Psychology Factsheets

www.curriculum-press.co.uk Number 219

Drug Treatments for Addiction

This Factsheet aims to give an overview of the use of agonist and One such treatment that is
antagonist drugs as a treatment for addiction, including the biological routinely used is drug treatment in
explanation for their function, evidence on their effectiveness and the the form of agonist and antagonist
potential downsides to their use. Words in bold are defined in the substitution. These drugs work at
glossary and the worksheet allows the opportunity to practise what the level of the synapse and alter
you have learned. the effect of neurotransmitters
in the brain. They are often used
The examiner expects you to be able to: to treat people who are addicted to Heroin is one of the most
•• Give an example of common agonist and antagonist drugs. particular substances, most often dangerous illegal drugs, and is
•• Describe the difference between agonist and antagonist drugs such as heroin. responsible for hundreds of deaths
substitution.
•• Explain the effects of these drugs on the brains of addicts. Exam Hint: While the medication described here is most
•• Evaluate the use of these drugs with regards to their often used to treat drug addiction, it can be used for other
effectiveness. addictions too. As you read on, try to think of other addictions
that these medications could be suitable for.
•• Discuss the downsides of their use, including side effects and
ethical issues.
B. Agonist substitution
Exam Hint: Make sure to check the specification of the exam A drug that is commonly used to treat addiction to opioids such as
board you are studying to know exactly what you are required heroin is methadone. In the brain of a person who is not addicted
to learn. Agonist and antagonist substitution is a required to opioids, naturally occurring chemicals called neurotransmitters are
component of the addiction topic for WJEC/Eduqas. AQA released into the small gap between the neurons (called a synapse)
requires an understanding of a drug treatment for addiction from the presynaptic neuron. These neurotransmitters fit into the
as part of the addiction topic. Edexcel requires knowledge
receptor molecules of the postsynaptic neuron. This causes an
of two treatments for addiction in the health psychology
electrical signal to be activated in the postsynaptic neuron, causing
topic, and methadone is mentioned as an example of a
contemporary issue in the biological psychology topic. further release of neurotransmitters to the next neuron and so on.
Opioids such as heroin cause an excess of a neurotransmitter called
dopamine to be released into the synapse. Over time, this causes
A. Introduction
the receptors to be less sensitive to dopamine, which then causes
Addiction is defined as the even more dopamine to be released. If the addict were to stop taking
compulsion to consume a heroin, they would suffer intense withdrawal effects caused by the
substance (e.g. alcohol or plummeting levels of dopamine. The heroin user therefore becomes
tobacco) or engage in an dependent upon the drug in order to avoid the withdrawal effects.
activity (e.g. gambling) to the
Methadone works by acting as a substitute for heroin. At the synapse,
point where it impedes on an
molecules of methadone fit into the receptor molecules of the
individual’s quality of life.
postsynaptic neuron.
Addiction can cause huge
problems, not just for the
individual who may struggle
to hold down employment
or relationships, but also for
society. Addiction costs the
economy millions in lost While it may seem strange to treat drug
productivity, as well as the addiction with drugs, this treatment can
health costs incurred by the be effective
NHS. Addictions such as
alcoholism for example can lead to liver failure, while smoking can
lead to lung cancer. Therefore, it is vitally important that addiction is
addressed, and potential treatments developed.

