PS452 Unit 9 Addiction Medications Paper Example

Three Patients, Four Prescriptions and One Question About Pills: A PS452 Unit 9 Treatment Medications Paper

[Student Name]

Purdue University Global

PS452: Psychopharmacology of Alcohol and Drugs

Unit 9 Treatment Medications Paper

[Instructor Name]

[Date]

The writer, the unit, the patients and every detail are composite and illustrative; the sources cited are real.

Three Discharges

In one week in March, our Albuquerque withdrawal unit discharged Gilbert, fifty-eight, after alcohol withdrawal; Dominic, thirty-three, after fentanyl withdrawal; and Skyler, twenty-four, after a month of heavy drinking. Each left with a different medication plan. Gilbert asked me, while I took his last vital signs, "Why would I take a pill to stop drinking? Isn't that just trading one thing for another?"

His question confuses two different uses of medication on our unit, and it misunderstands what treatment medications do.

Medication for Withdrawal Versus Medication for the Disorder

During withdrawal, medications manage a temporary, dangerous state. Gilbert received a benzodiazepine for five days because alcohol withdrawal can cause seizures and delirium; the drug enhanced GABA-A function while his brain readjusted, and it was tapered off before discharge. Mayo-Smith (1997) reviewed the evidence for this approach and supported benzodiazepines, dosed according to symptoms, as the treatment of choice.

Treatment of the disorder is different. Withdrawal ends in days, but the risk of relapse continues for months or years. Medications for alcohol and opioid use disorders aim to reduce that risk over the long term.

Medications for Alcohol Use Disorder

Kranzler and Soyka (2018) reviewed the diagnosis and medication treatment of alcohol use disorder. Several medications are approved, and others are used off label.

Naltrexone blocks opioid receptors. Alcohol's rewarding effects depend partly on the release of the brain's own opioids, so blocking those receptors reduces the pleasure of drinking and, for many people, the craving. The review found evidence that naltrexone reduces heavy drinking. Because it blocks opioid receptors, it cannot be given to someone taking opioids.

Acamprosate is thought to help restore the balance between glutamate and GABA that long-term drinking disrupts, reducing the discomfort and craving of early abstinence. The review found evidence that it helps people who have stopped drinking maintain abstinence. It is cleared by the kidneys, so doses are adjusted for kidney function.

Disulfiram works differently. It blocks aldehyde dehydrogenase, the enzyme that clears acetaldehyde, so drinking while taking it causes flushing, nausea, vomiting and a racing heart. It deters drinking through the expectation of that reaction. The review noted that it works best when someone supervises the daily dose, since people who want to drink can simply stop taking it.

Kranzler and Soyka also pointed out how seldom these medications are prescribed, given the evidence behind them.

Gilbert's pill would not replace alcohol; it would make the first drink less rewarding.

Gilbert's physician prescribed naltrexone, after confirming his liver tests were acceptable for it, and explained that it does not produce a high and is not addictive. Skyler's physician chose acamprosate, because he had stopped drinking and his main complaint was restlessness and craving.

Medication for Opioid Use Disorder

Dominic left on buprenorphine. Its value lies partly in protection. Larochelle et al. (2018) followed Massachusetts adults who survived an opioid overdose and found that those receiving methadone or buprenorphine afterward had substantially lower death rates, from overdose and from all causes, during the months they were on treatment. Extended-release naltrexone was not associated with a significant reduction, though relatively few people received it.

Buprenorphine, as a partial agonist, occupies mu receptors steadily, reducing withdrawal and craving, and its ceiling effect on breathing makes it safer than full agonists. Its tight binding also dulls the effect of any other opioid used while it is in place.

Matching the Medication to the Person

The choice among these medications depends on each patient's body, goals and circumstances, and the three discharges showed how. Gilbert wanted to cut down at first rather than promise lifelong abstinence, and naltrexone is supported for reducing heavy drinking even when someone is not yet abstinent; his liver tests, though elevated, were within the range his physician considered acceptable, with a recheck planned. Skyler had already stopped and wanted help staying stopped, and his kidneys were healthy, which suited acamprosate, a drug that is taken three times a day and does not interact with opioids. Neither man was a good candidate for disulfiram, which works best for highly motivated people with someone to supervise each dose, and which can cause a dangerous reaction if they drink. Dominic needed something entirely different: a medication that occupied his opioid receptors to quiet craving and protect him from the next counterfeit pill. Had any of the three been taking opioids for pain, naltrexone would have been ruled out, because it would block their pain relief and could bring on withdrawal.

Why Patients Hesitate

Gilbert's question reflects a common belief that recovery means getting off all drugs. Some recovery groups have held that view, and patients often fear judgment from family or peers for taking a medication. On our unit, I have found that explaining what a medication does at the receptor, in plain words, helps more than telling a patient to trust the doctor. A medication that blocks reward or eases withdrawal is not producing a high, and patients who understand that are more willing to try it.

Answering Gilbert

I told Gilbert that I could not advise him on medication, but that I could share what I had learned: that naltrexone does not create a high or a dependence, that it works by making alcohol less rewarding, and that research supports it. I suggested he ask the physician, who spent ten minutes with him before discharge. He said he would give it three months and return for a liver recheck in four weeks.

What Medications Cannot Do

Medications reduce craving, reward or risk; they do not resolve the reasons people drink or use, rebuild relationships or find jobs. All three patients left with referrals to counseling, and Dominic's included a group for people starting buprenorphine, where he could hear how others handled cravings and the opinions of relatives. Medication and counseling work on different parts of the same problem.

Conclusion

On our unit, benzodiazepines manage alcohol withdrawal, as Mayo-Smith's review supports, while naltrexone, acamprosate and disulfiram treat alcohol use disorder over the longer term through distinct mechanisms Kranzler and Soyka describe. Buprenorphine's protection against overdose death, shown by Larochelle and colleagues, makes it central for opioid use disorder. Gilbert's question about trading one drug for another had a pharmacological answer.

References

Kranzler, H. R., & Soyka, M. (2018). Diagnosis and pharmacotherapy of alcohol use disorder: A review. JAMA, 320(8), 815-824. https://doi.org/10.1001/jama.2018.11406

Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018). Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Annals of Internal Medicine, 169(3), 137-145. https://doi.org/10.7326/M17-3107

Mayo-Smith, M. F. (1997). Pharmacological management of alcohol withdrawal: A meta-analysis and evidence-based practice guideline. JAMA, 278(2), 144-151. https://doi.org/10.1001/jama.1997.03550020076042