Biological Model Treatment and Techniques
Genetic theory has not produced techniques that are applicable to treatment. However, if tests such as the skin flush test were developed which not only predicted alcoholism risk but also risk for other substance use disorders, those genetic tests might provide useful information about genetic risk factors. The question, is how can we use this “at risk” information? Promising advances in genetic engineering have been able to change the devastating impact of particular genetically transmitted disorders; based on our current understanding of
Biological Models of Addiction 103 the genetics of substance use disorders, however, it’s probable that these disorders are not caused by one “alcogene” but rather a combination of several genes which makes genetic engineering more complex and outcomes are less assured. I (AAC) was fortunate to have met Dr. Kenneth Blum at a conference presentation. I asked him, if genetic engineering continues to make advances, would we one day see a time where alcoholism could be eliminated by genetic engineering surgery? He explained that there were two problems to consider. The first is whether this type of genetic engineering might be considered an attempt to create a “Master Race” (which was the goal of Adolf Hitler.) The second problem with genetic engineering is that, by tinkering with particular genes, we may be reducing the likelihood of someone developing a substance use disorder but we’re not sure what other changes might take place. For example, the Pulitzer Prize winning author Ernest Hemingway was known to be a heavy, frequent drinker, probably an alcoholic. So, if Hemingway were to be subjected to genetic engineering, we might reduce his risk of developing alcoholism but would we also be taking away his incredible writing abilities?
Learning Opportunity 5.5 — Risk Factors
Imagine that you have a younger brother or sister or a close friend who recently had a baby who is determined to be at genetic risk for developing problems with drugs and alcohol when they grow up. What would you recommend to help reduce the possibility that your sibling or friend’s baby will develop an SLID when they grow up?
Fortunately, there are several treatments that have evolved out of the research on neurotransmitters. Most of this research has focused on drugs that help with detoxification and help clients manage cravings. For example, given the recent opioid epidemic, medication-assisted treatments (MAT) using drugs such as buprenorphine (Suboxone® and Subutex®) and dolophine (Methadone) can be used both to detoxify people dependent on prescription opioids and heroin, and as a type of maintenance alternative to using opioids with high overdose potential. There are certainly controversies regarding Suboxone and Methadone (such as a potential to abuse these medications), however, when taken properly and when combined with counseling, these medications allow people to function on a daily basis.
Several medications have been developed which help reduce craving and, in some instances, help act as agonists. Agonists work by occupying the particular receptor sites that produce the mood-altering effect or buzz from taking drugs. Therefore, if someone takes a drug of abuse then the agonist blocks the moodaltering effect of that drug. Naltrexone is an example of an agonist drug that is thought to help reduce opioid and alcohol craving. If someone injects heroin or ingests a prescription opioid such as Percoset while taking Naltrexone, that person will not experience the "high” of taking the opioid drug.
