College paper (~2009) detailing the psychopharmacology of substance abuse.

1. Pharmacological Intervention in Drug and
Alcohol Addiction
By Colleen Farrelly
HOPR 196
April 22, 2006

2. Pharmacological Intervention in Drug and
Alcohol Addiction
Treatment for drug addiction is a very complicated process, no matter which
approach is taken. In order to treat addiction, one must first understand the
underlying causes of addiction and the mechanisms by which it continues and
progresses. No one field offers a complete explanation and a sure treatment method
for addiction. In the field of neuroscience (in treatment, more accurately
neuropsychopharmacology), the underlying mechanisms of drug addiction lie
within neurochemical imbalances and within the plasticity (ability to adapt) of
neuronal synapses within certain brain pathways; treatment, then, consists of
correcting these imbalances and attempting to alter the synaptic connections formed
from the repeated use of psychoactive substances by administering counteractive
drugs.
First of all, it is important to understand the balance of neurotransmitters and
the plasticity of synapses. Many of the structures implicated in addiction are part of
the limbic system, the structures responsible for regulating essential animal
functions, such as eating, sleeping, reproduction, and emotions. Among these areas
are the ventral tegmental area (VTA), the nucleus accubens (NA), and the frontal
cortex. Many of these neurons release dopamine (and, additionally, glutamate) as
their primary neurotransmitter, which reinforces behaviors essential to survival in a
similar way to Pavlov’s classical conditioning of his dogs. When psychoactive
substances pass from the bloodstream (through a tight glial network called the
blood-brain barrier) to these dopaminergic pathways and act on these systems
(either directly or indirectly), they create a similar biochemical reinforcement as
eating would, and the brain begins to associate the behavior of taking the drug with
other necessary biological functions. (This is why highly psychologically addicting
drugs are as addicting as they are.) In addition, the drug-associated stimuli and
subsequent reward response create new structure and organization among affected
neurons: postsynaptic sites (which receive the neurotransmitters) adapt to the excess
2

3. dopamine by creating more receptor sites and new connections are formed and
reinforced as the same stimuli are presented.1
For example, in the mesolimbic dopaminergic system (including the VTA and
NA), neurons become primed (changed in structure and in connection) with the
repeated drug-taking stimuli (setting, ritual, drug ingestion itself) so that the
neurochemistry of the system becomes classically conditioned to associate the drug-
taking stimuli with pleasure. This conditioning continues to become stronger as long
as the drug is taken. When the person ceases use, the adaptation is still present, and
the brain will think it is missing something necessary for survival. In this way,
withdrawal will produce the opposite effects as intoxication of the particular drug
will (called the “law of opposites”). For example, cocaine intoxication produces
euphoria; withdrawal from cocaine produces dysphoria.
Eventually, the neurochemical balance and postsynaptic receptor sites (both
of which cause the physical dependence seen in addiction) will return to normal and
the conditioning will become dormant. However, the neuronal pathway connections
between the stimuli and pleasure will still exist (psychological dependence), so that
when the person is presented with a drug-taking stimulus (perhaps a pipe for the
crack addict or a favorite bar for the alcoholic), the connections created between
neurons will still carry the message that the drug is coming (much the same way that
seeing a carved turkey when one has not eaten in a day will produce hunger and
salivation), and the person will experience a “drug-hunger,” or a craving, for the
drug. This is termed the “reinstatement paradigm,” and it is the biggest challenge in
treating addiction, as the synaptogenesis (forming of new connections) during the
formation of an addiction is not easily reversed once it is established.2
Pharmacology offers several treatment options for addiction by correcting
either the binding of psychoactive substances or by correcting existing chemical
imbalances. Agonists are substances which act upon neurotransmitter receptors in
the same way that endogenous substances (which are naturally produced by the
body) would. For example, enkephalins (a type of endogenous opioid) bind to a
1
Self, pg. 398
2
Self, pg. 445-448
3

