Medical Interventions for Dealing With Addiction

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Various medicines are available to help individuals dealing with addiction.
Various medicines are available to help individuals dealing with addiction.

Now that we have explored the background of addiction, what it means, what can cause us to become addicted to something, met David and heard his story, it is time to begin looking at the interventions that are available for medically treating addictions.

We looked at three of the most common addictions that people encounter around the world, and explored a number of possibilities for dealing with them effectively.  Tobacco, alcohol, and drug addiction are the areas we are going to explore.

While gambling is another common and well-known addiction, there is at present no solid scientific evidence or approved studies that have demonstrated how medicines can help to curb a gambling problem.

Treatment Processes

Two main medical interventions need to happen when treating an addiction.  These deal with the withdrawal symptoms experienced when people are weaned off whatever they are addicted to, and help to affect the brain so that cravings reduce and people are able to manage their addictions both in the short and longer-term[1].

There is also an element of behavioral therapy used, which we will explore further in the next of this series, along with strategies to help you manage your cravings effectively so that you do not relapse.

It is important to recognize that addiction affects everyone in a different way, so what works to help you deal with your addictions might not be suitable for someone else.  Thankfully, medical professionals fully understand this, and those along with support groups will work closely alongside you to find the best solution for resolving your addictions.

Tobacco

While we have termed this section ‘tobacco,’ the real addictive substance contained within cigarettes is of course nicotine.  Nicotine is a highly addictive stimulant, and approximately 33% of individuals who use tobacco products will become nicotine dependent.  Compare this to the addiction rate of heroin (23%), and cocaine (17%), and you begin to understand the scale on which you can become dependent on nicotine.[2]  As such, quitting smoking can be much more difficult than giving up alcohol or other drugs, as the withdrawal symptoms when giving up tobacco can be complex and varied,[3] and as few as 4% of people who ‘kick the habit’ are able to do so ‘cold turkey[4].’

There is a wide range of treatment options available to you if you are looking to quit smoking, most of which come in the form of nicotine replacement therapy (NRT) with the most widely used being patches, gum and lozenges, or e-cigarettes.

  • Patches are easy to use and the most passive of NRT treatments, you simply apply the patch – usually to your shoulder, upper arm, or upper leg area – and get on with your day.  Long-term success of using patches exclusively is usually low, with typically around 8% of people using this NRT remaining non-smokers after six months.  Patches do have a part to play in smoking cessation however, as when used in line with prescribed medicines such as nasal or throat sprays or anti-depressants the success rate leaps dramatically to 35%[5].
  • Nicotine gum is another NRT that is best used alongside others.  As you are only supposed to use gum for 12 weeks, the chances of giving up for good (not having a cigarette for 12 months) are slim.  Given that gum is rarely used alone, there are few statistics around how successful it is as a cessation technique, although it is known to make a smoker up to six times more likely to quit.[6]  If you do not want to use patches and feel confident that you can give up smoking quickly, perhaps consider replacing cigarettes with gum gradually.
  • E-cigarettes are still relatively unknown to many smokers, and have been received with varying degrees of response.  However, more and more organizations, including the American Association of Public Health Physicians[7] are taking the position that e-cigarettes are a positive product, as they enable the simulation of smoking while only ingesting nicotine without any of the other 200-plus harmful chemicals that you typically find in a cigarette.  One remaining criticism of e-cigarettes is that they can potentially keep someone addicted to nicotine in the long-term.  However, there is almost universal agreement that this is outweighed by the otherwise wholly positive outcomes, with the American Journal of Preventative Medicine reporting in 2011 that 31% of people using e-cigarettes had given up completely in six months.[8]

It is likely that you will find yourself trying some of these methods either exclusively or in conjunction with each other.  Your doctor will be able to provide additional advice, as well as further prescribed assistance if you are struggling to withdraw from nicotine use.

Alcohol

If you have an alcohol dependency, then not all is lost, as the success rate for abstaining from it for 12 months after undergoing treatment is placed at between 50 – 60%.  In addition to this, the majority of those are able to stay abstinent for good.[9]

While the psychological side of alcoholism can be difficult to deal with, most of the medical treatments used are similar, with most treatment schedules also the same save for variations in dosage and severity of reactions.

Before any the prescription of any medication, however, patients will usually undergo a detoxification period, which can last from two to seven days, depending on the level of alcohol dependency one experiences.

