Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 11 Addiction Pharmacotherapy Updated by Melinda Haley, Walden University

Rationale For This Chapter Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Pharmacotherapy approaches are increasing Sometimes controversial Called a “crutch” Antimedication bias We have an ethical mandate to offer evidence- based treatment to clients

Terms and Concepts Terms and Concepts Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 38 Key Pharmacotherapy Terms Addiction Agonist Antagonist Neurotransmitter Receptor Reuptake

The Three Parts of the Synapse Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Pre-synaptic membrane of one neuron Controls neurotransmitter release Post-synaptic membrane of receiving neuron Facilitates intracellular response Minute space between the two called the synaptic cleft.

The Neurology of the Synapse Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Presynaptic Neurology Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Postsynaptic Neurology Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Figure hill.com/sites/ /student_view0/chapt er45/animations.html# hill.com/sites/ /student_view0/chapt er45/animations.html#

Diversity and Pharmacotherapy Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Race and gender can significantly impact the outcomes of psychopharmacotherapy Cross-ethnic variations in drug effects Ethnic variations in presence of enzyme CYP 2D6 impacts drug metabolism

Key Neurotransmitters Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Serotonin (5HT) Dopamine (DA) Norepinephrine (ADR)

Life cycle of neurotransmitters Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Synthesis Packaging and storing in synaptic vesicles Transport Release Binding to post-synaptic receptor proteins Diffusion, destruction, or reuptake

Key Concepts of Pharmacokinetics Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved How the body deals with the drug Four processes Absorption, Distribution, Biotransformation, Elimination Half-life Time required for the concentration or amount of drug in the body to be reduced by one-half

Key Concepts of Pharmacodynamics Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved How drugs act on the body Drugs bind to and interact with a receptor in one of two ways Agonists Activate or enhance cellular activity Antagonist Blocks the binding of agonists but does not activate the receptor

A Biological Theory of Craving Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Craving affects dependence, relapse, and treatment Multiple types of craving Three types of craving for alcohol Reward-sensitivity Stress reduction Disinhibition Hormones play a role in craving Anti-craving drugs

The Professional Counselor’s Role in Addiction Pharmacotherapy Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved More contact with clients than prescribing physicians Strong working alliance Client education Promote medication compliance Listen to client’s beliefs Ground discussion in client’s point of view

Pharmacotherapy of Alcohol Addiction Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Many systems play role in alcohol dependence More than 150 medications have been used to treat alcohol addiction Three types of treatment Aversion Alcohol withdrawal Anticraving

Aversion Treatment for Alcohol - First Line Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Disulfiram/Antabuse First pharmacotherapy available Goal: Develop an aversion

Alcohol Withdrawal Treatment – First Line Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 10% of those in withdrawal experience severe symptoms Diazepam/Valium, Lorazepam/Ativan, other Benzodiazepines (anxiolytic class) Increase sedation, memory problems, addiction

Alcohol Withdrawal Treatment – Second Line Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Baclofen/Lioresal (anticonvulsant) Lowered alcohol intake and craving, anxiety Carbamazepine/Tegretol (anticonvulsant) Fewer side effects than benzodiazepine Also anticraving properties

Alcohol Anticraving Treatment – First Line Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Acamprosate/Campral (anti-craving class) Eases excitotoxicity caused by withdrawal Naltrexone/ReVia/Depade (anti-craving class) Mixed studies Most helpful in handling relapses

Alcohol Anticraving Treatment – Second Line Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Lamotrigene/Lamictol (anticonvulsant) Efficacious with bipolar and unipolar depression, schizophrenia

Alternative Medicine Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Kudzu Ayahuasca Classic hallucinogens Ibogaine

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved American College of Neuropsychopharmacology Society for Neuroscience