17.5.1 The Use of Drug Therapy for Addiction

• Addiction to nicotine is treated using an agonist substitution method where a safer alternative to tobacco smoking is provided to patients (nicotine replacement therapy)
• Varenicline is a prescription medication that acts as an agonist on the nicotinic receptors in the brain and stimulates dopamine release in exactly the same way as nicotine 
• Varenicline is used to help those who want to give up smoking without using nicotine replacement therapy in chewing gum or skin patches
• Nicotine replacement therapy delivers nicotine in mouth sprays, chewing gum or small pouches that rest between the cheek and the gums or skin patches
• The nicotine in these products is usually less than the regular smoker is inhaling, is released into the bloodstream more slowly  and does not contain the harmful chemicals that are found in cigarettes.
• The amount of nicotine is reduced gradually over time, with the withdrawal symptoms managed over a period of two to three months until the person can give up nicotine completely

A nicotine patch contains a controlled dose and is usually applied to the arm.

• There is no specific drug that can target gambling addiction directly, but drugs that are used to reduce symptoms of other addictions, such as heroin and alcohol have been shown to work, taking an antagonist approach
• The main drug therapy for gambling addiction is the opioid antagonist naltrexone that works by blocking the reward system in the brain when the person engages in their addictive behaviour, in this case gambling
• Naltrexone reduces the release of dopamine in the nucleus accumbens therefore decreasing the feeling of pleasure and increasing the release of GABA in the mesolimbic system, which is a neurotransmitter that decreases cravings 

Gambling can be as addictive as other types of addiction and may be treated with the same therapy used to treat other addictions.

 

Research which investigates the use of drug therapy for addiction

• Stead et al (2012) reviewed 150 nicotine replacement therapy trials and found that the chances of stopping smoking were increased by 50-70% with the use of nicotine replacement therapy compared to placebo and to no treatment groups, supporting the effectiveness of the nicotine replacement
• Ward et al (2018) investigated the use of naltrexone therapy for gambling addiction and found that after six weeks of treatment all ten participants showed a decrease in cravings, with six patients giving up gambling completely 

Evaluation of drug therapy for addiction

Strengths

• Drug treatment is cheaper and easier to engage with than other forms of treatment, such as CBT, as it requires only a prescription and medical supervision
• Drug therapy for addiction removes stigma as it encourages people to view addiction as a medical issue, rather than a moral or psychological weakness, and so makes those addicted more likely to seek help 

Weaknesses

• Drug therapies can have side effects, such as sleep disturbances, gastrointestinal problems and headaches, which may result in people not taking their medication, leading to relapse
• Drugs do not work in the same way for everyone, as small genetic variations between people can have a significant effect on the outcome of drug treatments, such as naltrexone, the effectiveness of which depends on a variation in a single gene - the μ-opioid receptor gene

Link to Approaches:

Drug therapy is clearly a biological approach, with focus very much being on the neurochemical effects of the therapy in the brain and subsequently on behaviour. The explanations for the effectiveness of drug therapy include the role of the nicotinic receptor neurons and the dopamine reward system.