A diagram showing how agonist substitution works at the level of the synapse

1
 Psychology Factsheet
219. Drug Treatments for Addiction www.curriculum-press.co.uk

As methadone is an agonist drug it produces an enhanced response in Dopamine is key in the development of addiction. When opioid
the postsynaptic neuron, causing the neuron to activate. Methadone is drugs are taken, dopamine secretion is increased. It is this high level
therefore partially mimicking the effect of heroin. As it activates the of dopamine that gives the rush of pleasure associated with taking
dopamine receptors, it reduces the withdrawal symptoms, but it does drugs such as heroin. However, because naltrexone works to block
not give the euphoric high associated with heroin. dopamine receptors, were an individual who was taking naltrexone to
then take an opioid such as heroin, they would not receive their usual
Unlike heroin and many other opioids, methadone is given orally
high. The levels of dopamine would be increased, but as the receptor
rather than injected. This means that the blood concentrations of the
molecules are now blocked, it prevents the activation of the neuron.
drug will rise and fall slowly, rather than the erratic spike caused
when heroin is injected. This means that the addict’s behaviour will Naltrexone is only given to people who have stopped using drugs, and
be more stable, and thus further treatment (such as psychological who show a commitment to staying drug free. It can only be given
counselling) can take place. Giving the drug orally also reduces many to those who have overcome the effects of withdrawal. It is given
of the risks associated with the use of needles such as the transmission predominantly as an oral medication, although it can also be given
of infection. through an injection. Naltrexone can be given for up to six months.
Often, naltrexone is used alongside psychological counselling in
As methadone is still a potentially dangerous drug, its dosage is
order to reduce the risk of
carefully monitored. Addicts are usually started on 10mg a day, which
relapse.
is slowly increased by 10mg each day until they no longer show signs
of withdrawal symptoms. The maintenance dosage is usually between Because it blocks the
60mg-120mg a day. For the first three months, a doctor or a nurse dopamine receptors, therefore
administers methadone until they can be certain that the addict can preventing activation of
self-administer without supervision. neurons, naltrexone is starting
to be used for other addictions
However, methadone should not be seen as a cure for addiction; the
aside from opioids, such as
individual is still addicted to a substance, but now it is methadone
alcohol or even gambling, While methadone is always given orally,
rather than heroin. The aim of using methadone is that once the addict
both of which cause a release naltrexone can be given orally or as an
has been stabilised, they can gradually have their dosage lowered (a
of dopamine in the brain, and
process called detoxification) until they reach a point where they will
a pleasurable sensation.
no longer be dependent upon the drug.
Exam Hint: Methadone and naltrexone have different
Exam Hint: It is important to state that methadone is not a functions, and are used at different stages of an addict’s
cure for addiction. Methadone is a highly addictive substance recovery. If asked to choose a suitable treatment for an addict,
in its own right, and its use is closely supervised. Methadone methadone would be appropriate for someone who has just
is just one tool used to fight addiction, and should not be started treatment as it helps reduce withdrawal symptoms,
seen as the sole solution to a complex problem. whereas naltrexone would be used to prevent relapse once
the individual has overcome the initial withdrawal.

C. Antagonist substitution
While methadone acts as an agonist because it enhances neuron D. Effectiveness
activity, other drug treatments for addiction act as antagonists. 1. Methadone
Antagonists have the opposite effect, and reduce activity in neurons. As a treatment for opioid
One such drug is naltrexone. Naltrexone is also used in the treatment addiction, methadone has
of opioid addiction; however, it is used predominantly for addicts in been common in the UK for
recovery. Its primary function is to prevent relapse (as opposed to decades. Therefore, there is
methadone which aids in the reduction of withdrawal symptoms). a large body of evidence to
support its effectiveness.
Antagonist and agonist
drugs have some similarities •• The National Institute Methadone has been shown to be effective
in how they function. Both for Health and Care in the treatment of heroin addiction
work at the level of the Excellence (NICE)
synapse, and both fit into reviewed 31 studies and found much lower rates of opioid use in
the receptor molecules on participants who were given methadone w h e n c o m p a r e d to
the postsynaptic neuron. those given a placebo. This suggests that methadone is successful
However, antagonist drugs in the treatment of addiction.
work to block these receptors, •• Van den Brink (2006) conducted a meta-analysis and found
meaning that the naturally that, providing that the dosage was correct, methadone is an
occurring neurotransmitters effective treatment.
(in this case dopamine)
A diagram showing how antagonist •• Gowing et al (2001) found that methadone programmes are
cannot activate the receptor
substitution works at the level of the effective at reducing the social harms associated with drug
molecules. This results
synapse use; it allows addicts to separate themselves from the negative
in reduced activity in the
effects of “drug culture” and to achieve legal, social and
neurons.
financial security. This can be important in preventing relapse.

