Poneza Model Of Drug Addiction

Drug addiction is a worldwide public health problem due to the financial burden and the impact that has within the family (Potenza, Sofuoglu, Carroll, & Rounsaville, 2011). Addiction translated from Latin means ¨bound to¨ or "enslaved by" that now is tantamount to compulsive substance abuse (Potenza et all., 2011). Nonetheless, people with gambling and eating disorders share some clinical and biological features with people with drug addiction, fact that suggested reconsidering the core characteristics of this pathology (Potenza et all., 2011). Several models have been proposed to understand addictions and most of these perspectives address the role of motivation, positive and negative reinforcement in the development and maintenance of substance

The aim of the first phase is abstinence, wherein it may be necessary pharmacological intervention to ameliorate withdrawal symptoms (Potenza et all., 2011). The second, focus on developing motivation, and gaining skills to fight against cravings (Potenza et all., 2011). The purpose of the third phase is to develop long-term strategies to engage new and healthy behavior patterns (Potenza et all., 2011). Thus, the scheme of treatment has two major branches: behavioral and pharmacological strategies (Potenza et all., 2011). There are three categories of behavioral interventions that have shown efficacy in the treatment of addictions (Potenza et all., 2011). The first one, brief motivational model, is based on the motivational brain circuitry to improve the decision-making process directed toward long-term goals (Potenza et all., 2011). Contingency management models focuses on the principles of behavioral pharmacology and operant conditioning, therapy that has had consistent results and also has been effective in improving treatment engagement (Potenza et all., 2011). The third approach includes cognitive behavioral therapies, which goal is to encourage the individual to realize which maladaptive behaviors and cognitions keep them in using substances, to acquire new skills and tactics to shift those patterns, and discontinue the use of drugs in a long-term fashion

In the classical approach the target of medications are positive reinforcement or the drug reward system; agonist medications are used to replace the drug of abuse to a much safer and long-acting drug (e.g., methadone for opioid addicts) (Potenza et all., 2011). Antagonist medications block the effects of the drug by two pathways: pharmacological (e.g., the use naltrexone to arrest the rewarding effects of opioids) and pharmacokinetic (e.g., antibodies); immunotherapies have limited clinical use especially in polydrug abusers (Potenza et all., 2011). There's also medications targeting negative reinforcement of drugs, which are used to attenuate the symptoms of withdraw and to delay relapses (e.g., bupropion in nicotine addiction) (Potenza et all., 2011). Vulnerability to addiction is an individual matter, and factors involved are comorbidities such as cognitive deficits (e.g., attention) and psychiatric conditions (e.g., schizophrenia) (Potenza et all., 2011). Some medications have been tested in clinical trials with promising results, like galantamine as a cognitive enhancer in abstinent cocaine users, improving working memory and attention (Potenza et all., 2011). Behavioral and pharmacological treatments complement each other; hence, they ought to be applied simultaneously to improve engagement in treatment and to prevent relapse (Potenza et all., 2011).