Pharmacological Intervention for Substance Addiction

Medically supervised detoxification or withdrawal

For example, opioid withdrawal symptoms can be treated with pharmacological intervention. Currently, there is a drug called lofexidine which is FDA approved for these symptoms treatment. This drug is an alpha-2-adrenergic agonist; it has a predominant effect on vegetative manifestations and alleviates withdrawal pains, and also has its moderate sedative effect and potentiates the sedative effects of psychotropic drugs, which is valuable for drug addiction practice.

Nicotine replacement therapies

As National Institute on Drug Abuse states, “The U.S. The Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban) and varenicline (Chantix).” The latter has a unique design and pharmacodynamic ability both to act as a partial agonist of the α4β2-nicotinic acetylcholine receptor (n_XR) subtype, and to act in a physiological mode, i.e., with a lower potency than nicotine, without causing addiction, but at the same time block the access of nicotine to these cholinergic receptors.

Alcohol relapse prevention

National Institute on Drug Abuse states three drugs that are approved for alcohol addiction treatment: Naltrexone, Acamprosate (Campral), and Disulfiram (Antabuse). The latter inhibits acetaldehyde dehydrogenase and prevents the transformation of alcohol to acetaldehyde since it is the latter that causes the intoxication accompanied by undesirable symptoms. After oral administration, t is extensively metabolized, recovering to diethyldithiocarbamate, excreted by the kidneys in the form of glucuronide, or decomposes to form diethylamine and carbon disulfide, part of which (4–53%) is excreted through the lungs.

Opioids relapse prevention

Various treatments are used for detoxification: reducing the dose of methadone, reducing the dose of methadone plus additional medications, prescribing other opioid agonists, clonidine, lofexidine, adrenergic agonists, buprenorphine, and symptomatic medications. One of the most widely used methods is to replace illegal drugs with an equivalent dose of oral methadone, with a gradual dose reduction, usually over several weeks. Currently, methadone is considered the most effective pharmacological intervention for detoxification. Buprenorphine has a mixed agonist/antagonist effect and is comparable in efficacy to methadone and also improves withdrawal symptoms when taken. In addition, patients with this drug completed detoxification more often than with methadone. Buprenorphine binds to the receptor in an almost irreversible manner, the release of the receptor is slow. This prevents the binding of most other opioids with a receptor, and if buprenorphine is taken first, other opioids will not be able to knock it out, even at high doses.

Co-occurring conditions

Treatment of possible mental conditions contributing to addiction. For example, depression and alcohol dependence have a bi-directional relationship. Depression can provoke the development of alcohol dependence, and the latter can be one of the etiological factors in the onset of a depressive episode. Thus, chronic intake of large doses of alcohol causes dysfunctions of the “stress system,” similar to that in depression, particularly increased release of corticotropin-releasing factor, activation of the hypothalamic-pituitary-adrenal system, and the autonomic nervous system.

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