tend to be opposite from the effects of the drug if a drug makes you sleep withdrawal may cause insomnia if a drug makes you numb withdrawal may cause pain if a drug makes you happy withdrawal may cause sadness o detox is a set of procedures designed to get a person through withdrawal syndrome but does not address psychological dependence psychological dependence desire or compulsion to experience effects of a drug because it produces pleasure or reduces comfort 0 comes about because of the rewarding effects of the drug dopamine system 0 psychological dependence may also be related to an individual s fears about experiencing withdrawal symptoms 0 characterized by cravings tolerance produces dependence 0 physical dependence is de ned as the presence of withdrawal syndrome tolerance involves the body and brain changing setpoints to compensate for and counteract the effects of a drug 0 when the drug is no longer in the body the compensatory mechanisms are still present leading to withdrawal symptoms 0 in order for withdrawal symptoms to occur the body must have developed tolerance to the drug s effect how does drug addiction develop and progress Biopsychosocial risk factors contribute to initiating and continuing drug use 0 The brain s reward circuitry reinforces drugtaking behaviors despite negative consequences 0 Motivation and compulsion to take drugs increases Tolerance develops requiring increasing drug taking 0 The body adapts 0 continued drug exposure by changing its set points leading to psychological and physical dependence 0 When abstinent withdrawal symptoms occur contributing to relapse How does it stop General treatment strategies Treating a biobehavioral disorder must go beyond just xing the chemistry 0 Pharmacologicaltreatments o Medications 0 Medical services Psychosocial therapy 0 Social services Why is it important to treat someone with a substance use disorder 0 Drug addicts have difficulty leading healthy and productive lives that are not a drain on the resources of our society 0 Health care costs Crime and criminal justice Accidents Spending resources to treat addicts will save resources in the long term 0 Personal suffering from a disease 0 Rehabilitation is an attainable goal 0 Rehabilitation is not the same as abstinence OOO Treatment strategies Pharmacotherapy o Antagonist therapy Antagonist drugs Give patients a medication that blocks the receptors for the drug someone is addicted to This prevents the addicted drug from producing a El high Antagonist medications are not addictive themselves No tolerance develops Do no relieve cravings Eg naloxone Used for treating morphine overdose Fast acting Works because it binds to opiate receptors and has a higher affinity than morphine and will eventually quotwin outquot so the morphine no longer can bind to the receptors Antagonist treatment for opioid dependence Naltrexone El Oral and long lasting Opioid antagonist with high affinity for opioid receptors Blocks effects of heroin for 24 hours No tolerance or dependence develops with naltrexone Relatively few side effects Frequent noncompliance patients don t take it Sustained release formulas are available Delivered as a depot injection 0 Drug goes into tissue eg muscle and is slowly released for up to 7 months so far 0 Agonist therapy Agonist drugs I Give patients a medication that is an agonist at the receptor for the drug someone is addicted to n Reduces drug cravings but does not cause intoxication high a Eg nicotine replacement such as nicotine gum or patch For opioid dependence n Methadone Is an agonist for opioid receptors Acts as a substitution for heroin or other opiates o Prevents opioid withdrawal symptoms 0 Can be used as a maintenance treatment 0 Currently the most successful maintenance treatment for chronic opioid dependence 0 Expensive Can be used as a detox treatment Methadone dose is gradually reduces the slower the better Relapse happens frequently 0 Eg LAAM is a longeracting alternative to methadone but it has not caught on in the US a Partial agonist treatment for opioid dependence o Buprenorphine O O 0 Is a partial agonist for opioid receptors Safer because overdose is less likely This limits is efficacy Can be used for maintenance treatment but has had limited success ls being considered as a detox treatment Because it is a partial agonist theoretically it would result in fewer withdrawal symptoms Results of clinical tests show it is not necessarily better than methadone for detox but there may be potential because the withdrawal symptoms follow a different pattern 0 Agonistreplacement therapy 0 Maintenance treatment 0 Detoxi cation detox Psychosocial o 12 step programs eg alcoholics anonymous 0 cognitive behavioral therapy CBT o psychotherapy pharmacotherapy can be highly ineffective in the long term without psychotherapy administered by trained mental health professionals a social workers MSW LCSW n psychiatrists MD a psychologists PhD a other licensed counselors and therapists often psychotherapy accompanies pharmacotherapies and can be conducted in multiple ways 0 12 step programs based on the model of alcoholics anonymous somewhat similar to group therapy but the therapists are recovered addicts who have been through all stages of the program basic path a admitting that one cannot control one s addiction or compulsion n recognizing that a higher power can give one strength In examining past errors with the help of a sponsor experienced member In making amends for these errors a learning to live a new life with a new code of behavior a helping others who suffer from the same addictions or compulsions o cognitive behavioral therapy CBT interactive n includes building a trusting relationship and following particular protocol to change behavior awareness a linkage between events and thoughts challenges maladaptive thinking patterns and tries to replace them with adaptive ones teaches coping skills like relaxation can be effective for substance use disorders as well as other psychiatric conditions is addiction a disease The disease model The most widely accepted model of addiction in the media by addicts and their treatment providers Originally applied to alcoholism goes all the way back to the alcohol temperance movement Was later applied to cocaine and opioid addiction This model is used both in treatment of alcoholics in professional settings and in self help groups such as AA or narcotics A The disease model does not exclude the neurobiological changes that occur with addiction or the biopsychosocial model It is based largely on evidence of the disregulation of brain function in addiction Dr Leshner former director of the national institute on drug abuse NIDA said that addiction is a brain disease because it is tied to changes in brain structure and function He claims it is as though a switch is thrown when someone goes from voluntary drug use to the state of addiction 0 Bene ts of the disease model 0 O O Addiction was previously seen as a sign of personal and moral weakness Despite large scale acceptance of the disease model there is still ambivalence about this including the fact that illicit drugs will get you arrested rather than treated Reduces stigma no one blames someone for coming down with a disease lnvolves the medical profession in treating addiction Can reduce guilt experienced by a recovering addict which helps in the recovery process eg a lapse is seen as part of the recovery process not a horrible thing Criticisms of the disease model 0 0 How does one de ne disease Does it require some sort of de nitive test a Eg blood test Addiction like psychiatric disorders can only be diagnosed through clinical signs and symptoms Additionally the disease model is criticized by people who use behavioral approaches to understanding and treating substance abuse and addiction
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