Question

Should the Addictions be Treated with Pharmaceutical Agents? Although he is a physician, Breggin (2008) has long been a critic of the pharmaceutical industry. For example, he observed that “Drug companies heavily promote the unproven speculation that the problems they treat are biological in origin and result from biochemical imbalances.” This is, as he points out, an unproven hypothesis. It appears to be right, but sometimes the accepted theory is proven to be absolutely wrong. For example, 50 years ago every physician knew that stomach ulcers were caused by stress. The standard treatment was antacids and possibly tranquilizers. Now it is known that the vast majority of ulcers are caused by bacterial infections in the wall of the stomach and the standard treatment is a course of antibiotics and antacids to help the stomach lining heal. The “biochemical imbalance” is not automatically correct, it is just the most promising theory developed to date. However, nobody knows what a normal neurochemical balance in the brain actually is, much less how to achieve that balance. In spite of their “we’re here to help” public image, pharmaceutical companies want to sell you more pharmaceuticals so they make a profit (Breggin, 2008). Through media campaigns, they attempt to make physicians and the general public believe they need pharmaceuticals to deal with life’s problems. While this is not to dismiss the benefit of certain medications in the treatment of certain disorders (such as hypertension, for example), do we need medications to deal with all of life’s problems? People have found ways to cope with the problems of living for 10,000 generations before the rise of the pharmaceutical industry. Why do they suddenly need medications to cope? There is a rather interesting paradox inherent in the pharmaceutical treatment of a substance use disorder, in that we attempt to medicate hypothetical chemical imbalances in the brain, the exact nature of which we do not understand, with pharmaceuticals whose effects we also do not fully understand. It is important to keep in mind that although marketed as treatments for specific conditions, the psychopharmaceuticals have a blanket effect on the entire brain, not just the one subsystem that is hypothetically malfunctioning. As a result, other pharmaceutical agents are also used to treat various forms of mental illness side-effects such as drowsiness, ataxia, etc. Breggin (2008) suggested that some of psychopharmaceuticals in use today cause lifelong damage to the brain. The basic premise of psychopharmaceuticals is that they disrupt the function of the brain, hopefully in a more normal manner. The premise is the same for alcohol and for the drugs of abuse, although they usually seek euphoria. Surprisingly, from this perspective, it is possible to argue that the substance use disorders are attempts at self-medication by the abuser. However, we know so little about the normal function of the brain that neither the current generation of psychopharmaceuticals nor any of the drugs of abuse are able to selectively dampen the function of just one region of the brain (Breggin, 2008). The medications impair the function of every region of the brain to some degree, leaving the question of whether they have “cured” the disorder, or just immobilized it behind a chemical straight jacket, unanswered. These effects are “...then interpreted (or misinterpreted) as improvements” (Breggin, 2008, p. 1). When alcohol or illicit drugs are abused, the biochemistry of the individual’s entire brain is also affected, although it might only be observed in one domain of neurological function. Although the reader might question the relevance of this discussion to the addictions, it is important to remember that the substance use disorders (SUDs) have been classified as medical disorders. The pharmaceutical companies are searching for medications that can be used to treat the SUDs, and already existing medications are often being used “off label” to treat alcohol and illicit drug addiction. (Note: “Off label” is a term that refers to the application of a pharmaceutical to a disorder for which it has not been identified as an effective treatment by the FDA.)

1. Are treatments using the pharmaceutical agents described above an improvement over the damage drugs of abuse cause to the brain? Why or why not?

2 . Many patients neither want, nor will they accept, pharmacotherapy for their substance use disorders (Harris, Kivlahan, Bowe, & Humphreys, 2010). Imagine science discovers a compound that will eliminate the individual’s “craving” for alcohol or another drug of abuse with 100 percent certainty. Do we, as a society, have the right to force such treatments on a patient, even if they are effective? Who should be able to decide what medications an addict receives to help him or her escape from the addiction?

3.Are the SUDs medical disorders, behavioral disorders that affect the body (e.g., obesity), or a legal problem? Why? What implications does your answer have for how the disorder/problem is treated?

4.Do you believe that the SUDs should be treated with pharmaceutical agents? Why or why not?

Answer 1

1. Abusive drugs like alcohol or others are normally sought for an euphoria. Very quickly patients develop dependence on these substances as they have a high abuse potential. While used for a long term these substances may harm over all brain functions including but NOT limited to cognitive decline, more depression, low mood, irritability, lack of enthusiasm, criminal temdency etc.

Pharmaceutical agents are used for deaddiction under medical supervision.Although a few of them have abuse potential others have less of it.

While used under strict supervision and proper restriction they can indeed create a great rehab for an abuser.

So these agents should be used judiciously whenever feasible.

Q 2. In this hypothetical scenario, supposedly we have discovered a substance that can cease all cravings.

As a society we presume that we should force any such blanket ban on individuals.

However. Individuals who are going through serious adversities in life or livelihood and seeking change from inside may be prescribed such drugs.

Alternatively concerned family members or next to kins might have some say in such cases.

All cases should be weighed thoroughly and on individual basis.

3. SUDs whether they are behavioral problem or legal problem that depends on their spectrum.

At base..all the SUD s are somewhat behavioral problem as it causes dependence.

In some cases (alcohol/heroin etc) criminal orientation increases when Substance use is done beyond limit. Then they are also called legal .

Q4.

SUD s should be treated by pharmaceutical agents.

As pharma agents

A. Decreases dependence

B. May work towards root cause of abuse like anxiety grief depression

C.can decrease adverse effect on other systems (alcoholic hepatitis,cirrhosis, Infectve endocarditis in IVDU)

D. Can decrease long term damage to brain