Post University Unit 6 Alcoholism Medications Discussion Responses

Rebecca DRE: DB 6.1There are various medications that can be prescribed for individuals with alcohol addiction. Though none of the medications available today can completely cure alcoholism, there are medications that can help reduce cravings and minimize withdrawal symptoms to support alcohol addiction treatment. Medication-assisted treatment should be prescribed in conjunction with comprehensive treatment that includes counseling and social support (SAMHSA, 2015). Four medications designed for alcoholism treatment are Naltrexone, Acamprosate, Disulfiram, and Topiramate. Each of these medications works in a different way to manage withdrawal symptoms, reduce cravings, and support abstinence. However, these medications come with various challenges, such as side effects, accessibility, limitations, and long-term sustainability.Naltrexone blocks opioid receptors in the brain that contribute to the pleasurable effects of alcohol and cravings, effectively reducing the urge to drink (NIDA, 2009). In a meta-analysis of randomized controlled trials, Naltrexone was found to reduce relapse risk by 36% (Srisurapanont Jarusuraisin, 2005). Naltrexone is also helpful in curbing consumption for individuals that have minor relapses early in treatment, as they will find that they will not experience the same rewards of alcohol they had before taking Naltrexone (NIH, 2008). However, Naltrexone is limited in its ability to sustain abstinence long-term. Naltrexone has been found to be most effective during the initial phases of treatment, approximately within the first three months, and becomes less effective for long-term treatment (NIDA, 2009).Acamprosate, or Campral, is designed to minimize withdrawal symptoms, such as insomnia, anxiety, restlessness, and dysphoria (NIDA, 2009). Acamprosate regulates gamma-aminobutyric acid (GABA) and glutamate neurotransmitter systems in the brain to support alcohol abstinence by reducing withdrawal symptoms (NIH, 2008). One strength of Acamprosate is that it has also been found to be more effective with individuals suffering from more severe dependence (NIH, 2008). However, similar to Naltrexone, Acamprosate helps sustain abstinence for a limited time, as Acamprosate has been found to maintain abstinence for several weeks or months (NIDA, 2009). Acamprosate is also taken three times per day, whereas Naltrexone is taken only once daily (NIH, 2008).Disulfiram, or Antabuse, helps individuals abstain from alcohol by causing an unpleasant reaction when combined with alcohol, such as flushing, nausea, and palpitations (NIH, 2008). Disulfiram works by interfering with the degradation of alcohol, which results in the accumulation of acetaldehyde, which causes unfavorable reactions (NIH, 2008). This writer found this approach very interesting, as this medication effectively uses negative reinforcement to support abstinence. Not surprisingly, Disulfiram has a low compliance rate when self-administered, with the exception of highly motivated individuals (Allen Litten, 1992). Disulfiram is also not typically prescribed as a first line of treatment due to risks of toxicity (Del Re et al., 2013). Disulfiram has been found to work well in a monitored fashion, such as in a clinic or by a spouse, to increase sustainability through accountability (NIH, 2008). Disulfiram can also be taken episodically, such as before high-risk situations where alcohol will be present (NIH, 2008).Topiramate is currently not an FDA-approved medication for alcohol addiction, but it has been shown in two randomized controlled trials to significantly improve alcohol consumption outcomes (NIDA, 2009). Topiramate works by increasing inhibitory neurotransmission and reducing stimulatory neurotransmission, leading to mood stabilization and effectively reducing one’s urge to drink (Del Re et al., 2013). Evidence has demonstrated Topiramate’s efficacy in treating certain mood-related disorders, such as bipolar disorder, borderline personality disorder, and post-traumatic stress disorder, making it a potentially ideal treatment for comorbid disorders (Del Re et al., 2013). In addition to the barrier of Topiramate not yet been FDA-approved for alcohol use disorder, Topiramate also has difficult side effects, such as paresthesia, nausea, taste perversion, anorexia, headache, and difficulty concentrating (Del Re et al., 2013).As scientists continue to work on the research and development of new medications, it gives this writer hope that medically-assisted treatment for addiction will continue to grow. Just as any psychiatric, medical, or neurological disorder would be treated with a combination of pharmacological and behavioral or psychotherapeutic treatment, addiction would require the same. Addiction occurs in the brain, so it should be treated in the brain. Additionally, the more awareness is spread on the development and course of addiction, the less of an impact stigma and systemic barriers will have on the development of addiction treatment. Allen, J. P., Litten R. Z. (1992). Techniques to enhance compliance with disulfiram. Alcohol and Experimental Research, 16(6), 1035-1041.Del Re, A. C., Gordon, A. J., Lembke, A., Harris, A. H. S. (2013). Prescription of topiramate to treat alcohol use disorders in the Veterans Health Administration. Addiction Science Clinical Practice, 8(1), 12-20.NIDA. (2009). Principles of drug addiction treatment: A research-based guide(2nd ed.). National Institute on Drug Abuse. National Institutes of Health.NIH. (2008). Helping patients who drink too much: A clinician’s guide. National Institutes of Health. SAMHSA. (2015). Medication for the treatment of alcohol use disorder: A brief guide. Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services.Srisurapanont, M., Jarusuraisin, N. (2005). Naltrexone for the treatment of alcoholism: A meta-analysis of randomized controlled trials. International Journal of Neuropsychopharmacology, 8(2), 267-280.Jesus LRE: DB 6.1Class and professor,This student found that primary care clinicians must be familiar with available treatment resources for patients diagnosed with substance abuse or dependence disorders. The clinician’s responsibility to the patient does not end with the patient’s entry into formal treatment; instead, the physician may become a collaborative part of the treatment tea or, minimally, continue to treat the patient’s medical conditions during the specialized treatment, encourage continuing participation in the program, and schedule followup visits after treatment termination to monitor progress and help prevent relapse.However, understanding the specialized substance abuse treatment system can be challenging. No single definition of treatment exists, and no standard terminology describes different dimensions and elements of treatment. Describing a facility as providing inpatient care or ambulatory services characterizes only one aspect (albeit an important one): the setting. Moreover, the specialized substance abuse treatment system differs around the country, with each State or city having its peculiarities and specialties. Minnesota, for example, is well known for its array of public and private alcoholism facilities, mostly modeled on the fixed-length inpatient rehabilitation programs initially established by the Hazelden Foundation and the Johnson Institute, which subscribe to a strong Alcoholics Anonymous (AA) orientation and have varying intensities of aftercare services. California also offers several community-based social model public sector programs that emphasize a 12-Step, self-help approach as a foundation for lifelong recovery. In this chapter, the term treatment will be limited to describing the formal programs that serve patients with more severe alcohol and drug problems who do not respond to brief interventions or other office-based management strategies. It is also assumed that an in-depth assessment has been conducted to establish a diagnosis and determine the most appropriate resource for the individual’s needs.Moderate use, however, lies at one end of a range that moves through alcohol abuse to alcohol dependence:Alcohol abuse is a drinking pattern that results in significant and recurrent adverse consequences. Alcohol abusers may fail to fulfill central school, work, or family obligations. They may have drinking-related legal problems, such as repeated arrests for driving while intoxicated. They may have relationship problems related to their drinking.People with alcoholism — technically known as alcohol dependence — have lost reliable control of their alcohol use. It does not matter what kind of alcohol someone drinks or even how much: Alcohol-dependent people are often unable to stop drinking once they start. Alcohol dependence is characterized by tolerance (the need to drink more to achieve the same “high”) and withdrawal symptoms if drinking suddenly stops. Withdrawal symptoms may include nausea, sweating, restlessness, irritability, tremors, hallucinations, and convulsions.Although severe alcohol problems get the most public attention, even mild to moderate problems cause substantial damage to individuals, their families, and the community.JesusAmerican Psychological Association. (2012, March 1). Understanding alcohol use disorders and their treatment. National Institute on Alcohol Abuse and Alcoholism. (2018). “Alcohol Use Disorder.”Substance Abuse and Mental Health Services Administration. (2017). Critical substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse, and Mental Health Services Administration. Retrieved from Magill, M., Ray, L.A. (2009). “Cognitive-behavioral treatment with adult alcohol and illicit drug users: A meta-analysis of randomized controlled trials.” Journal of Studies on Alcohol and Drugs, 70 (4): 516-527. Elizabeth DRE: DB 6.2Opioid addiction treatment with medical assistance can benefit a person’s mind, body, and spirit. People can safely stop using opioids by using methadone, buprenorphine, naltrexone, and suboxone, which also helps people curb their cravings and lessens the effects of opioids (NIDA, 2009). This assists in lessening the body’s physiologic reliance on opioids, which can significantly lower the likelihood of relapse (NIDA, 2009). Also, these drugs can aid in lowering the physical withdrawal symptoms that might be connected to opioid usages, such as nausea, vomiting, and restlessness (NIDA, 2009).In order to achieve long-term recovery, people who are receiving medically assisted therapy may find it psychologically beneficial to