2
 Psychology Factsheet
219. Drug Treatments for Addiction www.curriculum-press.co.uk

2. Naltrexone •• Many studies only

Naltrexone is a much newer treatment, and so the evidence into its follow up participants
effectiveness is ongoing. for a year or so after
treatment. This is an
•• NICE reviewed 17 studies into the effectiveness of naltrexone
issue as some addicts
for heroin addiction, and found that the drug did not improve
may relapse after
retention rates for addicts on the treatment programme.
a longer period of
•• However, the same studies found that those individuals given time. Therefore, this
naltrexone were much less likely to relapse, particularly if may exaggerate the
they were highly motivated and supported. This suggests that overall effectiveness The results of studies into effectiveness
naltrexone may not be effective for everyone, but for those who of drug treatment for can be skewed by the people who leave
are motivated to stay abstinent from drug taking, naltrexone addiction. the study before the end (attrition rate)
may be effective.
•• Gowing (2001) also found that naltrexone is effective for
people who are motivated to quit, but of little use for those who Exam Hint: Make sure to read the exam question carefully.
There is no need to evaluate the methodological issues of
are less motivated.
research into the effectiveness of these drugs if the question
•• Unlike methadone, naltrexone may have applications beyond is only asking you to describe the research findings.
substance abuse. Recent evidence suggests that behavioural
addictions such as gambling could also be treated by naltrexone.
Because the drug is a dopamine antagonist it prevents the pleasurable E. Ethical issues and Social Implications
feeling caused by the release of dopamine. As behavioural addictions 1. Side Effects
also stimulate the release of dopamine, naltrexone could be used to •• Methadone can cause nausea, stomach pain, breathing problems,
reduce the reward response in the brain. heart palpitations, dizziness and hallucinations.
•• Lahti et al (2010) found a significant decrease in relapse rates of •• It is possible to overdose on methadone. In 2013 for example,
gamblers who had taken naltrexone. 429 deaths in the UK were attributed to methadone. Many of
3. Issues with research these deaths came from methadone being combined with other
The research into the effectiveness of both methadone and naltrexone drugs.
is hampered by a number of methodological issues. •• Naltrexone carries a risk of liver problems, so people taking this
•• Studies on people who drug will need regular monitoring of liver function.
are seeking treatment for •• There is a risk of overdose; if someone is taking naltrexone,
addiction may be skewed and then they take heroin, they may take a much larger dose
by a high attrition rate. than usual since their dopamine receptors are blocked. The
Not everyone who starts individual does not get the desired high, and so takes more
treatment will continue drugs, leading to a heroin overdose.
through to its conclusion,
and many people may 2. Ethical issues
drop out. This is an issue •• Both methadone and naltrexone could be argued to be treating
as it means that those the problem, rather than addressing the root cause of the
participants who continue addiction. Addiction is a complex phenomenon, and there are
to the end of a study may many factors than can contribute to the development of an
be different to those who addiction. Poverty, upbringing, trauma or mental illness could
drop out, in terms of their all be factors that
motivation, commitment, cause an addiction
or level of addiction. to develop. By
Unlike methadone, naltrexone can
using drugs such
• Therefore, studies may also be used to treat behavioural
as methadone or
be prone to sample bias addictions, such as gambling
meaning the final sample naltrexone as a way
is not representative of all addicts. Therefore, it may make the of dealing with the
treatment appear to be more effective than it really is. addiction, we may
be ignoring the true
•• Much of the research into both of these drugs take place in cause. This means
Western, industrialised nations. Addiction, and in particular that without further
drug addiction is common in many countries that differ support the addiction
greatly from Europe or the USA. Therefore, it is unclear how may return, or the
successful these treatments would be in cultures that do not individual replaces
have government funded health care, or little in the way of the addiction with
social services. another unhealthy Methadone comes with some unpleasant
behaviour instead. side effects

