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The Thirteenth StepAddiction in the Age of Brain Science$
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Markus Heilig

Print publication date: 2015

Print ISBN-13: 9780231172363

Published to Columbia Scholarship Online: November 2015

DOI: 10.7312/columbia/9780231172363.001.0001

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Pills for Addiction Ills

Pills for Addiction Ills

(p.206) 17 Pills for Addiction Ills
The Thirteenth Step

Markus Heilig

Columbia University Press

This chapter first considers medications to treat heroin addiction. These include methadone, buprenorphine, and naltrexone. All three bind tightly to opioid receptors but without activating them at all. Because the receptors are now occupied by an inactive molecule, patients can inject as much heroin as they wish but will not experience a high no matter what. The chapter then turns to medications for the treatment of alcoholism. Disulfiram, discovered in the 1920s, continues to be marketed under the trade name Antabuse. Disulfiram works by blocking a step along the sequence through which alcohol is broken down and eliminated from the body. As a result of this blockade, the toxic substance acetaldehyde accumulates in the bloodstream. What that means is that if alcohol is consumed while a patient is on disulfiram, the accumulation of acetaldehyde results in facial flushing, as well as an extremely unpleasant and potentially dangerous reaction that includes a pounding heart and elevated blood pressure. This is intended to deter alcohol use, but does not reduce cravings for alcohol. Naltrexone was approved for alcoholism treatment in 1994 under the name Revia. It works by blocking the reward from alcohol, thus preventing a relapse to heavy drinking.

Keywords:   addictive disorders, medication, addiction, methadone, buprenorphine, naltrexone, opioid receptors

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