Abnormal Psychology

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422 CHAPTER 9


problems, although the withdrawal symptoms may be unpleasant. John Lennon
was not medically supervised when he stopped using heroin, and he described his
disturbing withdrawal experience in his song “Cold Turkey”: “Thirty-six hours/
Rolling in pain/Praying to someone/Free me again.” Because substance abuse and
dependence cause permanent brain changes (which are evident even years after
withdrawal symptoms have ceased; Hyman, 2005), O’Brien (2005) proposed that
treatment for substance use and dependence should not end with detox, but rather
should be a long-term venture, similar to long-term treatment for chronic diseases
such as diabetes and hypertension.

Medications
Medications that treat substance abuse or dependence operate in any of several
ways: (1) They interfere with the pleasant effects of drug use; (2) they reduce the un-
pleasant effects of withdrawal; or (3) they help maintain abstinence. Because of the
high relapse rate among those who are dependent on a substance, however, medi-
cations should be supplemented with other relapse prevention strategies (O’Brien,
2005), described in the sections on treatments targeting psychological and social
factors. We now turn to consider medications for specifi c types of drug abuse and
dependence.

Stimulants
Of all drugs, stimulants have the most direct effects on the dopamine reward
system. Unfortunately, medications that modify the action of the dopamine re-
ceptors per se (in the dopamine reward system) have not yet been developed.
However, some medications do affect the functioning of dopamine. For example,
a medication that helps people stop smoking
is bupropion (marketed as Zyban), which
acts by affecting the functioning of several
neurotransmitters—including dopamine.
Bupropion can help to decrease cravings,
both for nicotine and for methamphetamines
(Killen et al., 2006; Newton et al., 2006).
Alternatively, smoking can be treated by de-
livering nicotine through a form other than
cigarettes, such as via skin patches, chewing
gum, nasal inhalers, or sprays. These types
of treatments are commonly referred to as nicotine replacement therapy because
they replace a more harmful method of nicotine intake (smoking) with a less
harmful method. After a period of time, the user tapers off nicotine by using
less of the replacement form.

Depressants
Medication for dependence on depressants (such as alcohol) minimizes withdrawal
symptoms by substituting a less harmful drug in the same category for the more
harmful one. For example, longer-acting benzodiazepines, such as Valium, may be
substituted for alcohol or other depressants.
Disulfi ram (Antabuse), a medication for treating alcohol abuse and depen-
dence, relies on a different approach. Antabuse causes violent nausea and vomit-
ing when it is mixed with alcohol. When an alcoholic takes Antabuse and then
drinks alcohol, the resulting nausea and vomiting should condition the person to
have negative associations with drinking alcohol. When Antabuse is taken con-
sistently, it leads people with alcohol dependence to drink less frequently, even
though it does not make them more likely to become totally abstinent (Fuller et
al., 1986; Sereny et al., 1986). Antabuse may also be effective in treating cocaine
dependence (Baker, Jallow, & McCance-Katz, 2007; Carroll et al., 2004). How-
ever, many patients choose to stop taking Antabuse instead of giving up drinking
alcohol (Suh et al., 2006).

Nicotine replacement therapy—via skin patches,
gum, nasal sprays, and inhalers—provides the
user with nicotine in a less harmful manner than
smoking cigarettes.

Scott Barbour/Getty Images


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Antabuse
A medication for treating alcohol abuse and
dependence that induces violent nausea and
vomiting when it is mixed with alcohol.
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