4. receptor kappa-1; opiates such as morphine have a similar chemical structure to
enkephalins and will fit into the receptor site like the right key will fit into a given
lock. Antagonists, on the other hand, block receptor sites or bind to the substance so
that the substance (endogenous or other) will not be able to bind; antagonists
produce no signal in the receptor cell, much the way the wrong key will produce no
effect on opening the lock. In addition, some substances can be partial agonists.
These substances will bind well enough to receptor sites that they will produce some
effect in the receptor cell, but they do not elicit the same magnitude of response as an
agonist would. In this way, they can function as an agonist or an antagonist, as they
block the true agonists from binding. These properties become especially important
in treating overdoses and in treating a patient’s withdrawal symptoms.3
In addition, drug metabolism is important to pharmacology and its efforts to
treat addiction. When a drug is ingested, it must eventually be broken down, or
metabolized, for elimination, much the same way food must be digested before it
can leave the body. Enzymes within the liver accomplish this through a series of
steps, until the final product of the reactions and their by-products can be removed
from the body. Catalysts, special proteins, speed up the rate of the reaction and the
metabolic processes. In this way, catalysts can speed up the slowest step in
metabolism (referred to as the rate-limiting step) and change which products stay in
the body for the longest period of time. Certain drugs can either act as catalysts
themselves to speed up the metabolism of a substance or can bind to catalysts or
enzymes to slow the metabolic process down. This becomes especially important in
the long-term treatment of addiction.4
These aforementioned properties carry several implications for addiction
treatment with pharmaceuticals. First, the primary types of neurotransmitters
involved in the patient’s addiction (dopamine in cocaine dependence, for instance)
will dictate which drug is prescribed. It would make no sense to treat cocaine
addiction (which works on the dopaminergic and norepinephrine systems) with a
drug that works on the endogenous opioid systems. Second, the functions of drug
3
Perrine, pg. 18-19
4
Perrine, pg. 124
4

5. action and desired effect on the patient must match. If someone has overdosed on
heroin, a drug that treats opiate cravings will not necessarily reverse the effects of
the overdose. The situation and the drug administered must match. Lastly, catalytic
drugs or drugs inhibiting catalysts must match the patient’s situation. If a certain
metabolite (product created during substance break-down) produces an unpleasant
effect that might cause a person to avoid taking a certain substance, the administered
drug must prolong the length of time before that metabolite is broken down, so that
it can accumulate in the body, producing its unpleasant effect. In all, care must be
taken to match the patient’s circumstances and drug(s) of choice with the right
prescription.
From this, drugs used in treating addiction can be categorized according to
function and according to the abused substance for which they will work best. The
first category includes drugs used in overdoses, the most common of which is used
in the reversal of opiate overdoses. These drugs either block receptor sites or prevent
the substance from binding by changing the substance’s chemical structure. The
second category includes the maintenance drugs, typically used in treating heroin
addiction. These drugs prevent withdrawal but do not produce the euphoric effects
of heroin, and they try to eliminate the use of needles (and, hence, prevent the
spread of HIV and other transmitted diseases among addicts). The third category
encompasses drugs used in detoxification. These slowly ease patients off drugs
without having to experience full-blown withdrawal symptoms. The fourth category
is for anti-craving drugs. These drugs block cue-triggered cravings from the prior
synaptogenesis upon onset of the addiction and help prevent relapse. Finally, some
drugs are used in the treatment of pain in recovering patients or in patients on
maintenance programs. These are important, as certain drugs of addiction primarily
take away pain (such as the opiates) and as the introduction of pain to such patients
may trigger relapse into the addiction.
First, drugs can be used to reverse overdoses. In opiate overdoses, the patient
receiving the drug, called naloxone, will often be hypotensive, disoriented and
possibly experiencing respiratory failure. Naloxone is an opiate antagonist that
5

