Drug Therapy (AQA A-Level Psychology): Revision Notes
Drug Therapy
Drug therapy represents a biological approach to treating addiction that targets the neurochemical factors within the brain. This treatment method has developed from understanding that addictions can be explained through neurochemical processes and genetic influences, leading to medical interventions that address these physical causes directly.
Drug therapy involves the use of chemicals that affect brain functioning or other body systems. In treating psychological disorders like addiction, these medications typically work by altering neurotransmitter levels to reduce addictive behaviours.
Types of drug therapy
Drug therapy for addiction operates through three main approaches, each working through different mechanisms to help individuals overcome their dependence.
Aversives
Aversive drugs create unpleasant physical consequences when the addictive substance is consumed. The most common example is disulfiram, used in alcohol addiction treatment. This medication causes hypersensitivity to alcohol, producing severe hangover symptoms including nausea and vomiting within just five to ten minutes of alcohol consumption. The goal is to create such unpleasant associations with drinking that the person avoids alcohol entirely.
Agonists
Agonist medications function as drug substitutes by binding to the same neuron receptors as the addictive substance and activating them. This approach provides similar effects to the original drug but in a safer, medically controlled manner.
Example: Methadone Treatment
Methadone exemplifies the agonist approach in heroin addiction treatment. It works by:
- Satisfying the addicted person's craving for euphoric effects
- Being 'cleaner' with fewer harmful side effects than street drugs
- Allowing for gradual dose reduction over time
- Controlling withdrawal symptoms to stabilise individuals
Antagonists
Antagonist drugs work by binding to receptor sites and blocking them, preventing the addictive substance from producing its usual effects, particularly the euphoric feelings that drive continued use. Naltrexone serves as an opiate antagonist for treating heroin addiction.
Antagonist treatment requires additional psychological interventions such as counselling to address the underlying psychosocial causes of addiction, as blocking the drug's effects alone does not resolve all aspects of addictive behaviour.
Nicotine replacement therapy
Nicotine replacement therapy (NRT) delivers nicotine through gum, inhalers, or patches, providing the psychoactive substance found in tobacco but without the harmful chemicals present in cigarettes. Although nicotine is the primary addictive component in tobacco, it causes less harm to health when delivered through these alternative methods.
Neurochemical Process of NRT
NRT works neurochemically by delivering controlled doses of nicotine that bind to acetylcholine receptors in the brain's mesolimbic pathway, stimulating dopamine release in the nucleus accumbens. This process mimics what occurs during cigarette smoking, satisfying the neurochemical craving whilst eliminating exposure to toxic tobacco compounds.
The treatment allows for gradual nicotine reduction using progressively smaller patches over two to three months, helping manage withdrawal symptoms and making the quitting process more manageable for smokers.
Drug therapy for gambling addiction
Currently, no drugs are officially approved specifically for gambling addiction treatment. However, research continues into potential candidates, with opioid antagonists such as naltrexone showing particular promise.
This interest stems from recognition of similarities between gambling addiction and substance addictions in the DSM-5. The neurochemical explanation for gambling addiction suggests it activates the same dopamine reward system as substances like heroin and nicotine.
Opioid antagonists affect gambling behaviour by reducing dopamine release in the nucleus accumbens through their impact on another neurotransmitter, GABA, in different parts of the mesolimbic pathway. This neurochemical activity dampens the cravings associated with gambling addiction.
Research by Kim et al. (2001) has demonstrated connections between this neurochemical activity and subsequent reductions in gambling behaviour. However, even if naltrexone were prescribed for gambling addiction, patient compliance might be poor due to unpleasant side effects.
Research continues seeking equally effective drugs with more tolerable side effect profiles.
Evaluation
Research support
Lindsay Stead et al. (2012) conducted a comprehensive review of 150 high-quality research studies examining NRT effectiveness. Their findings demonstrated that all forms of NRT prove more effective than both placebo treatments and no treatment at all in helping smokers quit.
Key Research Findings
Nasal spray emerged as the most effective nicotine delivery method, with NRT users showing up to 70% greater likelihood of remaining abstinent from smoking six months after quitting.
Additional research benefits include evidence that NRT is safer than continued cigarette smoking as it eliminates harmful tobacco smoke elements, and it does not appear to foster new dependencies.
These findings support the validity of neurochemical explanations for nicotine addiction and suggest potential for developing further life-saving drug therapies.
Side effects
NRT commonly produces side effects including sleep disturbances, gastrointestinal problems, dizziness, and headaches. More concerning are the side effects associated with drug treatment for gambling addiction.
The naltrexone doses required to affect gambling behaviour are typically much higher than those used conventionally for opiate addiction treatment, resulting in correspondingly worse side effects.
Even when negative effects are anticipated, patients risk discontinuing therapy, particularly when experiencing adverse effects without the counterbalancing benefits of euphoria that come with drugs of dependence. The risk of side effects must be carefully weighed against both the benefits of drug therapy and alternative psychological treatments.
Limited treatment effectiveness
Drug therapy often appears convenient, requiring only daily tablet consumption rather than wholesale changes to thought processes. However, this perceived strength becomes a weakness for many substance and behavioural addictions.
Treatment Paradox
Individuals severely affected by addiction, such as heroin users who spend most of their time seeking their next fix, may be too disorganised and undermotivated to maintain daily medication regimens.
This creates a paradox where drug therapy, despite its perceived convenience, proves ineffective for many individuals.
The treatment appears best suited to a relatively small subset of addicts who are highly motivated and not leading chaotic lifestyles.
Individual differences
Genetic variations between individuals create substantial differences in drug treatment outcomes. Research by Tammy Chung et al. (2012) found that naltrexone effectiveness for alcohol addiction depends on variations in a single gene. Individuals with one genetic variant respond much more readily to treatment than those with alternative versions.
These findings suggest drug treatments need to become more tailored to individual genetic profiles before achieving consistent effectiveness across different populations. However, this is not necessarily a serious limitation, as improved understanding of addiction's neurochemical mechanisms can lead to development of new treatments effective for broader populations.
Removal of stigma
Continued research into drug treatments encourages growing perception of addiction as a medical rather than moral problem. Research rapidly reveals the neurochemical, genetic, and physiological basis of addiction, gradually eroding views that addiction represents moral failure or psychological weakness.
Social Benefits
This shift towards viewing addiction as a medical condition reduces stigma, as neurochemical imbalances can hardly be considered the addicted person's fault. Reduced stigma increases the likelihood that sufferers will acknowledge their condition and seek treatment, improving their chances of recovery with associated social, individual, and economic benefits including improved health, reduced unemployment, less stress, and decreased crime rates.
Key Points to Remember:
- Drug therapy uses three main approaches: aversives create unpleasant consequences, agonists substitute safer alternatives, and antagonists block the drug's effects
- Nicotine replacement therapy provides controlled nicotine doses whilst eliminating harmful tobacco chemicals, with research showing 70% better quit rates than placebo
- No approved drugs currently exist for gambling addiction, though opioid antagonists like naltrexone show promise by reducing dopamine-driven cravings
- Side effects can be problematic, particularly for gambling treatments requiring higher doses than conventional use
- Treatment effectiveness varies based on individual genetic differences, suggesting need for more personalised approaches