Pharmacology and addiction therapy

Pharmacology and addiction therapy

26th September 2019 Off By krzys

Efforts have been underway for over a hundred years to develop professional, effective help for people addicted to alcohol.

Initially, most of these attempts, both based on moralizing, psychotherapy (psychoanalysis) and pharmacological methods (opium, barbiturates), proved unsuccessful for most alcoholics. Since then, similarly to other mental disorders, there are “pendulum” changing views and the dominant behavior towards addicts. These changes in the concept of etiology, and hence, and the treatment of alcoholism were conditioned by both the progress of biological-medical, psychological and sociological knowledge, as well as the changing general social, cultural and other anthropological atmosphere. Not without significance was the fact of the market struggle for the patient between medical staff and people with humanistic education (psychologists, sociologists, social workers) and non-professional therapists, as well as the emancipation of self-help movements. The avalanche of knowledge caused the encapsulation of the language and the practical inaccessibility of the conceptual apparatus for people from other professional circles, online rehab services.

The first attempts at pharmacological treatment of alcoholism with opium and barbiturate preparations were unsuccessful, although in some people the intensity of drinking decreased, most often there was a “change” of alcohol addiction to opiate or barbiturate addiction. In the interwar period, in the USA, and after World War II and in Europe, methods based on the ideology of the Alcoholics Anonymous movement and various forms of group psychotherapy began to triumph. They supplanted pharmacological methods until more and more interest in behaviorism and its particular form, theory of behavior learning. According to this theory, alcoholism is a learned behavior caused by repetition of activities that bring pleasant sensations (euphoria, antidepressant and anxiolytic activity, ease of making social contacts.

Behaviorists assumed that in order for the patient to “get used to” drinking, he should be conditioned negatively on the stimulus drinking alcohol. For this purpose, a number of substances causing unpleasant symptoms were used (e.g. to cause nausea and vomiting, emetic root or apomorphine was used, disulfiram – Anticol, Esperal, Antabuse was used to experience unpleasant symptoms of acetaldehyde poisoning), which had associate the patient with the taste or smell of alcohol. Both the low effectiveness of these techniques and ethical doubts have become a reason for criticizing these methods. Currently, disulfiram is sometimes used for so-called “forcing abstinence.” The revolutionary progress that was made in the 1950s and six tenths in pharmacotherapy of mental disorders did not concern, unfortunately, the treatment of alcoholism. Most drugs useful in the treatment of psychotic, depressive and anxiety disorders have proved ineffective and sometimes even dangerous in the case of alcoholism. This contributed to the consolidation of a bad opinion about the role of drug treatment in the treatment of alcohol addiction. The sixties and seventies was a rapid development of psychological and sociological theories of human behavior. He found his reflection in the development of psychosocial influences on addicts and their environment. In contrast, psychopharmacology did not offer anything new to addicts. This condition continued until the end of the eighties.
addiction recovery online

Currently, most contemporary concepts of human behavior, including mental disorders, are integrative. In psychiatry, there is a “dimensional” approach, which consists in departing from attempts to describe the etiological groups of disorders, and describing the disorder of a particular patient with the help of many dimensions – smaller or larger: genetic, biological (mechanical damage to the central nervous system, infections and other somatic diseases, poisoning, the influence of drugs and other psychoactive substances, etc.), personality, environmental. The effect of this approach is comprehensive. Patients with endogenous depression or even conditioned by organic damage to the central nervous system are not denied psychotherapy and environmental interactions, and people with psychogenically depressed depression are often given antidepressants that accelerate and facilitate the use of psychotherapy. On the other hand, in Poland, among therapists treating addicts, the polarization of attitudes towards therapy, which is unfavorable to patients, often turns out to be open to hostility. This state, although it has understandable conditions to some extent, should change as soon as possible.

Modern pharmacotherapy extending abstinence and reducing the amount of alcohol drunk
In recent decades, there has been a sharp increase in knowledge about the biological determinants of alcohol abuse, biochemical and physiological mechanisms of addiction and pharmacological ways of influencing alcohol consumption. While for many years this knowledge had little to do with specific treatment techniques for addicts, it has been found in recent years that of about 100 drugs and other substances that reduce alcohol consumption in experimental animals, at least 10 may be used in the treatment of people addicted to alcohol. Two drugs (acamprosate and naltrexone) have been registered for the treatment of addicts, and several are undergoing intensive clinical trials.

Akamprozat (Campral) is the first (registered in 1993 in France) modern drug that extends abstinence and reduces alcohol consumption. The pharmacological action of acamprosate is quite complicated, but it is believed to mainly reduce the sensitivity of excitatory amino acid responsive (NMDA) receptors and GABAAergic receptors. Clinically, this results in a decrease in craving for alcohol, and people taking acamprosate maintain abstinence twice as often as compared to those receiving placebo. In multi-center studies conducted in nine Western European countries on over 3300 people addicted to alcohol, using various forms of psychotherapy, it was found that among people treated with psychotherapy and acamprosate after a year abstinence was maintained by 22% of patients, while those treated with psychotherapy and patients receiving placebo the percentage of abstainers was almost twice lower (12%). Even greater differences between those treated with acamprosate and those receiving placebo concerned those who discontinued abstinence. Acamprosate patients were less likely to drink alcohol, and when it happened, they drank more than twice as much as those taking placebo. Akamprozat is a relatively safe drug. Side effects are rare, usually only at the beginning of the treatment, but are transient and mild. It does not cause addiction, and in case of overdose is relatively low toxic. It does not interact seriously with alcohol. The drug is also registered in UK, although the manufacturer has not yet introduced it to our market.
A review article was published in Polish about acamprosate.

Naltrexone (ReVia, Nemexin, Trexan) has been widely used since 1994 in the US for the treatment of alcohol addicts. The treatment uses interference in one of the pathomechanisms of addiction, consisting of positive strengthening. Alcohol has an euphoric effect, the more it is abused, the more its lack is felt as an unpleasant sensation that can be removed by subsequent drinking and entering into euphoria. The euphorising effect of alcohol is the result of, among others stimulating the secretion of endorphins (substances produced by the body that have an effect similar to morphine, but many times more potent) that stimulate (like morphine) opiate receptors. Naltrexone blocks opioid receptors, endorphins secreted by drinking alcohol can no longer stimulate them, and thus cause euphoria. People who have been accustomed to euphoric reactions after drinking alcohol notice the uselessness of drinking and limit the amount of alcoholic beverages consumed.

Naltrexone reduces alcohol consumption by approximately 50% on average in people who have stopped abstinence. An unexpected effect of naltrexone treatment on addicts was the increase in abstinence and the increase in the number of people abstaining from those taking placebo. The pharmacological mechanism of this phenomenon, probably consisting of reducing craving, is unknown. It was also found that the combined treatment with psychotherapy and naltrexone produced significantly better results than psychotherapy alone. Naltrexone causes few side effects, does not enter into toxic reactions with alcohol. This drug is not yet registered in Poland for the treatment of people addicted to alcohol, but nevertheless it is becoming more and more commonly used in private practices.