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Overview
Students make predictions about the success rate for treatment of addiction compared with treatment for other chronic diseases. Then students evaluate case studies of individuals with different diseases to compare and contrast how the diseases are similar to, or different from, the others.
Drug addiction is a recurring chronic disease that can be treated effectively, similar to other chronic diseases.
By the end of these activities, the students will
Addiction has many dimensions and disrupts many aspects of a person's life. Scientific research and clinical practice have yielded a variety of effective approaches to treatment for addiction to certain drugs, such as heroin. Continuing research is yielding new approaches to developing medications to treat addiction to other drugs, such as cocaine, for which no medications are currently available.
Drug abuse and addiction lead to long-term changes in the brain's chemistry and anatomy. The changes in the brain cause drug addicts not only to lose the ability to control their drug use, but their addiction also changes all aspects of their lives. Drug addicts often become isolated from family and friends and have trouble in school or work. In addition, the compulsive need for drugs can lead to significant legal problems. While the biological foundation for drug addiction does not absolve an individual from the responsibility of his or her actions, the stigma of drug addiction needs to be lifted so individuals may receive proper medical treatment, similar to that for other chronic diseases.1
Addiction is a recurring chronic disease. No cure is available at this time, but addiction can be treated effectively. Drug addiction is often viewed as a lapse in moral character. This value judgment influences how society deals with the disease, both socially and medically. Unfortunately, because people, including physicians, have often viewed addiction as a self-inflicted condition, drug addicts have not always received the medical treatment common for other chronic diseases. Treating addiction requires more than a "just say no" approach.
Treatment for addiction is often very effective. Treatment is successful when the addict reduces or abstains from drug use, improves his or her personal health or social function, and becomes less of a threat to public health and safety.2 Certain addictions, such as heroin addiction, can be treated with pharmacological agents.3,4 Methadone, the most common pharmacological treatment, prevents craving and withdrawal symptoms in heroin addiction. Methadone is an opiate receptor agonist. That is, methadone binds to the opiate receptor just as heroin does. Methadone, however, does not produce the euphoria or "high" that results from heroin use.
 Figure 5.1: Methadone can be part of an effective treatment plan for addiction to opiates. Photograph of pills by, and used with permission of, Roxane Laboratories, Inc. All Rights Reserved. |
A second medication prescribed for heroin addiction is naltrexone. Unlike methadone, naltrexone is an opiate receptor antagonist. Instead of competing with heroin for the opiate receptor, naltrexone prevents heroin from binding to the receptor, thereby preventing heroin from eliciting the euphoric high.
 Figure 5.2: Agonists are chemicals that bind to a specific receptor to elicit a response, such as excitation or inhibition of action potentials. Methadone is an agonist that, like heroin, binds to opiate receptors. Unlike heroin, however, methadone does not produce the same level of euphoria. Antagonists are chemicals that bind to a receptor and block it, producing no response and preventing other chemicals (drugs or receptor agonists) from binding or attaching to the receptor. Naltrexone is an antagonist that binds to the opiate receptor and blocks heroin from binding. |
Table 5.1 outlines the different pharmacological agents used to treat addiction. The development of medications to treat drug addiction has been difficult because the brain, the target of addictive drugs, is such a complex organ. Until scientists understand how drugs affect the chemistry of the brain, they cannot develop medicines that will alter the effects of addictive drugs.
| Medication | Treatment for addiction to | Mechanism |
|---|---|---|
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Methadone |
Heroin |
Opiate receptor agonist |
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LAAM |
Heroin |
Opiate receptor agonist |
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Naltrexone |
Heroin |
Opiate receptor antagonist |
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Naloxone |
Heroin, alcohol |
Opiate receptor antagonist |
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Buprenorphine |
Heroin |
Mixed opiate receptor agonist and antagonist |
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Nicotine gum, patches |
Nicotine |
Provide low doses of nicotine |
Pharmacological therapies, if available, are not sufficient for effective treatment. Behavioral treatment in combination with pharmacological treatment is the most effective way to treat drug addiction.5,6 Recovering addicts need to address the behavioral and social consequences of their drug use and learn to cope with the social and environmental factors that contribute to their illness.7 Behavioral treatments can occur either individually or as a group.6
Relapse is a common event for recovering drug addicts. In many ways, relapse should be thought of as a normal part of the recovery process. A recovering drug addict is more likely to experience a relapse if he or she also has other psychiatric conditions or lacks the support of family and friends.
Principles of Effective Drug Addiction Treatment1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. 2. Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential applicants can be lost if treatment is not immediately or readily available. 3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems. 4. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture. 5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most patients, the threshold of significant improvement is reached at about three months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. 6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community. 7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM) are very effective in helping individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important. 8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder. 9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment. 10. Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions. 11. Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring. 12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients avoid high-risk behavior. Counseling also can help people who are already infected manage their illness. 13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment is often helpful in maintaining abstinence. Source: Principles of Drug Addiction Treatment: A Research-Based Guide (1999). National Institute on Drug Abuse http://www.nida.nih.gov/PODAT/PODATIndex.html.
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Despite the preconceptions and value judgments many people place on addiction, it is, in many ways, similar to other chronic diseases such as diabetes and coronary artery disease. Genetic, environmental, and behavioral components contribute to each of these diseases. Some people may argue that drug addiction is different because it is "self-inflicted." As presented in Lesson 4, the initial choice to use drugs is voluntary but, once addiction develops, drug use is compulsive—not voluntary. Moreover, voluntary choices do contribute to the onset or severity of other chronic diseases as well. For example, a person who chooses to eat an unhealthy diet and not exercise increases his or her risk for coronary heart disease.
Successful treatment for any chronic disease necessitates patient compliance with the prescribed treatment regimen. Adhering to a treatment plan is difficult for those with any chronic disease. Less than 50 percent of diabetics follow their routine medication plan, and only 30 percent follow their dietary guidelines.2 Problems adhering to a treatment plan lead to about 50 percent of diabetics needing to be treated again within one year of diagnosis and initial treatment. Similar statistics hold true for other chronic diseases: Approximately 40 percent of patients with hypertension need emergency room treatment for episodes of extreme high blood pressure, and only about 30 percent of adult asthma sufferers take their medication as prescribed. Although treatment for drug addiction statistically is more successful than treatment for other chronic diseases, drug addicts commonly have relapses during treatment and recovery and begin using drugs again. The difficulties in following a treatment plan and coping with the stresses of a chronic disease illustrate how difficult changing human behavior is. Activities 2 and 3 of this lesson provide more insight into this topic.
Scientific research is likely to change how drug addiction is treated. Research to understand how the brain works and how drugs cause changes in the chemistry and function of the brain may lead to new medications to treat disease. Scientists continue to work on developing medications that relieve the cravings experienced when drugs are withdrawn. Also, scientific advances may reveal ways to reverse the long-term damage to the brain that drugs inflict.
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