Treating addiction: substitution, antagonists, glutamate, vaccines — and the model's limits
Lays out the pharmacotherapies for substance use disorders — full and partial agonist substitution, antagonists, aversive drugs, glutamate-targeting drugs, vaccines — and the problems with relying only on the biomedical model.
Where this fitsConnects to 3 · Unlocks 2
- Connects to
- Agonists: full, partial, inverse and biased — Methadone (full) vs buprenorphine (partial) is full vs partial agonism in practice.
- Antagonists and allosteric modulators (PAMs and NAMs) — Naloxone, flumazenil and rimonabant are antagonists.
- Absorption and routes of administration — Substitution works partly by changing the route to a safer, slower one.
- Unlocks
- Randomized controlled trials: randomize, control, blind — Whether any of these treatments works is a clinical-trial question.
- The War on Drugs, decriminalization and legalization — How society treats drug use is a policy question too.
Orient
Pharmacotherapy of substance use disorders. Agonist substitution treatment – prescribing a substitute drug for the abused agent (full: methadone, nicotine patches; partial: buprenorphine, varenicline). Antagonists directly block the reinforcing effect. Newer approaches target glutamate (NAC, ceftriaxone) or use vaccines. And the medical (brain-disease) model has real problems.
Course terms
Your professor's wording, word for word from the slides. Learn the term and this definition — the explanation underneath is only there to help it make sense.
- Agonist substitution treatment
“Prescribing a substitute drug for the abused agent”Slides 06, p. 8
Heroin → methadone; nicotine → lozenges, gum, patches.
- Partial agonist substitution
“Same idea as full, but with less stimulation”Slides 06, p. 9
Buprenorphine (opioids), varenicline (nicotine).
- Antagonist treatment
“Antagonists directly block the reinforcing effect and eventually reduce the compulsive behavior”Slides 06, p. 9
Naloxone, flumazenil, rimonabant — but no positive reinforcement makes adherence difficult.
- xCT
“xCT (cystine-glutamate exchanger): protein pushes glutamate out of the glial cell in exchange for an amino acid, cysteine”Slides 06, p. 10
N-acetylcysteine (NAC) increases xCT; general anti-craving effects.
- GLT-1
“Reuptake transporter for glutamate = more efficient reuptake”Slides 06, p. 10
Ceftriaxone increases GLT-1.
- Drug vaccines
“Stimulates the production of drug-specific antibodies (to nicotine, opiates, cocaine, or amphetamine)”Slides 06, p. 10
Antibodies bind the drug in the blood so it can't cross the blood-brain barrier.
From your course: Course slides 06, pp. 24–31
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