take charge of their addiction and regulate their cravings. Moreover, behavioral therapy can help people understand their addiction better and recognize triggers that could cause relapses (Stevens Smith, 2018). This can give people the abilities and information they need to control their addiction even in trying circumstances.Last but not least, receiving medical care can aid a person in finding their spirituality again. Addiction can cause many people to feel alone, ashamed, and guilty, which might cause them to stop engaging in spiritual activities (Stevens Smith, 2018). People can reaffirm their spiritual convictions and find their life’s purpose through counseling and spiritually oriented activities (Stevens Smith, 2018). This can strengthen the basis for long-term healing and help people feel more a part of something bigger than themselves.There are many advantages to receiving opioid addiction therapy with medical assistance. Medically aided treatment can help the patient by reducing physical cravings and withdrawal symptoms, giving them control over their addiction, and improving their quality of life (NIDA, 2009). Moreover, medically assisted treatment can give patients the abilities and information needed to control their addiction and sustain long-term recovery (Stevens Smith, 2018).For the community, medically assisted therapy helps stop the spread of infectious diseases linked to intravenous drug use, like HIV and Hepatitis C (NIDA, 2009). Moreover, medically assisted treatment can lower the mortality, criminal activity, and healthcare expenditures related to opioid addiction that is tied to opioid use (NIDA, 2009).The stigma associated with medically assisted treatment is its biggest disadvantage. Many people, even those receiving addiction treatment, believe that abstinence from all substances is the only way to experience true recovery and that medically assisted treatment does not qualify as such (Witte et al., 2021). Despite its success and effectiveness as an addiction treatment, medically assisted treatment will remain stigmatized until society understands how crucial it is for opioid addiction recovery.References.NIDA. (2009). Principles of drug addiction treatment: A research-based guide (2nd ed.). National Institute on Drug Abuse. National Institutes of Health.Stevens, P., Smith, R. L. (2018). Substance abuse counseling theory and practice (6th ed.). Pearson.Witte, T. H., Jaiswal, J., Mumba, M. N., Mugoya, G. C. T. (2021). Stigma surrounding the use of medically assisted treatment for opioid use disorder. Substance Use Misuse, 56(10), 1467-1475.Meghan ERE: DB 6.2Dr. Fernandez and Class -In the video about replacement therapy, the counselor tells the group that opiates effect brain chemistry differently and therefor, treatment programs which require them to completely abstain from using drugs are not effective (YouTube, 2008). Instead, he offers, “replacement therapy” is the more effective model to use when treating opiate addiction (You Tube, 2008). Replacement therapy includes the use of methadone, buprenorphine, naltrexone, and suboxone (You Tube, 2008). The reason that these drugs are effective is that they target the same receptors in the brain as opioids but the “buzz” is minimal so it doesn’t produce the same high as the opioids (You Tube, 2008). In addition, these replacements are “long acting” so it maintains a steady level in the body throughout he day, as opposed to opiates which can have extreme highs and crashes (YouTube, 2008). The clinician shares that since the replacement therapies stay more “constant” throughout the day, they do less damage to the brain (YouTube, 2008). I appreciated the way he explained the limitations of the replacement therapy in that they are not there as a “magic bullet” to make them feel better if they are having a bad day since it takes several days to build in their system. The drugs are not intended to be responsive to bad days in that way he reminded them that the addict’s role in their own treatment is to do the counseling work needed to tackle the hard days (YouTube, 2008).I found the video entitled, “What is Suboxone” to be a very clear, easy to understand explanation of what this drug may be effective. Particularly, the explanation that the molecule only partially, but not perfectly, fits into the receptor, made a great deal of sense in understanding why it would help in reducing cravings, but not result in the same high as the opiate does (You Tube, 2022).Suboxone has been shown to help reduce cravings and dependence on opioids as well as helping addicts to remain in treatment programs for extended periods of time (Medical News Today, 2019). There are risks for mild to severe side effects on suboxone, including becoming dependent (Medical News Today, 2019). According to the World Health Organization, more than 70% of drug-related deaths involve opiates (WHO, 2021). The National Institute on Drug Addiction estimates that the cost of suboxone treatment in conjunction with counseling to be approximately $6500 per year (NIDA, 2021). While this is not a small cost,, I found the following “costs” of NOT treating a user to be startling:“ Each year, opioid overdose, misuse, and dependence account for:$35 billion in health care costs.