Treatments and triggers for drug dependence

- [Voiceover] Drug addiction is a medical problem, and just like other psychological diseases, it has both physiological and psychological components. So it makes sense that treatments for drug addiction would address both physiological and psychological sides of the problem. For serious addictions, hospitalization might be needed as the person goes through withdrawal both to make sure they don't hurt themselves, and to help their body get used to operating without the drugs. This initial period of separating the addict from the drug is called 'detoxification'. It's when you kind of try to flush out all the toxins from your body. Some medications are used during that stage to help with the basic symptoms of withdrawal like vomiting, nausea, pain, et cetera. This is important but sometimes strong addictions require strong medications to help break the cycle of addiction in addition to addressing those symptoms. For example, let's consider opiates. Remember opiates, such as heroin, act at the neural receptor site for endorphins to reduce pain and give people a sense of euphoria, which is a highly addicting sensation. A medication called methadone, which is an opioid agonist, activates the opioid receptors, but it acts much more slowly, so it dampens the high. The benefit here is that it reduces cravings and eases withdrawal symptoms. Also, if the person does take heroin again, then they won't be able to experience the high because all the receptors are already taken with methadone. So like many other pharmacological treatments that we'll talk about, methadone has been shown to be more effective when it's combined with behavioral therapy. So we'll talk more about the different behavioral or psychological therapies in just a minute. But we're gonna go over a couple other medications first. For stimulants like tobacco, medications replace the effects of nicotine, which is the primary addictive ingredient in tobacco. Now you do this by either delivering low levels of nicotine through a patch, or lozenge, or something, or they deliver chemicals that act on nicotine receptors in the brain. In this case, the medication either prevents the release, or the re-uptake of dopamine, which is the neurotransmitter that sends the reward signal to the brain. These medications help reduce cravings, primarily. For alcoholics, medications work by blocking the receptors involved in the rewarding effects of drinking and craving for alcohol. They can also help reduce symptoms of withdrawal, such as anxiety, insomnia, and dysphoria, which is just a bad feeling, the opposite of euphoria. Preventing symptoms of withdrawal is more than just making it easier on the patient physically because these symptoms are often similar to the initial conditions that drove the person to the drug in the first place. So it's important, even from a psychological perspective, to prevent a relapse during this critical early stage by minimizing those negative symptoms. As we mentioned before, behavioral treatments are also an important component of treating drug addiction. In-patient treatments require residents in a hospital or other treatment facility. Out-patient treatments mean that the patient can live at home or wherever and then just come in for therapy or meetings. Most behavioral treatments can happen in either of those settings, so it just depends on what's best for the patient. Cognitive behavioral therapy, or CBT, is another type of psychological treatment for drug addiction, and has been used successfully with patients addicted to alcohol, marijuana, cocaine, methamphetamines, and nicotine. As the name suggests, CBT addresses both the cognitive and behavioral components of the addiction. Patients learn to recognize problematic thought patterns and develop more positive thought patterns and coping behaviors. They also learn to anticipate problematic situations. Say, for an alcoholic, going to a party where there would be alcohol, would be a problematic situation. And self-monitor for cravings so that they can apply their coping strategies early. Maybe go to a different party, or go to dinner with a friend instead of going to the party. Fortunately, research shows that the skills people learn in CBT last after the therapy ends, which is very important. We want long-lasting treatments. Another type of behavioral treatment is motivational interviewing, sometimes called motivational enhancement therapy, and this type of therapy involves working with the patient to find intrinsic motivation to change. It's considered a very focused, very goal-directed type of therapy, because it tends to involve very few sessions with a therapist, and it can be a doorway for the patient to engage in another treatment program such as group meetings or CBT. Group meetings such as "Alcoholics Anonymous" or "Narcotics Anonymous", or any of those, can help recovering addicts support each other and realize they're not alone. These meetings are often part of a 12-step program which help people go through the process of recovery. I'm not gonna list all 12 steps, but they can be broken down into three main categories. The first is acceptance, which means that you acknowledge your addiction is a chronic-progressive disease that you can't control on your own, so you have to admit the problem. Second category would be 'surrender', meaning you have to give yourself over to a higher power, and accept the help offered through that power and through the group. The third category is active involvement in meetings and activities which could include helping other recovering addicts. So becoming a sponsor to someone new to the group. Even though the steps are generally sequential, most groups acknowledge that people may revisit certain steps repeatedly over time. There's plenty of evidence showing these 12-step programs are helpful in treating alcohol addiction and early evidence suggests that it's useful for other types of addiction as well. Those just haven't been around quite as long. Sometimes there are parallel group meetings for families of recovering addicts, which can help people in the addict's life understand the problem and help them help their loved one. So that's really important as well. When we're talking about therapy, it's important to consider the idea of relapse, which is when a recovering addict may slip up and take illegal drugs again. Relapse depends more on the addictive potential of the drug that they were using and the environmental triggers they're currently experiencing than anything else. More addictive substances make relapse more likely, as does encountering anything that a recovering addict used to associate with his or her addiction. This is why it can be so hard sometimes for people to stay clean. If they go through the treatment, it seems successful, but then they go right back into the same apartment, same group of friends, same situations that kind of got them into that mess, then it's very likely that those cues will trigger a relapse. This is part of why CBT can be helpful. It can teach people how to anticipate and avoid situations that would lead to a relapse.