6. prevents the binding of the ingested opiate. It must be administered either
intravenously or intramuscularly, as stomach enzymes will break it down. Naloxone
is a very powerful antagonist, as 1 mg will block 25 mg of heroin. Typically, a .5-10
mg dose is administered, and the patient is gradually brought out of the overdose.
The dosage is then taped by 60% until all the symptoms have subsided and the
patient has finally recovered from the overdose. Naloxone is non-addicting and will
produce no signs of withdrawal itself. Overdose drugs also exist for alcohol
overdoses; the primary drug is Ro 15-4513, which blocks the neurochemical effects of
alcohol intoxication by working on the GABAerigic system (the primary system
involved in alcohol’s effects). Ro 15-4513 is a benzodiazepine (anti-anxiety drug) and
binds to GABA receptors. These drugs have been especially important in emergency
medicine, as naloxone will prevent patient death and undo the acute effects of opiate
usage and as Ro 15-4513 will reduce a severely intoxicated person’s belligerent or
anxious behavior-quite important in patients receiving treatment for injuries
sustained while intoxicated (car accidents, falls, or fights)—so that doctors can more
easily assess injuries and treat the patient.5
The second category is that of the maintenance drugs. These drugs are mainly
used in the treatment of opiate addiction. Methadone, which was invented as a
possible treatment for heroin withdrawal in the 1930s, has long been used as a
maintenance drug. Methadone maintenance programs came into existence in 1963
and were created by Dr. Vincent Dole and Dr. Marie Nyswander in New York City.
The main concept is to substitute a non-euphoric opiate addiction (methadone) for a
euphoric one (heroin), an orally-administered one for an injection-administered one.
Methadone is a slow-acting opiate, meaning that it has a substantial time between
dosage administration and the onset of withdrawal symptoms (which tend to be
milder than the ones caused by heroin), allowing the patient to center his or her life
around something other than his or her opiate addiction. In addition, maintaining a
constant blood opiate level (rather than the highly variable one with heroin use), a
patient’s immunological and neuroendocrinal responses are substantially better,
5
Perrine, pg. 87, and Feldman, pg. 657
6

7. leading to better overall health. By providing this service to opiate-dependent
patients, these patients should not have to find money to get the drugs to stave
withdrawal, and they should not have to interact with drug dealers. Ideally, this
would allow them to function better in society, reduce crime rates among addicts,
and allow for better health, as no needles (or needle-sharing!) are necessary.
However, a study done by the Institute for Social Research at the University
of Michigan has found that the methadone maintenance program has not reduced
any of these problems substantially and that it has also failed to lessen illicit drug
use among its participants, as well as failed to lessen the spread of HIV infection
among users.6
In addition, the United States of America has put many regulations on
the length of methadone treatment for heroin addicts.7
Six-year success rates for
willing participants are around 40% when used in addition to counseling or group
therapy.8
LAAM is another maintenance drug that has been used in place of
methadone. Like methadone, LAAM is a synthetic, long-acting opiate agonist (with
duration of up to 96 hours, three times that of methadone) that is cheaply produced.
It, too, relieves the patient’s cravings, redirects activity from drug-obtaining
behaviors, lowers the chances of HIV infection, promotes better immunological
functioning, and leads to less mortality (from either overdoses or from violent
encounters with heroin dealers). In fact, LAAM at first seemed to work even better
than methadone, but it has since been linked to cardiotoxic reactions (especially with
prolonged usage), leading to its eventual removal of use from maintenance
programs.9
Maintenance programs, on the whole, have created much social and political
controversy, as their aim is to replace one addiction with another, rather than
attempt to get the patient off of drugs altogether. This seems to undermine
America’s War on Drugs and its anti-drug campaigns. Some view it as a soft-on-
6
Feldman, pg. 547
7
These include a demonstrable minimum of one year of opiate addiction with current evidence of opiate
use and abuse.
8
Feldman, pg. 547
9
Meyer, pg. 270
7