$14.8 billion in criminal justice costs$92 billion in lost productivity” ( Pew Trusts, 2021).In my opinion, treatment is always worth it to both the user and to society. I continue to believe that our healthcare system is broken in many ways, limiting access to adequate treatment to many who need it most.The High Price of the Opioid Crisis, 2021. (2021). Pew.org. Suboxone: Side effects, dosage, uses, and more. (2019, September 1). Www.medicalnewstoday.com. National Institute on Drug Abuse. (2021). How much does opioid treatment cost? National Institute on Drug Abuse. World Health Organization. (2021, August 4). Opioid Overdose. World Health Organization. qtpie20121. (2008). HBO Treating Opiate Addiction With Replacement T. In YouTube.What Is Suboxone? (n.d.). Www.youtube.com. Retrieved October 4, 2022, from Jesus LRE: DB 6.2Class and Professor,Abundant evidence shows that methadone, buprenorphine, and naltrexone reduce opioid use and opioid use disorder-related symptoms. They reduce the risk of infectious disease transmission and criminal behavior associated with drug use. These medications also increase the likelihood that a person will remain in treatment, associated with a lower risk of overdose mortality, reduced risk of HIV and HCV transmission, reduced criminal justice involvement, and a greater likelihood of employment.Methadone is the medication with the most extended history of use for opioid use disorder treatment, having been used since 1947. Many studies (some of which are summarized in the graph below) support methadone’s effectiveness in reducing opioid use. A comprehensive Cochrane review in 2009 compared methadone-based treatment (methadone plus psychosocial treatment) to placebo with psychosocial treatment and found that methadone treatment effectively reduced opioid use, the opioid use-associated transmission of infectious disease, and crime Patients on methadone had 33 percent fewer opioid-positive drug tests. They were 4.44 times more likely to stay in treatment compared to controls. Methadone treatment significantly improves outcomes, even when provided in the absence of regular counseling services long-term (beyond six months). Outcomes are better in groups receiving methadone, regardless of the frequency of counseling received.Buprenorphine, which was first approved in 2002, is currently available in two forms: alone (Probuphine®, Sublocade™, Bunavail®) and in combination with the opioid receptor antagonist naloxone (Suboxone®, Zubsolv®). Both formulations of buprenorphine are effective for treating opioid use disorders. However, some studies have shown high relapse rates among patients who tapered off buprenorphine compared to patients who maintained the drug for longer.Naltrexone was initially approved for treating opioid use disorder in a daily pill form. It does not produce tolerance or withdrawal. Poor treatment adherence has primarily limited the real-world effectiveness of this formulation. As a result, there is insufficient evidence that oral naltrexone is an effective treatment for opioid use disorder. Extended-release injectable naltrexone (XR-NTX) is administered once monthly, which removes the need for daily dosing. While this formulation is the newest medication for opioid use disorder, evidence suggests it is effective.The double-blind, placebo-controlled trial that was most influential in getting XR-NTX approved by the FDA in 2010 for opioid use disorder treatment showed that XR-NTX significantly increased opioid abstinence. The XR-NTX group had 90 percent confirmed abstinent weeks compared to 35 percent in the placebo group. Treatment retention was also higher in the XR-NTX group (58 percent vs. 42 percent), while subjective drug craving and relapse decreased (0.8 percent vs. 13.7 percent). Improvement in the XR-NTX group was sustained throughout an open-label period of 76 weeks. These data were collected in Russia, and additional studies are required to determine if effectiveness will be similar in the United States.A NIDA study showed that once treatment is initiated, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid use disorder. Because naltrexone requires complete detoxification, initiating treatment among active opioid users was more difficult with this medication. However, once detoxification was complete, the naltrexone formulation had a similar effectiveness as the buprenorphine/naloxone combination.JesusNIDA. 2021, December 3. How effective are medications in treating opioid use disorder? Retrieved from Rebecca DRE: DB 6.3There are various medications to treat nicotine addiction, including prescription medications and various forms of over-the-counter (OTC) nicotine replacement therapy (NRT). Prescription medications that are considered safe and effective for nicotine addiction treatment include bupropion and varenicline (Stevens Smith, 2018). Bupropion and varenicline are both effective in sustaining smoking abstinence. In a comparative study by Benli et al. (2017), bupropion had a success rate of 18.6% sustained abstinence after one year, and varenicline had a 20.5% success rate.OTC NRTs include Nicorette gum, Nicorette Lozenge, NicoDerm patch, Nicotrol spray, and Nicotrol inhaler (Stevens Smith, 2018). These NRTs have been found to be equally effective for smoking cessation (NIDA, 