Behavioral Science

Substance Abuse Disorders 141
How can the positive reinforcement
effects of drugs be reduced?
How does disulfiram work?
What side effect of opiate antagonists
may result in compliance problems?
What are the three major ways
of reducing withdrawal?
What criteria should be used when
selecting a substitute drug for treating
withdrawal?
Giving specific receptor antagonists
to prevent the binding of receptors
by the drug of dependence; therefore,
precipitating withdrawal and preventing
the effects of the drug (eg, naloxone or
naltrexone treatment for opiates)
Converting reward to punishment (eg,
the use of disulfiram [Antabuse] for
alcohol dependence)
Giving dopamine or opiate antagonists
to cause general inhibition of the
reward pathways
Negative discriminative stimuli (eg, telling
the patients that their drug of choice
will be ineffective; therefore, they avoid it)
Disulfiram inhibits aldehyde
dehydrogenase in the liver. Alcohol is
then unable to be fully metabolized,
leading to flushing, headache, and
nausea from accumulation of the
aldehyde intermediate.
Anhedonia
1. Substitute drugs that act as agonists
for the same receptor, and therefore,
prevent severe withdrawal (ie, using
methadone to treat heroin or opiate
dependence)
2. Substitution by partial agonist for the
same receptor, thereby, preventing
severe withdrawal and counteracting
the effects of the drug if it is taken
3. Substitution of a different route of
administration to prevent some of
the adverse effects of the drug itself
while still preventing withdrawal (ie,
using the nicotine patch for smoking
cessation)
Substitute drugs should be:
Less rewarding
Less damaging
More manageable
Able to allow the patient to be more
functional (eg, methadone)