29 Nov Using Drugs to Treat Tobacco and Alcohol Addiction
Addiction to tobacco and, consequently, nicotine is one of the toughest illnesses to treat. It ranks right up there with heroin and Xanax on the addiction scale. Thankfully, however, a serious of tobacco addiction pharmaceutical therapies have been developed, which has helped reduce the number of Americans lighting up. Studies have shown, however, that each of the drugs is most effective when combined with behavioral treatment, especially individual and group therapy. During behavioral skills training, smokers learn how to avoid situations that most commonly cause them to want to smoke, or at least learn how cope with cravings if the situation cannot be avoided. Strategies include cigarette refusal skills, assertiveness, and time management. When combined with medications, the patients can focus on their treatment without be plagued by cigarette cravings.
Nicotine Replacement Therapy (NRT) comes in many different varieties and formulas, such as the transdermal patch, spray, gum and lozenge. NRT is based on the theory that maintaining a low, constant level of nicotine in the body will help prevent withdrawal symptoms, which are often responsible for continued smoking. Unfortunately, many smokers will stop smoking tobacco and switch to abusing one of the NRTs.
Zyban, or bupropion, was initially sold as Wellbutrin, an antidepressant, and was repurposed for nicotine addiction when users reported a decrease in tobacco cravings without the associated weight gain. By blocking the reuptake of certain catecholamines, such as norepinephrine and dopamine, Zyban offers users some stimulant effects and takes the place of food for someone who is in the early stages of tobacco withdrawal.
Chantix, or varenicline, is a newly FDA-approved nicotine addiction drug that blocks the reward mechanism associated with nicotine. The body’s nicotine receptors, alpha-4 beta-2, typically cause the release of dopamine when nicotine is introduced. Varenicline mildly stimulates and occupies the receptor, but not enough to cause dopamine to be released. Varenicline also prevents nicotine from activating the dopamine, thus eliminating the positive feelings associated with smoking. This reduces nicotine cravings, which can lead to abstinence.
Drug Treatment for Alcohol Addiction
Most common alcohol addiction treatment programs do not replace alcohol with a pharmacotherapy, such as Antabuse. However, these treatments do exist and have shown modest success, at least in the short-term. Like many anti-addiction medications, patient compliance is the biggest hurdle to success.
Antabuse, or disulfiram, is the most well-known of the anti-addiction medications for alcoholics. Antabuse prevents the body from effectively breaking down alcohol, resulting in an increase of acetaldehyde. If a person drinks and levels of acetaldehyde increase enough, the person will begin to feel ill and experience flushing, nausea and heart palpitations. Unfortunately, Antabuse is not very effective in that it requires the patient to adhere to a strict dosing schedule, compliance with which is not very high. Some motivated individuals, however, take Antabuse prior to particularly challenging situations, such as social functions where alcohol is being served. Others allow a medical professional or family member to routinely administer the medication in order to ensure compliance.
Also used for opioid addiction, naltrexone blocks the neuroreceptors that control the positive effects of drinking and cause alcohol cravings. In heavy drinkers, defined as those women who drink four or more alcoholic beverages a day or those men who drink five or more a day, naltrexone can reduce relapse and cut the relapse risk in the first 90 days after sobriety by about a third. However, naltrexone is less helpful in helping drinkers maintain sobriety.
Campral, or acamprosate, may help alcoholics maintain sobriety for several weeks or months, even if the patient has a particularly severe form of dependence. The drug targets the gamma-aminobutyric acid (GABA) and glutamate neurotransmitters and may alleviate some symptoms of protracted withdrawal such as depression, restlessness, sleep disturbance or anxiety.
Topiramate is the newest anti-drinking medication and has not yet been approved by the FDA; little is known about how it acts on the body. Studies suggest, however, that Topiramate increases GABA’s inhibitory transmission and reduces glutamate’s stimulatory transmission. Topiramate was studied in a recent clinical trial and found to be effective in increasing the number of drinkers who stay sober for 28 days or more.
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