2021). NRTs work by providing individuals with a dose of nicotine to minimize withdrawal symptoms and cravings that lead to relapse. Research has found that individuals using NRTs to quit smoking are 50-70% more likely to succeed, which increases even more with the combination of therapeutic behavioral treatment (NIDA, 2021). Research has also found that individuals that use more than one type of NRT are more successful in preventing relapse than those that just use one type (NIDA, 2021). For example, an individual might use the NicoDerm patch in addition to the spray or inhaler as needed, which is a safe and effective way to successfully wean from nicotine addiction.Despite the well-known lethal dangers of nicotine products, cigarettes, e-cigarettes, and other tobacco/nicotine products are not only legal, but they are also a multibillion-dollar industry and sold in nearly every country in the world (Tiffin, 2015). This level of revenue greatly benefits the government through sales tax, so to suddenly remove it would lead to a significant financial deficit (Tiffin, 2015). Knowing that such a deficit will not affect the pockets of political heads, this deficit will likely impact governmental programs and services, such as non-profit organizations that many of us likely work for. So, it is not so simple to just make it illegal now that they have been legalized for centuries due to the financial cost it would be to countries around the world.Still, efforts are continually made to educate the public on the dangers of tobacco and nicotine products. The Federal Cigarette Labeling and Advertising Act of 1965 began with the requirement to have warning labels on cigarette packages, banned smoking on domestic airline flights scheduled for two hours or less, and illegalized cigarette labels in advertisements (CDC, 2022). Over time, cigarettes then became illegal to advertise cigarettes, smoke on airline flights, smoke in buildings that include children’s services, and in many states, smoke in public areas (CDC, 2022). Additionally, as of December 2019, it is illegal to purchase cigarettes under the age of 21 instead of the previous age of 18 (CDC, 2022). Many consumer stores have also pulled all nicotine products off their shelves and have committed to only selling OTC NRTs. Despite these many legal changes and barriers to prevent the public from these deadly addictive products, this writer feels that as long as they are legal, people will continue to purchase them and suffer the consequences. This writer also feels that as long as the government is making such large profits off of tobacco sales, they will continue to be legal for use and purchase.Benli, A. R., Erturhan, S., Oruc, M. A., Kalpacki, P., Sunay, D., Demirel, Y. (2017). A comparison of the efficacy of varenicline and bupropion and an evaluation of the effect of the medications in the context of the smoking cessation programme. Tobacco Induced Diseases, 15(Feb), 1-10.CDC. (2022). Office on Smoking and Health (OSH): Legislation. Centers for Disease Control and Prevention. NIDA. (2021). Tobacco, nicotine, and e-cigarettes research report: What are treatments for tobacco dependence?National Institute on Drug Abuse. Stevens, P., Smith, R. L. (2018). Substance abuse counseling theory and practice(6th ed.). Pearson.Tiffin, N. H. (2015). Why do we still permit tobacco use? Canadian Journal of Respiratory Therapy, 51(4), 85.Meghan EThe NIH article (2010) cited a 2008 World Health Organization study that looked at the impact of state and federal legislation to reduce nicotine use: “The WHO Report on the Global Tobacco Epidemic, 2008—The MPOWER Package emphasized tobacco-control strategies that include taxation, advertising bans, smoke-free policies on smoke-free environments, and enforcement of existing bans (WHO, 2008). WHO estimated that a 70% increase in tobacco price could prevent up to about 25% of all tobacco-related deaths worldwide” (WHO, 2008).Similar to opioid replacement therapy, nicotine replacement therapies (NRTs) target the receptors in the brain that are satisfied by nicotine use. Attaching to these receptors helps to reduce cravings and withdrawal (NIDA, 2022).Not to get too political, but the reason that I believe that nicotine continues to be legal, particularly since we know the devastating long-term consequences, is because tobacco and tobacco lobbies hold a tremendous amount of money and political power in this country (similar to the NRA). I believe that making tobacco products more expensive is certainly a deterrent to some, but as a highly addictive substance, it is not the full solution. Children are still able to obtain nicotine products daily easily and we don’t see much anti-smoking campaigns like we used to. The National Institute on Drug Abuse recommends a combination of therapies as the most effective, citing the need to incorporate some level of behavioral therapy/talk therapy in addition to NRTs (NIDA, 2022).National Institutes of Health. (2010). The Background of Smoking Bans. Nih.gov; National Academies Press (US). National Institute on Drug Abuse. (2022, May). What are treatments for tobacco dependence?National Institute on Drug Abuse. 2008. WHO report on the global tobacco epidemic, 2008: The MPOWER package .Geneva: World Health Organization