Treatments and triggers for drug dependence | Processing the Environment | MCAT | Khan Academy

Treatments and triggers for drug dependence | Processing the Environment | MCAT | Khan Academy


– [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.

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