Substance use disorders are
common, but only a small minority of patients receive adequate treatment.
Although psychosocial therapies are effective, relapse is common. This review
focuses on novel pharmacological and other treatments for patients with
alcohol, opioid, or cocaine use disorders who do not respond to conventional
treatments.
Disulfiram, acamprosate, and the opioid antagonist naltrexone have
been approved for the treatment of alcoholism. A novel, "as needed"
approach is the use of the mu-opioid antagonist and partial kappa agonist
nalmefene to reduce alcohol consumption. Other novel pharmacological approaches
include the GABA-B receptor agonist baclofen, anticonvulsants such as
topiramate and gabapentin, the partial nicotine receptor agonist varenicline,
and other drugs.
For opioid dependence, opioid agonist therapy with methadone
or buprenorphine is the first-line treatment option. Other options include oral
or depot naltrexone, morphine sulfate, depot or implant formulations, and
heroin (diacetylmorphine) in treatment-refractory patients.
To date, no
pharmacological treatment has been approved for cocaine addiction; however, 3
potential pharmacological treatments are being studied, disulfiram,
methylphenidate, and modafinil. Pharmacogenetic approaches may help to optimize
treatment response in otherwise treatment-refractory patients and to identify
which patients are more likely to respond to treatment, and neuromodulation
techniques such as repeated transcranial magnetic stimulation and deep brain
stimulation also may play a role in the treatment of substance use disorders.
Although no magic bullet is in sight for treatment-refractory patients, some
novel medications and brain stimulation techniques have the potential to enrich
treatment options at least for some patients.
Purchase full article at: http://goo.gl/VKaheg
By: Soyka M1, Mutschler J2.
- 1Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336 Munich, Germany; Privatklinik Meiringen, Postfach 612, CH - 3860 Meiringen, Switzerland. Electronic address: michael.soyka@privatklinik-meiringen.ch.
- 2Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Selnaustrasse 9, 8001 Zurich, Switzerland.
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