All you need to know about: treating addiction Premium

Discover the roots of addiction medicine, modern treatments, and pharmacotherapy from senior interventional neuropsychiatrist Alok Kulkarni.

The roots of addiction medicine began in the ancient civilisations of Africa and Europe. Special methods to care for persons addicted to alcohol were developed in ancient Egypt. There are references to individuals considering chronic intoxication as a sickness that enslaved the body and soul dating back to the fifth century BC.

Native American healers used botanical agents (hop tea) to suppress cravings for alcohol, and the root of the trumpet vine to induce aversion to alcohol. In 1774, Anthony Benezet published the book ‘Mighty Destroyer Displayed’, where he observed that intoxication had a tendency to self-accelerate: “Drops beget drams, and drams beget more drams, till they become to be without weight or measure.”

We have come a long way since. Modern treatments encompass a bio-psycho-social approach that integrates neuropharmacology, psychotherapy, and social interventions. Addiction is multidimensional and disrupts many aspects of an individual’s life. A similarly multimodal approach is needed to treat it.

Pharmacotherapy helps the individual remain abstinent and thus functional in the family, at work, and in society. Among people who are unable to quit a drug after repeated treatment failures, the treatment goal changes to reducing the frequency of substance use and the severity of relapse. Combined treatments with pharmacotherapy and psychotherapy can lead to better treatment retention and outcomes.

Intoxication results from being under the acute influence of a drug. It typically produces pleasurable feelings, altered emotional responsiveness, altered perception, and impaired judgement. Intoxication states can range from euphoria or sedation to life-threatening emergencies when overdose occurs. The initial challenge to the clinician is diagnosis, as intoxication can mimic other psychiatric conditions. 

The assessment involves a thorough patient history, physical and mental state examination, and laboratory screening. The first priority is general supportive care and resuscitative action to ward potential life-threatening complications off. The assessment also involves ascertaining the severity of the substance ingestion, a patient’s level of consciousness, substances involved, and co-occurring disorders.

Standardised questionnaires are available for use by the clinician and the patient. However, acute intoxication may impede an individual’s ability to provide information, so that can also be obtained from the patient’s family. Toxicology screens provide information regarding the types of substances used. Urine is the most widely used specimen because of the ease of obtaining a sample, the relatively high concentrations of drugs and metabolites present in urine, and the stability of the metabolites when frozen.