Methods of Modifying Addiction

Methods of Modifying Addiction

1. One method of treating addiction is using aversion therapy. Aversion therapy is based on classical conditioning. There are two main examples of aversion therapy.

2. The first example of aversion therapy is antabuse, which is used to treat alcohol addiction. Individuals are given a drug called antabuse. This causes a disulfiram reaction, which stops the enzyme that breaks down alcohol in the liver from working and therefore causes a build up of acetaldehyde in the bloodstream

   • This, in turn, causes a range of unpleasant symptoms such as sweating, heart palpitations, headaches and vomiting. Once the association has been made the person will try and avoid contact with the behaviour

3. Rapid smoking is a form of aversion therapy used to help smokers overcome their addiction. Smokers sit in a closed room and take a puff on a cigarette every six seconds until they finish a specific number of cigarettes or feel sick.The theory is that the smoker will associate this unpleasant feeling with smoking and develop an aversion to it. This might be repeated over several sessions to try and make the association stronger

4. Studies into the effectiveness of antabuse show that antabuse patients have significantly greater abstinence duration than placebo groups. This supports the use of aversion therapy as it shows that it works in treating addictions

   • However, studies that look at the effect of antabuse in the long term are rare and they tend to lack scientific rigour as they are not full randomised control trials
     • Additionally, it is difficult to carry out placebo studies, as patients will be aware which condition they are in if they drink and no adverse effects are experienced

5. A study on 100 smokers who attended a clinic that used rapid smoking was compared with a control condition who watched a video about giving up smoking. The rapid smoking group showed a significant decrease in their urge to smoke in the 24 hours and week after the procedure. At four weeks the difference between the groups was no longer significant and therefore the impact of rapid smoking on long-term abstinence remains unclear.

6. There are many ethical issues associated with aversion therapy. There is a risk of harm as it can cause very negative effects to an individual if they drink alcohol while on medication. Despite this, the people undergoing this therapy will have given valid consent based on information provided by their doctor or pharmacist

7. However we must consider more ethical alternatives. There may be more ethical ways of achieving the same association such as the use of covert sensitisation. This is when individuals are encouraged to imagine feelings of being sick and vomiting when they have the urge to drink. It is much more ethical than using a drug like antabuse to induce such an unpleasant reaction

8. In 2008, the NHS spent just under £2.25 million on antabuse medication. Such financial costs are damaging to society. However, it is argued that investing in treatment and prevention saves the NHS money in the long run.

9. A second method of modifying addiction is agonist and antagonist substitution. This method acts on specific biological processes that either mimic or block the effects of particular substances in the brain

10. An agonist is a chemical that binds to a postsynaptic receptor and activates that receptor to produce a response. In the case of medication, agonists are designed to imitate the action of another substance such as heroin

11. One example of an agonist used in the treatment of addiction is methadone. The aim is that by giving heroin users methadone as a substitute, it will reduce cravings and prevent withdrawal symptoms

    • It has some of the same effects as heroin but does not give people the same ‘high’. A doctor, nurse or pharmacist sees patients each day for the first three month. This supervision helps to make sure that the dosage is right and ensure that people do not take multiple doses at once or sell on their methadone to other users

12. An antagonist binds to a receptor, but rather than causing a reaction, it blocks the usual function of a particular substance. One example of an antagonist used in the treatment of addiction is naltrexone. Naltrexone should be used by people who have stopped using opioids and have demonstrated that they are highly motivated to stay free from drugs. It is recommended that it is offered alongside a psychological intervention

13. NICE assessed 31 reviews of methadone’s effectiveness, including 27 randomised controlled trials. They found higher levels of retention for people using methadone than placebo or no treatment and lower rates of illicit opioid use

    • NICE also reviewed 17 studies concerning the effectiveness of naltrexone for heroin addiction. Many of the randomised controlled trials showed no significant difference between naltrexone and a control treatment for retention
      • However, when the results were pooled they did find naltrexone was associated with a reduction in relapse rates, particularly in those that were highly motivated, and where the patients were closely monitored and offered extra support

14. There are also side effects that need to be considered. Methadone may interact with other drugs sich as alcohol and antidepressants to cause respiratory problems. There is also a danger of overdose with these drugs – in 2013, methadone was responsible for 429 deaths in the UK. Critics of methadone also suggest that all methadone achieves is creating another addiction

15. A report said that prescribing methadone was an ‘expensive failure’ and costs society money, not only for the methadone but for the 320,000 problem drug users on benefits

    • DrugScope highlighted that the National Audit Office had described drug treatment as good value for money for the taxpayer, as many people taking methadone becomes able to function in society as a result of making their addiction more manageable