Psychoactive Drugs Tobacco, Alcohol, and Illicit Substances

6. How can addiction to psychoactive drugs be prevented and treated?

• 6.1 What are the different approaches to treating drug addiction with medications?
• 6.2 What are the different behavioural therapies for treating drug addiction?
• 6.3 What ethical issues are raised by research on drug addiction?

Drug addiction is treated with medications and with behavioural therapies, a kind of psychotherapy. A combination of the two appears to be the most effective approach. Many treatments have been very successful but some remain controversial for ethical reasons. New and better treatments are being developed.

It remains unclear whether a treatment should be considered successful only if a person gives up the drug completely, or if reducing the amount or the frequency of drug-taking can also be considered a success. More...

6.1 What are the different approaches to treating drug addiction with medications?

Methadone is a medication used as a substitute for heroin
Source: Methadonetreatment.net

A variety of medications and behavioural treatments have been shown to be effective in treating drug addiction.

In terms of treatments with medications, two options are:

1. Medications or procedures that interfere with the action of drugs in the body. For example, some medicines block the pleasurable effects of drugs while others cause unpleasant reactions when combined with the drug and therefore make the drug repugnant to the user. The main problem with these medicines is that drug dependent patients often do not take the medication regularly, thereby making the treatment ineffective. It also remains ethically controversial whether a patient who does not consent to a treatment can be forced to follow it or whether treatments with other, potentially irreversible, effects should be used.
2. Substitution or maintenance treatment. Drug users are given a substance that acts like the drug in some ways without inducing some of its more harmful effects. This option has been widely used to treat dependence to opioids with methadone and other substances substituted for heroin. It aims to help drug users avoid previous illegal and harmful drug-taking habits and the associated risks of death, crime, and disease. Even though substitution therapies are effective in reducing harm to society (e.g., criminal activity) or to the individual (e.g. HIV infection), they contribute to the continuation of the dependence which raises ethical issues.

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Table 5. Pharmacological treatments for substance dependence

6.2 What are the different behavioural therapies for treating drug addiction?

Behavioural therapies try to replace the motivation to use drugs with the motivation to engage in other behaviours. They aim to help people ‘unlearn’ their drug-taking behaviour, learn new ways to respond to cravings, and develop new skills in order to remain drug-free. Such therapies include the provision of psychotherapy, psychosocial support, and counselling to encourage behavioural and emotional change. These therapies rely on the same principles of learning and motivation that are used to describe the development of dependence.

There are four types of behavioural therapies:

• Cognitive behavioural therapies focus on identifying what triggers drug-taking and on learning new ways to respond to cravings.
• Relapse prevention therapies are techniques aimed at developing greater self-control in order to avoid relapse, for instance by identifying emotional and environmental triggers of craving and drug use.
• Contingency management techniques use rewards and punishments to help people stop using a drug.
• Motivational enhancement therapy works by motivating the patients by asking their opinion on specific drug-related behaviours and by exploring the goals they want to achieve.

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6.3 What ethical issues are raised by research on drug addiction?

The rapid pace of change in the field of neuroscience research brings with it a host of new ethical issues in both research and treatment, which will need to be addressed.

An influential set of moral principles guide the ethics of biomedical research. The principles of:

• Autonomy: People must voluntarily consent to treatment or research participation and any information they give to a researcher must remain private.
• Non-maleficence: The risks of participating in the research must be as small as possible.
• Beneficence: The benefits to society and to participants must be greater than the risks.
• Justice: The risks and benefits of research must be distributed fairly.

However, research on drug dependence is changing quickly and this raises new ethical issues, both regarding research on animals and on humans. For example, a person identified by genetic screening as vulnerable or at risk of becoming drug-dependent may suffer from reduced self-esteem. If this information is available to others, it may disadvantage the person by reducing chances of finding a job, a company prepared to offer insurance, or a partner.

Clinical trials compare the effects of different drug or behavioural treatments, and sometimes placebos, on the drug use, health, social adjustment, and well-being of persons with drug dependence. Thus, a person participating in a clinical trial might benefit from it. Because drug companies pay for many clinical trials, it is important to ensure that the public can trust the results. The criteria for good clinical trials agree in requiring that a representative sample of the population at risk is recruited into such studies. Independent monitoring of compliance with the study protocol is recommended.

Other ethical issues include ensuring equal access to treatment for all those who may need it. Questions are raised as to what extent public money should fund drug dependence treatments and whether someone should be forced to accept medical treatment for drug dependence. More...