Drugs used in treatment of addiction. What is Addiction? It is well known that the initial decision to use drugs is voluntary It is well known that the.

Drugs used in Drugs used in treatment of addictiontreatment of addiction

What is Addiction?What is Addiction?

It is well known that the initial decision It is well known that the initial decision to use drugs is voluntaryto use drugs is voluntary

Addiction is a chronic, relapsing brain Addiction is a chronic, relapsing brain disease characterized by disease characterized by compulsivecompulsive behavior of a person to behavior of a person to continue taking continue taking drugs drugs despite their many adverse health despite their many adverse health and negative consequences (and negative consequences (cravingcraving))

Drugs of addictionDrugs of addictionStimulants - stimulate the central nervous system

- amphetamines, cocaine, nicotine

Depressants - depress the CNS

- alcohol, barbiturates, benzodiazepines

Analgesics - powerful painkillers- from opium poppy , morphine, heroin

Hallucinogens - dramatically alter perception

- LSD, cannabis, Marijuana

No single treatment is appropriate for all individuals

Pharmacological (medications)

Psychological

Behavioral Therapies

Medical and Social Services

Family Services; solving legal problems

of Addiction

Aim of pharmacological Aim of pharmacological treatmenttreatment

Treatment of withdrawal (“detox”)Treatment of withdrawal (“detox”)

Medications used to alleviate withdrawal Medications used to alleviate withdrawal symptomssymptoms

Treatment of psychiatric symptoms Treatment of psychiatric symptoms Reduction of cravings Reduction of cravings Substitution therapySubstitution therapy

Medications for Drug AddictionMedications for Drug Addiction

Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies..

Alcohol:Alcohol: Naltrexone, Disulfiram, AcamprosateNaltrexone, Disulfiram, Acamprosate

Opiates:Opiates: Naltrexone, Methadone, clonidineNaltrexone, Methadone, clonidine

levo-alpha-acetylmethadol (LAAM)

Nicotine:Nicotine: Nicotine replacement (gum, patches, Nicotine replacement (gum, patches, spray), spray),

bupropionbupropion Stimulants:Stimulants: [[None to dateNone to date]]

Treatment of Chronic Alcoholism•Hospitalization,

psychotherapy and nutritional therapy may be needed. Drug therapy includes: •BZs (e.g. diazepam) are used to prevent alcohol withdrawal symptoms. They are preferred over barbiturates because of their wide margin of safety. The dose must be tapered slowly over several weeks.

Disulfiram Disulfiram The drug given by itself to nondrinkers has little effects however, it causes extreme discomfort to patients who drink alcohol (Flushing, throbbing headache, nausea, vomiting, sweating, hypotension and confusion). Disulfiram acts by inhibiting aldehyde dehydrogenase thus, alcohol is metabolized as usual but acetaldehyde accumulates. Acetaldehyde will form the toxic intermediates; methanol and formaldehyde.

Naltrexone is an  opioid receptor antagonist used primarily in the management of  alcohol dependence and opioid dependence (blocking the drugs’ euphoric effects)blocking the drugs’ euphoric effects)

Acamprosate stabilize the chemical balance in the brain by antagonizing glutamatergic N-methyl-D-aspartate recepotors and  antagonizing gamma aminobutyric acidn(GABAA) receptors

Treatment of Morphine Treatment of Morphine AddictionAddiction

HospitalizatiHospitalization on

Drug therapyDrug therapy

HypnoticsHypnotics to help sleeping. to help sleeping.NaltrexoneNaltrexone helps patients overcome opioid helps patients overcome opioid addiction by blocking the drugs’ euphoric effects. addiction by blocking the drugs’ euphoric effects.  Gradual withdrawal of morphine to a stabilizing Gradual withdrawal of morphine to a stabilizing dose just sufficient to prevent withdrawal symptoms.dose just sufficient to prevent withdrawal symptoms.

Substitution therapy Substitution therapy with with methadone methadone which is a which is a long acting opioid, long acting opioid, (1 mg methadone to 4 mg morphine for (1 mg methadone to 4 mg morphine for 1 week)1 week)

Then, methadone is withdrawn gradually over Then, methadone is withdrawn gradually over a period of 3 days. a period of 3 days.

Why Methadone??Why Methadone??