3
 Psychology Factsheet
219. Drug Treatments for Addiction www.curriculum-press.co.uk

•• It could also be argued that addicts who are forced into

treatment programmes are having their free will taken away. Exam Hint: While drug treatments such as methadone and
naltrexone are not without their social and ethical drawbacks,
Convicted criminals with substance abuse problems may be
they remain at this point in time one of the most effective
forced into treatment as part of a reduced prison sentence or
methods of addiction treatment. You should make this
as a requirement of their parole. Not only could this be argued evaluation point clear in the exam.
to be unethical, it may also result in poor outcomes for the
addicts, as the research suggests that being motivated to quit
their addiction is a strong predictor of treatment success.
Glossary
3. Social Issues Addiction: the compulsion to engage in a behaviour or consume a
Addiction, and in particular drug addiction has huge effects on society. particular substance.
There is a high cost to the NHS who has to treat drug users. In families Agonist: a drug that blocks the receptor molecule, and activates it in
where there is drug use, children may be at risk of harm, and may be place of the usual neurotransmitter.
removed from families by social services. Drug addicts are less likely
to be employed, and will be more likely to be in receipt of benefits. Alcoholism: addiction to alcohol.
If methadone and naltrexone can reduce the number of drug users, Antagonist: a drug that blocks the receptor molecules, preventing the
many of these economic neurotransmitters from binding to them.
and social problems would Attrition rate: the number of participants that drop out of a study.
be reduced.
Detoxification: the process of reducing the dosage of a drug slowly
However, drug treatment over time until it is no longer needed.
can be expensive, and this
cost needs to be offset by Dopamine: a neurotransmitter found in the brain. It has many
the potential benefits that functions and uses.
it brings. Doward (2011) Heroin: an opioid drug that gives users a feeling of euphoria.
argued that drug treatment High: the euphoric feeling produced by many drugs.
provides good value for Are prisoners who are forced into
money to the taxpayer, as Meta-analysis: when a researcher pools together all the findings
treatment programmes denied free will?
it reduces the burden on the from previous research in an area to look for trends.
https://pixabay.com/en/arms-arrest-crime-
NHS, as well as allowing criminal-2029247/ Methadone: an agonist substitution drug, used primarily to reduce
many more people to the withdrawal symptoms of heroin use.
function in society and contribute to the economy. Methadone has Naltrexone: an antagonist substitution drug, used to prevent relapse
also been shown as effective in reducing criminal behaviour (National in drug users.
Treatment Agency, 2009).
Neuron: cells that make up the brain, spinal cord and nervous system.
However, one potential danger with methadone is that it can sometimes
be sold on. Some people who are legally prescribed methadone may Neurotransmitter: a chemical in the brain that allows neurons to
illegally sell it on to other users. Taking into consideration that heroin communicate with each other.
use is more common in deprived areas, and that recovering drug Opioids: a family of drugs that primarily work as pain relivers.
addicts may struggle financially, the temptation to make money by Placebo: a fake drug given in clinical trials.
selling methadone may be overpowering.
Receptor molecule: a protein molecule that receives chemical
One issue with the use of messages in the form of neurotransmitters from outside of the cell.
drugs to treat addiction is
Presynaptic neuron: the cell before the synapse.
that we may be ignoring
the wider social problems Postsynaptic neuron: the cell after the synapse.
that are ultimately to blame Sample bias: when the sample of participants used in a study is not
for addiction. A 1998 generalisable to the target population.
report from the Advisory
Council for the Misuse Synapse: the gap between one neuron and another.
of Drugs highlighted that Withdrawal effects: unpleasant symptoms caused by stopping taking
drug addiction was strongly Deprivation and poverty are strongly
linked with deprivation, linked with addiction. Drug treatments do
unemployment and poverty. nothing to solve these issues.
It could be argued that
methadone and naltrexone are “papering over the cracks” of a much
larger societal issue. This means that while these drugs may be doing
Acknowledgements: This Psychology Factsheet was researched and written
a good job at helping people who become addicted to drugs, they are by Natalie Austin, edited by Jeanine Connor and published in January 2018
doing nothing to help prevent people initiating an addiction in the first by Curriculum Press. Psychology Factsheets may be copied free of charge by
place. Because drug treatments are so effective, it may be that there is teaching staff or students, provided that their school is a registered subscriber.
No part of these Factsheets may be reproduced, stored in a retrieval system,
less impetus to try to solve the problems in society that leads to drug or transmitted, in any other form or by any other means, without the prior
abuse in the first place. permission of the publisher. ISSN 1351-5136

4
 Psychology Factsheet
219. Drug Treatments for Addiction www.curriculum-press.co.uk

Worksheet: Drug Treatments for Addiction

Name:

1. Explain the difference between an agonist and an antagonist drug.

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

...........................................................................................................................................................................................................................
2. John has been a heroin addict for 5 years. He has just decided that he wants to quit. Should John be prescribed methadone or naltrexone?
Explain why, with reference to the function of the drug at the synapse.

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................
3. Wendy was previously addicted to opioids, but she has managed to abstain from drug use for six months. Should Wendy be prescribed
methadone or naltrexone? Explain why, with reference to the function of the drug at the synapse.

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

........................................................................................................................................................................................................................
4. “Research into the effectiveness of drug treatments for addiction is hampered by a high attrition rate”.
Explain what this statement means. Refer to specific research in your answer.

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

.....................................................................................................................................................................................................................
............................................................................................................................................................................................................................

5. Why could it be argued that treatments such as methadone are not addressing the root cause of addiction?

. ............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

............................................................................................................................................................................................................................

.............................................................................................................................................................................................................................

.............................................................................................................................................................................................................................

..................................................................................................................................................................................................................................