8. drugs stance, while others view it as more successful at preventing the adverse
social and medical consequences of heroin addiction than the maintenance programs
really are. Perhaps the programs serve as a compromise between the two stances on
the problem of heroin addiction.
Another category of drugs used in the treatment of addiction are the drugs
used in detoxification. These are important, as they lesson the symptoms of
withdrawal, which can either be unpleasant enough to trigger the patient to reuse
the substance or, in the case of withdrawal from depressants like alcohol, can be life-
threatening in severe cases. Drugs used in detoxification typically are agonists of the
substance previously used by the patient and gradually wean the patient off drugs
altogether. Two of the substances with which detoxification drugs are used are to
ease withdrawal are opiates and alcohol.
First, any opiate can be substituted when the patient is addicted to an opiate
and is experiencing withdrawal symptoms. Typically, opiate withdrawal symptoms
include diarrhea, cramps, fatigue, anxiety, fever, tremor, hypothermia, nausea,
vomiting, cold sweats, and piloerection (hence the term “cold turkey” used for the
cessation of opiate use without pharmacological intervention) and vary in severity
and duration depending on usual dosage, intervals between dosages, duration of
opiate use, and the patient’s psychological well-being. Severe cases may last for
several weeks. Usually, detoxification drugs (such as methadone) are substituted in
dosages similar to the patient’s typical dosage and decreased by about 10% per day
until the patient is drug-free. This process can be sped up or slowed down
depending on how the patient reacts to the gradual withdrawal. Another drug, an
alpha-2-adrenergic receptor agonist called clonidine, has been used to ease
withdrawal symptoms, but this drug tends to produce profound sleepiness and has
become a street drug outside of detoxification centers. Although these drugs lessen
the severity of withdrawal symptoms, they also prolong the duration of withdrawal,
which can occasionally pose problems for patients in short-term treatment
programs.10
10
Perrine, pg. 90
8

9. Alcohol withdrawal, however, must be monitored closely, as severe
withdrawal symptoms (called delirium tremens, or DTs), such as seizures,
hallucinations, and occasionally death can result, in addition to the usual
withdrawal symptoms of nausea, vomiting, sweats, tremors, tachycardia, anxiety,
and headaches. Most of the symptoms occur as a consequence of alcohol’s
interactions with GABA and glutamate receptors within the brain, so drugs working
on these systems (which will show a cross-tolerance in response to alcohol tolerance)
are usually administered. Benzodiazepines, such as diazepam (Valium), are
prescribed for the relief of anxiety and for the prevention of seizures. Haloperidol, a
typical anti-psychotic used in the treatment of positive schizophrenic symptoms, is
given to reduce the occurrence of hallucinations. Like opiate withdrawal, the
symptoms of alcohol withdrawal vary according to the usual dosage, duration of
use, and periods between use—as well as if the patient has ever sustained a head
injury, such as a concussion or a traumatic brain injury. Also like opiate withdrawal,
drugs used in alcohol detoxification are gradually tapered until the patient is
substance-free.11
In the treatment of addiction, detoxification is certainly a step in the process,
but it is not the last step. After a patient has undergone withdrawal, he or she ideally
must not return to substance use or will likely return as a detoxification or overdose
patient once more. Two types of rehabilitation drugs are used to try to keep the
patient from relapsing: aversion therapy drugs and anti-craving drugs. When used
in conjunction with long-term counseling and group meetings (such as Alcoholics
Anonymous, Narcotics Anonymous, or Cocaine Anonymous), these drugs can be
very effective in preventing relapse in substance-dependent patients.
The first type of relapse-prevention drugs includes those used in aversion
therapy. Aversion therapy lies on the classical conditioning principles that the
patient uses the substance of choice because he or she perceives its effects as
pleasant. If the substance no longer produces the sought-after pleasant effects, the
patient will eventually become reconditioned to associate the substance with
11
Feldman, pg. 658
9

10. unpleasant effects and cease use of the substance. Aversion therapy incorporates
drugs that will create such unpleasantness with the patient’s self-administration of
alcohol.
Disulfiram is one such drug used in treating alcohol dependence. It inhibits
an enzyme called aldehyde dehydrogenase, which is part of the metabolism of
alcohol (see diagram below).
10