Synthetic opioid agonist , AnalgesicSynthetic opioid agonist , AnalgesicQuick absorption, slow eliminationQuick absorption, slow eliminationEffects last 24 hours; once-daily dosing Effects last 24 hours; once-daily dosing maintains constant blood level maintains constant blood level Prevents withdrawal and reduces craving Prevents withdrawal and reduces craving

Levo-α-acetylmethadolLevo-α-acetylmethadol

levo-α-acetylmethadol (LAAM) is a synthetic opioid similar in structure to methadone. It has a long duration of action due to its active metabolites.

LAAM is indicated as a second-line treatment for the treatment of opioid dependence if patients fail to respond to methadone.

Medications for Sedative-Medications for Sedative-Hypnotic DependenceHypnotic Dependence

Taper: slowly decrease dose to minimize withdrawal symptoms

May first convert to longer-acting agent

Role for anticonvulsants Use non-addictive medications for

residual anxiety symptoms (SSRIs and other antidepressants)

Treatment of Stimulant Treatment of Stimulant DependenceDependence

Symptomatic treatment Behavioral therapies effective for

treating stimulant addiction. There are no proven medications for

the treatment of stimulant addiction. Slowly decrease dose Medications to treat withdrawal

symptoms Anxiety Depression * NIDA

Medications for Stimulant Medications for Stimulant DependenceDependence

Medications used to treat stimulant-induced psychiatric symptoms: Antidepressants Antipsychotics Anti-anxiety agents Medications to treat agitation, violence

ER and outpatient settings Medications to treat co-occurring

psychiatric disorders

Attention deficit Attention deficit hyperactivity hyperactivity

disorder (ADHD) disorder (ADHD)

ADHDADHD

more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age in children. 

ADHD: EtiologyADHD: Etiology

ADHD is a heterogeneous behavioral disorder with multiple possible etiologies

CNSinsults

Geneticorigins

Neuroanatomicalneurochemical

ADHD

Environmentalfactors

ADHD symptomsADHD symptomsSymptom Home

impairmentsSchoolimpairments

Socialimpairments

Self-impairments

Hyperactivity Interferes withroutines atdinner, bedtime

Runs aroundroom

Disrupts games Feels rejected

Impulsivity Is destructive Disrupts class Does not getinvited by otherchildren tosocial events

Gets intotrouble often

Inattention Is inattentive,according toparent; somechildren sayhomework is a“nightmare”

Gets behind inschoolwork

Cheats ingames

Thinks of self as“stupid”

Stimulants for ADHD

1st line treatment currently available include short-,

intermediate-, and long-acting drugs. starts with low dose then increase the

dose

MethylphenidateMethylphenidateRitalinRitalin

CNS stimulantCNS stimulant increases attention, decreases increases attention, decreases

impulsiveness, and hyperactivityimpulsiveness, and hyperactivity Methylphenidate blocks the Methylphenidate blocks the

transporter for dopamine and transporter for dopamine and norepinephrinenorepinephrine

* WebMD

AmphetaminesAdderall

Dopamine (DA) and Norepinephrine (NE) Dopamine (DA) and Norepinephrine (NE) modulating agent modulating agent

Adderall is a combination of stimulants Adderall is a combination of stimulants (amphetamine and dextroamphetamine). (amphetamine and dextroamphetamine).

It increases the ability to pay attention, It increases the ability to pay attention, focus, and control behavior problems.focus, and control behavior problems.

This drug may also be used to treat This drug may also be used to treat certain sleeping disorders (narcolepsy).certain sleeping disorders (narcolepsy).

Antidepressants

2nd line treatment TCAs (Imipramine, Desipramine)TCAs (Imipramine, Desipramine) Bupropion Bupropion (targets dopamine and

norepinephrine) most effective for treatment of ADHD combined with depression.)

VenlafaxineVenlafaxine

AtomoxetineAtomoxetine

Non stimulant drug Non stimulant drug a selective norepinephrine

reuptake inhibitor (NRI) is approved for use in children,

adolescents, and adults.  Excellent for inattentiveness

Clonidine Clonidine

high blood pressure medication can high blood pressure medication can manage ADHD symptoms of manage ADHD symptoms of aggressive behavior, impulsions, aggressive behavior, impulsions, hyperactivityhyperactivity

It is classified as a centrally acting αIt is classified as a centrally acting α22 adrenergic agonist. adrenergic agonist.

GuanfacineGuanfacine 

Guanfacine belongs to a class of medications called centrally acting alpha2A-adrenergic receptor agonists.

Used for hypertension

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