How to treat alcohol and drug addiction?

According to world health organisation (WHO) a drug is defined as any substance that, when taken into the living organism may modify one or more of its functions. When any drug or alcohol takes on a much higher priority in an individual and alters the person's physiological, behavioural and cognitive pattern then it is referred to as addiction. Common substances that are classified as psychoactive substances are alcohol, opioids, cannabinoids, cocaine, amphetamines, hallucinogens, sedatives, hypnotics, inhalants, nicotine, and other stimulants (e.g. caffine).

Alcohol treatment:

Alcohol treatment can be broadly divided into two types and they are often interlinked with each other. The basics of alcohol treatment is detoxification and alcohol treatment dependence.

Detoxification is the first major step in alcohol treatment. Treatment of alcohol withdrawal symptoms is called as detoxification. The best way to do detoxification in alcohol treatment is to stop alcohol suddenly. The drug of choice in alcohol treatment of detoxification is benzodiazepines. Chlordiazepoxide and diazepam are the most frequently used benzodiazepines. The drugs used are decreased steadily everyday before being stopped. Vitamins (thiamin and nicotinic acid) should be supplemented during this course of alcohol treatment. Hydration is the next important aspect that should be taken care.

Alcohol treatment for dependence can be achieved by several methods like
1. Alcohol treatment for dependence by behavior therapy: The most commonly used behavior therapy is aversion therapy and it can be used in combination with other methods like relaxation techniques, assertiveness training, self control skills and positive reinforcements.

2. Alcohol treatment for dependence by psychotherapy: The person is educated about the risks of continuing alcohol use and the importance of resuming personal responsibilities. This can be achieved by supportive and individual psychotherapy.

3. Alcohol treatment for dependence by group therapy: Group therapies are usually done by voluntary self help groups and the approach is partly religious in nature. Many are benefited through this because they are non- professional in nature.

4. Alcohol treatment for dependence by deterrent agents: The deterrent agents are called alcohol sensitizing drugs. Disulfiram is the commonly used effective drug. It produces unpleasant reaction when taken with alcohol. The disulfiram-ethanol reaction is life threatening and is characterized by flushing, tachycardia, hypotension, tachypnea, palpitation, headache, sweating, shock, convulsions, myocardial infarction, confusion and coma.

5. Alcohol treatment for dependence by other medications: Some of the other drugs used for alcohol treatment are benzodiazepines, antidepressents, antipsychotics, lithium, carbamazepine, and narcotics. These drugs are used only if there is special indication.

Drug treatment:

1. Opioid addiction: Morphine and heroin are the common drugs that causes drug dependence. Other opioids are codeine, thebaine, papaverine, nalorphine, hydromorphone, methadone, pethidine, and levallorphan. They are mainly administered intravenously for potency but they can be smoked or chased.

Drug treatment of opioid disorders: Drug treatment starts with proper diagnosis made by history, physical examination (pin point pupils), and laboratory tests. Detoxification of opioids is done abruptly and is followed by management of withdrawal symptoms. Drugs used to manage withdrawal symptoms are methadone, clonidine, naltrexone with clonidine, and other agents like levo-alpha-acetyl-methadol, buprenorphine, and lofexidine.

After detoxification phase the drug treatment for opioid addiction is continued by maintenance therapy using methadone and opioid antagonists. Individual psychotherapy, behaviour therapy, family therapy, group therapy, and psychotropic drugs are also included depending upon the persons needs. As relapse rates are high psychosocial rehabilitation is highly advised in both occupational and social levels.

2. Cannabis addiction: Cannabis produces very mild physical dependence and withdrawal syndrome. All active ingredients are called as marijuana or marihuana.

Drug treatment of cannabis disorder: As the withdrawal symptom is very mild, the management is usually supportive and symptomatic treatment. Psychotherapy and family therapy are important if there is psychic dependence.

3. Cocaine addiction: Cocaine can be administered orally, intranasally, or parentrally. They are sometimes used in combination with heroin or amphetamines.

Drug treatment of cocaine disorder: Drug treatment is seperate for cocaine overdose and cocaine chronic use. In cocaine overdose, the treatment consists of oxygenation, muscle relaxants, and IV thiopentone. In cocaine chronic use, bromocriptine and amantadine is used to reduce cocaine cravings.

4. Amphetamine addiction: Amphetamines are used medically for certain conditions to heighten energy and produce more capacity to work but continuous use leads to addiction.

Drug treatment of amphetamine disorder: Amphetamines intoxication is treated symptomatically with antipyretics, diazepam, halloperidol and antihypertensives. Acidification of urine with oral NH4CL 500mg facilitates the elimination of amphetamines. Antidepressants and supportive psychotherapy are helpful in treating amphetamine dependence.

5. LSD addiction: Lysergic acid diethhylamide is a powerful hallucinogen. Although tolerance and psychological dependence occurs with LSD use, no physical dependence or withdrawal syndrome is reported.

Drug treatment of LSD disorder: The drug treatment consists of symptomatic management with anti-anxiety, antidepressants along with supportive psychotherapy.

6. Barbiturate addiction: Barbiturates are sedative, hypnotic and anxiolytic agents that causes marked physical and psychological dependence.

Drug treatment of barbiturate disorder: Pentobarbital substitution therapy is suggested for the treatment of withdrawal syndrome. Supportive treatment should be followed after detoxification phase.

7. Benzodiazepines and other sedative-hypnotic addiction: Benzodiazepines and sedative-hypnotic are prescription drugs that are used to treat many conditions.

Drug treatment of Benzodiazepines or sedative-hypnotic disorders: The treatment is usually symptomatic. Flumazenil is a benzodiazepine receptor antagonist that is commonly used in detoxificaion followed by supportive treatment.

8. Inhalants addiction: Petrol, glues, aerosols, thinners, varnish removers are commonly used as inhalants.

Drug treatment of inhalant disorders: There is no specific treatment for this disorder and is usually associated with schizophrenia.

Though the above mentioned treatments are available for drug and alcohol addiction, the key factor is the addict's whole-hearted desire to recover from the addiction and will power to resist any cravings to drug and alcohol.