11. This allows levels of blood acetaldehyde to rise, producing tremor, nausea, severe
vomiting, and diarrhea with the ingestion of as little as 7 ml of alcohol. The drug was
accidentally discovered in the 1940s by Jens Hald, who was studying disulfiram in
the treatment of intestinal parasites. After accidentally ingesting a small amount of
the compound, he went to the local tavern with friends, drank brandy, and became
violently ill, discovering the first aversion-therapy drug for alcohol dependence
treatment.12
As disulfiram produces such violent illness, it is contraindicated in
patients within the stages of early recovery, as relapse is common within this stage,
and it is most effective in patients who also participate in counseling and a recovery
program such as Alcoholics Anonymous.
Several anti-craving drugs exist for the treatment of alcohol or opiate
dependence. These drugs either block the association pathways in the VTA or NA
created during the addiction process (implicated in the workings of stimuli-induced
drug craving) or block the pleasure when the patient relapses into use. Many of the
effective drugs in this category work on both systems. Naltrexone, nalmefone,
acomprosate, and, to some extent, ibogaine, are such drugs.
Naltrexone is an anti-craving drug used in the treatment of both alcohol and
heroin dependence. It is an opiate antagonist (working on the mu and delta
receptors of the endogenous opioid system), which can also be used in overdose
treatment and as a rapid detoxification drug, that produces no noxious side effects in
the case of patient relapse. It can be taken orally as little as 3 times per week, and it
blocks the effects of opiate use, as well as blocking craving in both opiate- and
alcohol-dependent patients. In alcohol-dependent patients, naltrexone is very
effective in reducing relapse rates and reducing consumption rates in those who do
relapse. A 1992 University of Pennsylvania study found that 73% of patients taking
naltrexone remained sober during the experimental 12-week period, compared to
the 45% of patients receiving a placebo.13
A similar study was conducted by
McClellan with regard to the effects of naltrexone in the treatment of heroin-
dependent patients systematically exposed to drug-use cues, but the study needed to
12
Feldman, pg. 658-659
13
Feldman, pg. 659
11

12. be abandoned because the levels of cravings experienced by the patients became
hazardous. However, a study of naltrexone’s efficacy in treatment of opiate-
dependent physicians produced a 74% one-year success rate.14
In all, naltrexone
works very well in highly-motivated patients while producing minimal side effects,
even with the ingestion of the substance of choice.
Another anti-craving drug which has yielded promising results in alcohol-
dependent patients is acomprosate, a partial agonist for glutamate receptors
(specifically, NMDA channels). It has doubled the rate of abstinence among alcohol-
dependent patients, lessoning drinking days by an average of nearly 50%. Like
naltrexone, the best outcomes were obtained in patients who also received
counseling or attended some sort of group therapy.15
Two less-studied anti-craving drugs are nalmefone and ibogaine. Nalmefone
is an opiate antagonist, also used as an overdose-reversal drug, which has proven
beneficial in preventing cravings among alcohol-dependent patients. Ibogaine is an
antagonist drug which works primary on glutamate and dopamine receptors
(though it may play a role in modifying kappa-opioid receptors). It comes from a
type of African shrub and is thought to have psychedelic effects, though it does not
work on the same receptors (5-HT) as other hallucinogens, such as LSD. In studies
conducted in the Netherlands, Israel, and St. Vincent, it has shown promising results
in blocking cravings in cocaine-dependent patients, as well as heroin-dependent and
alcohol-dependent patients. However, ibogaine and its derivatives are considered
Schedule I drugs in the United States, and medical experimentation is prohibited.16
In addition to the drugs directly affecting drug addiction treatment, drugs
prescribed for pain relief in drug-dependent and recovering patients are important
as well. “Few engender as much anger and hostility among physicians and other
health-care providers as alcoholics and heroin addicts. The diagnosis of either
condition immediately serves to make the person’s complaints and past medical
14
Feldman, pg. 547
15
Feldman, pg. 659
16
Abrams, pg. 24-25
12

