The ways in which addiction have been treated have changed a lot over the years. From the nearly 100-year-old 12 steps philosophy to quick fixes and accelerated detoxes to modern, evidence-backed approaches, addiction treatment is always controversial. Addiction is a disease unlike others and it is highly individualized. Even so, there are some commonalities and the use of medications as one component of treating addiction is becoming more acceptable for most patients. There are some downsides and some risks, but using drugs to combat addiction has its place.
Addiction as a Disease
Treating addiction has long been controversial, with many opinions, largely because addiction itself is controversial. Some people view it as a matter of willpower, some view addiction as a disease, and some see it as a combination of both. Experts in addiction medicine, psychiatry, and neurology now mostly view addiction as a disease of the brain. Substances like drugs, alcohol, and nicotine, actually change the brain, making it more and more difficult to quit as time goes on.
According to the National Institute on Drug Abuse (NIDA), addiction is a chronic disease. It is characterized by the compulsive and uncontrollable need to seek out and use a substance, like drugs or alcohol. This use continues for an addict, despite negative and harmful consequences. The substance abuse causes changes to the brain, which reinforce the substance abuse. Addiction is chronic because most people experience relapses after quitting.
Even this definition of addiction as a disease recognizes that the first few steps toward addiction are voluntary. Someone must choose to use and abuse dangerous substances. Over time, though, the choice to use the substance becomes less voluntary and more compulsive.
How Addiction Affects the Brain
The modern, most accepted idea that addiction is a disease of the brain is backed up by research that has uncovered exactly what happens in the brain during drug use and after long-term use and addiction. It all starts with dopamine. Dopamine is a chemical messenger in the brain that acts like a reward. When you experience something pleasurable, like a hug from a loved one, you get a small release of dopamine in the brain. You associate hugs with this nice feeling and you seek them out again because the dopamine reward made you feel good.
Addictive drugs also trigger a release of dopamine, but up to ten times more than during a natural experience, like a hug. This flood of dopamine causes a sensation called euphoria, or what a user would call a high. Alcohol, nicotine, narcotic prescription drugs, and illegal addictive drugs all have this in common. The high triggers a desire in you to seek it out again. The more intense the euphoria produced, the more addictive a drug is.
Over time and with more use of a substance the brain adjusts to the big releases of dopamine by turning it down. This means that for someone using drugs over the long-term, getting any sense of pleasure from anything becomes harder and harder. Only the drug will give that person relief from feeling bad or a feeling of pleasure. It becomes a cycle of abuse that is very difficult to break. Scans of the brains of people addicted to drugs actually show that they produce less dopamine.
The Principles of Effective Addiction Treatment
To treat an addiction requires a multi-pronged approach that is not necessarily the same for everyone. NIDA has outlined the principles of effective treatment, which are all based on evidence from research. A couple of these principles address the use of medications and medical treatment. For instance, one states that medical detoxification is a first step in treatment, but only a first step; there must be continuing treatment after detox. Another principle states that medications are an important part of addiction treatment, but are best when used along with behavioral therapies.
Medications Used for Addiction Treatment
The first step in treating any addiction in anyone is to detox. Detoxification is the time it takes the substance to leave the body. This is a period during which a patient is not using anymore and will experience withdrawal symptoms. The changes that have occurred in the brain cause these terrible symptoms, which in extreme cases can even be dangerous. Medical detox is often necessary, sometimes to administer medications like painkillers, but sometimes just to monitor the health of the patient. Once past detox, a patient may be ready for therapy combined with medications. Some of the medications used to treat addiction include:
- Methadone. Methadone is an opioid, the same type of drug as heroin, and is used for maintenance in heroin addicts. The difference between methadone and heroin is that the medication does not produce a high. It does, however, suppress withdrawal symptoms, giving an addict a chance to be weaned from opioids slowly and safely.
- Naltrexone. Naltrexone is an antagonist of opioids and can be used to treat painkiller and heroin addiction. It blocks the activity of opioids, making the use of the drugs pointless. In other words, the user will not get a high from an opioid if on naltrexone. This drug is used for maintenance of sobriety. It is also effective for alcohol addiction treatment.
- Buprenorphine. This drug is similar to methadone in that it suppresses withdrawal and reduces cravings for heroin and other opioids. Although it is an opioid, buprenorphine will not cause an overdose. A downside to this drug is that it is not as effective for users who have been taking very large doses of opioids. These patients need methadone instead.
- Acamprosate. This is a medication used to treat alcoholism. It is used by patients who have already started treatment and have stopped drinking for a few days. It works by helping to reduce cravings for alcohol and is supposed to be used to help someone avoid relapsing.
- Disulfiram. Also called Antabuse, this medication is used to prevent drinking. It very unpleasant symptoms, mostly severe vomiting, when taken with alcohol. If a patient in treatment takes the medication regularly it serves as a deterrent to drinking.
- Naloxone. Naloxone (Narcan) is an opioid antagonist that is used to treat overdoses rather than addiction. Overdosing is not hard to do with heroin and opioid painkillers, but if administered in a timely fashion, naloxone can reverse the effects and save a person’s life.
The Risks of Using Drugs for Addiction
Using drugs to treat addiction seems counterintuitive, but most experts agree that, based on empirical evidence, there is a place for medication in treatment. Some people still disagree with this and stick to a rigid philosophy of abstaining completely from all potentially addictive substances. As with any kind of drugs, there are some risks that come with using these medications to treat drug or alcohol addiction.
One risk is simply that they will not be effective. None of the drugs are meant to be used alone, as a sole treatment for addiction. They are supposed to be used in conjunction with therapy. They are also supposed to be part of ongoing treatment because addiction is considered to be a chronic disease. Anyone who relies only on a prescribed medication to beat addiction is likely to risk failure.
Some of these drugs may also fail if the patient is not committed to quitting. Naltrexone, for instance, works only when the patient is taking it as directed. It blocks the high from opioid drugs, but if a patient wants to get high, he or she can simply stop taking the medication. One way around this is a one-month injection of naltrexone, now an option for treatment.
Medications used to treat addictions also come with other risks, like side effects. Naltrexone can cause serious liver damage if taken in high doses. It can also cause a serious reaction including hallucinations, blurred vision, and confusion. Buprenorphine may cause dangerous effects as well, including slowed breathing, tiredness, agitation, hallucinations, jaundice, and bleeding.
Disulfiram is supposed to trigger serious vomiting and discomfort, but only if the patient drinks, so it should never be used by someone who has been drinking within the last 12 hours. It may also cause fatigue, weakness, and upset stomach, symptoms that can be severe and dangerous. Acamprosate is generally safer, but still may cause dizziness, upset stomach, diarrhea, gas, nausea, and weakness.
There is always a risk that comes with taking any kind of prescription medication. Those risks must be weighed against potential benefits, and for addicts, those benefits can be life-saving. The decision to use medications during addiction treatment should be made carefully by the doctor and patient with all the information regarding risks known.