PHARMACOLOGIC TREATMENTS FOR DRUG AND ALCOHOL DEPENDENCE (original) (raw)
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Pharmacotherapy in the Treatment of Drug Dependence: Options to Strengthen Effectiveness
Advances in Psychiatric Treatment, 1999
Treatment of people with drug problems requires a consideration of those inviduals in their personal and social context, while being mindful of the complex interaction of genetic and developmental influences. Approaches to treatment should reflect this often complex aetiology and phenomenology, and the totality of treatment will typically include social, psychological, educational and pharmacological therapies. Treatment should result in a health benefit; consequently the goals of treatment should be tailored to the health care needs of the individual. Thus, with many patients, treatment will include abstinence as an explicit objective, whereas with other patients, intermediate goals, such as reduction of harmful injecting, may be more realistic and achievable.
Current concepts on drug abuse and dependence
Journal of Mind and Medical Sciences, 2015
Drug addiction is a complex disease characterized by compulsive and uncontrollable desire to seek and consume the drug. In time, drug-related terminology has undergone many changes, arising from the deepening of the mechanisms of action, but also about the need for a greater precision in the definition. Drug dependence can be assigned not only to pharmacological effects of the drugs of abuse, but also to their interaction with each particular neurological and psychological constitution. The research on the neurobiological mechanisms of addiction processes allows both a better understanding of current pharmacotherapy and the development of new treatment strategies in drug abuse and dependence. In this review we intend to present the current concepts related to drug abuse and dependence.
he following review of current pharmacological treatments for nicotine, alcohol, cocaine, and opioid dependence addresses pharmacotherapies aimed at two stages of treatment: (i) acute withdrawal or the initial attainment of abstinence and (ii) chronic maintenance or prevention of relapse. Maintenance pharmacotherapies act as either blocking or substitution agents to attenuate protracted withdrawal symptoms. Detoxification is required prior to administration of a blocking agent, in order to prevent withdrawal from an abused agent. For example, naltrexone, a competitive opioid antagonist, completely blocks the subjective euphoria and production of physiological dependence of heroin use. Substitution agents will not precipitate withdrawal when given to drug-dependent patients, and instead act to reduce withdrawal symptoms and the desire for more drugs. Substitution agents may also produce cross-tolerance to other drugs from the same pharmacological class. Methadone is one example of an agent that is effective in reducing illicit opioid use by producing crosstolerance to heroin. The need for these pharmacotherapies is highlighted by the sharp increase in the rate of even the relatively uncommon abuse of opiates; 12.4% of young adults abused prescription pain relievers in the past year. 1,2
Drug and Alcohol Dependence, 1997
The prevalence of last year use of alcohol, cigarettes, marijuana and cocaine in the U.S. population and conditional prevalence of a proxy measure of last year dependence among last year users of each drug class were assessed as a function of age, gender and ethnicity. Analyses were based on three aggregated waves (1991, 1992 and 1993) of the nationally representative samples of the general population aged 2 12 interviewed in the National Household Surveys on Drug Abuse (n = 87915). An approximation of DSM-IV drug-specific last year dependence for each drug class was derived from self-reported symptoms of dependence, data on frequency and quantity of use and drug-related problems reported for the last year. Descriptive and multivariate analyses were conducted. The inclusion of cigarettes among the drugs, the large number of cases and the wide age range of respondents ( 2 12) enable us to make drug, age, gender and ethnic comparisons not otherwise possible in any other data set. The proxy measure of dependence, however, has limitations. The five major findings are that: (1) nicotine is the most addictive of the four drugs we examined; (2) among female last year users of alcohol and marijuana, adolescents are significantly more at risk for dependence than any other age group of women; (3) conditional prevalences of last year dependence on alcohol, marijuana and cocaine are higher among adolescent females than adolescent males but significantly different only for cocaine; (4) among adults, the rates of dependence are higher among males than among females for alcohol and marijuana, but lower for nicotine; and (5) among last year users, whites are more likely than any other ethnic group to be dependent on nicotine and blacks to be dependent on cocaine.
Drug Dependence, a Chronic Medical Illness
JAMA, 2000
The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.