13. history suspect.”17
This is because opiate-dependent patients seeking pain relief
present several problems to physicians.
First is the problem of obtaining an accurate account of medical problems and
drug usage from the patient. Patients may try to conceal the true amount of narcotics
they take for both fear of physician disbelief and for fear that the physician may be
unwilling to prescribe the high dosages of narcotics that they may need for adequate
pain relief due to an acquired tolerance. Without this information, it becomes hard
for the physician to figure out what dosage to prescribe. Several factors necessitate
the high dosages required to treat pain in recovering patients. First, the opiate-
dependent patient has acquired a cross-tolerance to all other narcotics. It is not that
the patient desires to become high of the pain medications, but, rather, that a low
dose will not relive the pain. Additionally, it is not because the patient has
experienced a decrease in pain tolerance that he or she needs for pain relief, but
because the opiate tolerance and subsequent synaptic changes have produced a
lowering of pain thresholds, so that even seemingly innocuous stimuli can trigger
pain receptors to signal the sensation of pain.
In addition to the problems of tolerance and obtaining an accurate drug
history, the physician may be faced with the question of what to prescribe and how
much to prescribe. Non-narcotics are recommended before narcotics, and
tranquilizers are contraindicated in substance-dependent patients. However, if non-
narcotics (such as NSAIDS, including aspirin and ibuprofen) do not provide
adequate pain relief, low doses of narcotics can be given until the dosage has been
raised high enough to relieve the pain but still low enough to not produce sedation
or euphoria. If the patient is going through detoxification, a short-acting parenteral
narcotic can be substituted for the detoxification drug, and the patient can gradually
be weaned from the prescribed narcotic. All in all, pain management is very
important in the treatment of addiction, as chronic or acute pain can trigger relapse
into drug use.18
17
Stimmel, pg. 387
18
Stimmel, pg. 381-391
13

14. Neuropsychopharmacology has provided many contributions to the field of
addiction studies, both with regard to the development of addiction and to the
treatment of addiction. It has offered solutions to cases of overdose, has made
detoxification and maintenance possible, and has offered solutions to the cravings
that often hinder recovery, as well as offered a solution to pain in substance-
dependent patients. However, it has not offered absolute solutions to the problems
and has a far way to go before the field can offer more effective treatments.
First, drugs that reverse opiate overdoses, such as naloxone, have both
positive aspects and negative aspects. Naloxone can prevent death in patients who
have overdosed, who would once have died from respiratory failure. However, the
person (or the person’s friends) has to seek medical help for the drug to be
administered and hence reverse the overdose symptoms. If he or she is alone, the
person may not be able to do this or be willing to do such, as non-medical use of
opiates is illegal. In addition, naloxone also may not cause withdrawal itself, but by
blocking the binding of opiates, it can induce opiate withdrawal in dependent
patients.
Similarly, maintenance drugs, such as methadone, possess both positive
aspects and negative ones. One the positive side, methadone can allow opiate-
dependent patients to regain normal societal function—finishing school, holding a
job, caring for a family—that would be nearly impossible otherwise. In addition,
methadone maintenance programs can reduce the chance of HIV infection, as it
eliminates the need for needles and cookers, and can also reduce mortality rates
from other infection (from lowered immunological response) and from violent
confrontations with dealers or from overdose.
However, several problems exist with these programs. First, by giving the
opiate-dependent patient an opiate drug, if he or she takes heroin in addition to the
methadone, and overdose can quickly result, and the possibility of contracting HIV
by sharing needles or cookers increases greatly, as does the possibility of violent
encounters with dealers. Second, methadone maintenance programs do not solve the
problem of addiction; they consist of merely substituting one addiction for another.
14

15. The dependent patient is still drug-dependent, albeit a better functioning drug-
dependent patient. If the goal is to achieve sobriety, providing drugs for the
dependent patient will not allow progress towards this goal. In addition, compliance
issues arise in maintenance programs, as the patient must show up to receive the
drug and must refrain from using other drugs to avoid overdosing. In all, these
programs do not serve their purpose as effectively as once hoped and should
probably be re-evaluated or restructured to lessen the problems of compliance.
In addition to the previous two pharmacological interventions, detoxification
drugs offer advantages and have disadvantages. One advantage to detoxification is
that slow, controlled withdrawal is safer and more comfortable than rapid,
uncontrolled withdrawal. Patients have lower morality rates when withdrawing
form depressants like alcohol and also are more likely to stay clean if withdrawal is
not as painful as they may have previously experienced when trying to get off the
drug without medical intervention. This means that long-term sobriety is more
likely to be achieved and the patient will stay in treatment long enough to learn
strategies for living life without the use of drugs. However, detoxification itself is
not a long-term solution to addiction. Without other interventions (such as
counseling or an after-care group), the patient is unlikely to stay clean.
Pharmacological intervention in detoxification is a beneficial first step, but it is not a
solution in and of itself.
Anti-craving drugs and aversive drugs can provide another step in treatment
after detoxification is complete and can play a role in achieving long-term sobriety.
These drugs have many positive features, as well as some negative ones. First, anti-
craving drugs and aversion-therapy drugs are useful in relapse-prevention. One-
year success rates have been as high as 70% in recent studies, over two times as high
as success rates without such intervention. In highly motivated individuals, these
drugs can help drug-dependent patients to stay drug-free for over a decade.19
However, the drugs only prevent cravings or produce unpleasant affects with
relapse when the patient takes them. Only two week after cessation of disulfiram
19
Perrine, pg. 127
15