This is often the most dangerous stage, as the body can go into shock and even suffer seizures from the sudden withdrawal of alcohol.  For those reasons, the initial process will often take place in a hospital, or with daily visits to an outpatient clinic, so that healthcare professionals can monitor you, and issue any medicines that you may need at this time.

From this point on, the focus is mainly on the psychological work you will need to do, as most prescribed drugs are not able to deal directly with the brain and wean you from alcohol.

However, drugs such as disulfiram, naltrexone, and acomprosate can all have varying effects on your need to drink.  Disulfiram is one that is now often prescribed, as drinking alcohol while taking the oral treatment induces severe vomiting, headaches, nausea, and swelling.[10]

Medical intervention can be a great tool in dealing with alcohol dependency, although the long-term focus will always be on psychological support and counseling.

Drugs

Drug dependency is often the most destructive of all addictions, and one that we saw have a huge influence on David’s life previously.

While prescribed medication for use in dealing with opiate addictions (heroin) is well established, others are less so.  Medicines for dealing with addiction to stimulants such as cocaine are becoming better known, however research into medical intervention for cannabis addiction is still in its infancy, no doubt due to the misconception many have held for years that you ‘cannot’ get addicted to it.

Like alcohol, much of the work you will do in escaping from drug addiction will be psychological; however, prescribed medicines are more powerful and used to a greater degree in dealing with this dependency.

Although methadone is the widely known used medical treatment for opiate dependency, buprenorphine and naltrexone (also used for alcohol dependents) can also be prescribed.

Methadone and buprenorphine work as effective opiate substitutes, targeting the sites of the brain that are engaged by drugs such as heroin, and can both mimic the effects of heroin to a lesser extent over a longer period, as well as working to suppress cravings.  Naltrexone has the effect of blocking the effects of heroin at receptor sites in the brain, and throughout the body.  This drug is only used following initial opiate detoxification, and in some cases, not at all.[11]

While medical intervention for cocaine addiction is relatively new, many of the drugs used work in much the same way.  One key element of decreasing cocaine dependency is managing the level of GABA in our brain, which controls and regulates excitability throughout the nervous system.[12]

As of now, N-acetylcycteine (NAC) is the only cocaine-craving suppressant that is available to buy over the counter, and works by reducing glutamate levels in our brain to curb cravings.  It has also been shown to repair brain damage caused by cocaine use in animals, although no such research has yet been completed on humans.  Side effects of NAC include diarrhea, nausea, and vomiting.

Much more common in terms of dealing with cocaine dependency is the use of prescribed drugs, all of which work to increase the levels of GABA in the brain, making us less likely to crave cocaine or any other stimulants.

Commonly prescribed medicines to deal with cocaine addiction include gabapentin, vigabatrin, and baclofen.  All three of these drugs work by relaxing the muscles throughout the body and increasing feelings of relaxation.  Gabapentin and vigabatrin are also used in the treatment of epilepsy.

Side effects from using these medicines are similar, and drowsiness, fatigue, muscle pain, and nausea are all common among those taking these products.

Whatever the nature of your addiction, help is never far away.  This is true in terms of both medicinal intervention, and psychological treatment.  Next, we will move onto the psychological side of dealing with addictions, which is often the most important element of the journey from dependency to abstinence.

Sources:

[1] http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction (Accessed 1 February 2013)

[2] http://smokingcessationleadership.ucsf.edu/Downloads/Steppsudtoolkit.pdf (Accessed 1 February 2013)

[3] http://www.ncbi.nlm.nih.gov/pubmed/20469625 (Accessed 1 February 2013)

[4] http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-success-rates (Accessed 1 February 2013)

[5] http://healthpsych.psy.vanderbilt.edu/health-patch.htm (Accessed 1 February 2013)

[6] http://www.sciencedaily.com/releases/2009/01/090106083830.htm (Accessed 1 February 2013)

[7] http://www.aaphp.org/Resources/Documents/20100207FDAPetitionSummary.pdf (Accessed 1 February 2013)

[8] http://www.telegraph.co.uk/sponsored/sponsored-features/8665900/Interesting-recent-stats-on-electronic-cigarette-use.html (Accessed 1 February 2013)

[9] http://www.webmd.com/mental-health/alcohol-abuse/understanding-alcohol-abuse-treatment (Accessed 1 February 2013)

[10] http://www.mayoclinic.com/health/alcoholism/DS00340/DSECTION=treatments-and-drugs (Accessed 1 February 2013)

[11] http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction (Accessed 1 February 2013)

[12] http://www.sciencedirect.com/science/article/pii/S0074769602130117 (Accessed 1 February 2013)