The Use of Drug Therapy for Addiction (AQA A Level Psychology): Revision Note

Drug therapies to treat nicotine addiction

• There are three types of drug therapy for addiction

  • Aversives, which produce unpleasant consequences such as vomiting (e.g. disulfiram, used to treat alcoholism by creating hypersensitivity to alcohol)

  • Agonists, which act as drug substitutes by binding to neuron receptors and activating them

  • Antagonists, which bind to receptor sites and block them so the drug cannot have its usual effects

• Addiction to nicotine is treated using an agonist substitution method, where a safer alternative to tobacco smoking is provided (nicotine replacement therapy)

  • Nicotine replacement therapy (NRT) delivers nicotine in mouth sprays, chewing gum or small pouches that rest between the cheek and the gums or skin patches

• Varenicline is a prescription medication that acts as a partial agonist on the nicotinic receptors, stimulating dopamine release while also blocking nicotine from binding

  • It is used by people who want to stop smoking without using NRT

• NRT provides the user with a clean, controlled dose of nicotine which operates neurochemically by binding to nicotinic acetylcholine receptors in the mesolimbic pathway, stimulating the release of dopamine in the nucleus accumbens just as it does in cigarette smoking

• The nicotine is delivered in a less harmful fashion, without the damaging chemicals found in tobacco, and is released into the bloodstream more slowly

• The amount of nicotine is reduced gradually over time, with the withdrawal symptoms managed over two to three months until the person can give up nicotine completely

Drug therapies to treat gambling addiction

• There is no drug currently officially approved for use in treating gambling addiction, but there is ongoing research into several candidates, the most promising being opioid antagonists such as naltrexone, conventionally used to treat heroin addiction

  • This has come about because of the similarities between gambling and substance addiction that are now recognised in DSM-5

• The main drug therapy for gambling addiction is the opioid antagonist naltrexone, which 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 by enhancing the release of GABA, an inhibitory neurotransmitter, and the outcome of all this neurochemical activity is a dampening down of the cravings associated with gambling addiction

Research which investigates the use of drug therapy for addiction

• Stead et al. (2012) reviewed 150 high-quality research studies into the effectiveness of nicotine replacement therapy and concluded that all forms of NRT are significantly more effective than both placebo and no treatment at all, with NRT users up to 70% more likely to still be abstaining from smoking six months after quitting

  • Nasal spray was the most effective method of nicotine delivery

• 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 therapy is convenient, requiring only that the individual takes a tablet every day rather than having to make wholesale changes to their thought processes as psychological therapies demand

• Drug therapy for addiction removes stigma, as research revealing the neurochemical and genetic basis of addiction encourages people to view it as a medical problem rather than a moral or psychological weakness

  • Addiction therefore becomes less stigmatised, and more people accept that a neurochemical imbalance can hardly be considered the addicted person's 'fault', making those affected more likely to seek help

Limitations

• Common side effects of NRT include sleep disturbances, gastro-intestinal problems and headaches, and naltrexone's are more serious, as the dose needed to affect gambling behaviour is much higher than for opiate addiction

  • Patients may therefore discontinue treatment, especially when negative effects come without the counterbalancing euphoria of the drug

• Drugs do not work the same way for everyone, as the effectiveness of naltrexone for alcohol addiction depends on a variation in a single gene, with one variant responding far better than the other

  • Chung et al. (2012) suggest drug treatments need to be tailored to individual genetic profiles before they are likely to be consistently effective

Issues & Debates

• Drug therapies are biologically reductionist, focusing solely on treating addiction through chemical means

  • This ignores psychological, cognitive and social influences (e.g., triggers, beliefs, peer pressure), offering only a partial explanation and treatment

• Framing addiction as a medical issue via drug treatment can help reduce stigma, promoting more socially sensitive and ethical support

  • However, drug side effects and varied responses across individuals raise ethical concerns about informed consent and personalised care