16. treatment, relapse will produce none of the adverse affects. Two problems can
contribute to patient non-compliance. Some patients express the view that these
drugs are crutches and that they do not need them to stay sober. Other patients may
decide to use again in frustration with sobriety, in essence deciding that either “one
won’t hurt” or that they “quit” recovery, “do not care anymore,” and should be able
to drink if they so desire (both essentially a denial of denial of their problem).20
In
these cases, the anti-craving drugs will not help prevent relapse because the
dependent patient has decided to stop taking them.
Therefore, such drugs are not really a solution for the problem of addiction.
The best results are obtained by patients involved in counseling or who attend
group meetings also. Patients must also be highly motivated to comply with the
doctor’s orders (which group meetings and support can instill). Much of the
addicted population (especially opiate-dependent patients) are not this motivated
and do not have a very strong support system, so drugs such as naltrexone are only
a real solution for an estimated 10% of the addicted population.21
Due to such a small
number of individuals who would benefit from such, their manufacture is not very
profitable to the companies with the money and resources to manufacture them. In
all, anti-craving drugs—when used by a motivated patient with a strong support
base—can be a very effective tool in preventing relapse, but they are not a solution
to addiction and are not appropriate for the entire addicted population.
Lastly, pain medications have benefits in the treatment of addiction, as well
as serious potential for harm. If used properly under the watchful eye of a physician,
they can relieve the pain that may impede or sabotage recovery. However, if a
narcotic is used for pain relief and is not carefully administered, it may do more
harm than good, either producing relapse in opiate-dependent patients or creating
another addiction in other recovering patients.
In all, neuropsychopharmacology offers insight into the biological causes of
addiction by examining pathway-alteration and receptor adaptation, as well as
providing solutions to addiction. One such solution is the development of overdose-
20
DeWors, pg. 22-23
21
Feldman, pg. 547
16

17. reversal drugs, which can save lives and make treatment of injuries easier. In
addition, pharmacology has offered a possible solution for the social and medical
problems caused by heroin addiction by substituting that addiction for a more
innocuous opiate addiction. Another solution that pharmacology offers is a way to
safely withdrawal a drug-dependent patient from drugs, which reduces mortality
rates and increases the likelihood that a patient will stay with his or her
rehabilitation program. Additionally, pharmacology has produced promising drugs
to fight cravings in recovering patients, helping them to achieve long-term sobriety.
Lastly, pharmacology has offered a solution to the pain-relapse connection by
providing pain relief to drug-dependent individuals. However, just as
pharmacology has offered potential solutions to drug addiction, it does not hold all
the answers, as pharmacological treatments yield the best results when used with
other treatments (such as 12-step programs) and as compliance issues can hinder
recovery progress. In all, pharmacology is a promising field in the understanding
and the treatment of addictions.
17

18. Sources
Abrams, Michael. “The End of Craving.” Discover Magazine, May 2003: pg. 24-25
DeWors, George Manter. White Knuckles and Wishful Thinking: Learning from the
Moment of Relapse in Alcoholism and Other Addicitons. Hogrefe and Huber
Publishers, Seattle, WA: 2000
Feldman, Robert S., Meyer, Jerrald S., Quenzer, Linda F. Principles of
Neuropsychopharmacology. Sinauer Associates, Inc., Sunderland, MA:
1997 Karch, Steven B., MD. Drug Abuse Handbook. CRC Press, Boston, MA:1998
Meyers, Jerrold S., Quenzer, Linda F. Psychopharmacology: Drugs, The Brain, and
Behavior. Sinauer Associates, Inc., Sunderland, MA:2005
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