Principles of Drug Addiction Treatment: A Research-Based Guide
Principles of Drug Addiction Treatment: A Research-Based Guide
Principles of Drug Addiction Treatment: A Research-Based Guide
)
Bupropion was originally marketed as an antidepressant
(Wellbutrin). It produces mild stimulant effects by
blocking the reuptake of certain neurotransmitters,
especially norepinephrine and dopamine. A serendipitous
observation among depressed patients was that the
medication was also effective in suppressing tobacco
craving, helping them quit smoking without also gaining
weight. Although bupropions exact mechanisms of action
in facilitating smoking cessation are unclear, it has FDA
approval as a smoking cessation treatment.
Varenicline (Chantix
)
Varenicline is the most recently FDA-approved medication
for smoking cessation. It acts on a subset of nicotinic
receptors in the brain thought to be involved in the
rewarding effects of nicotine. Varenicline acts as a partial
agonist/antagonist at these receptorsthis means that it
miloly stimulates the nicotine receptor but not sulnciently
to trigger the release of dopamine, which is important
for the rewarding effects of nicotine. As an antagonist,
varenicline also blocks the ability of nicotine to activate
dopamine, interfering with the reinforcing effects of
smoking, thereby reducing cravings and supporting
abstinence from smoking.
Combined With Behavioral Treatment
Each of the above pharmacotherapies is recommended
for use in combination with behavioral interventions,
including group and individual therapies, as well as
telephone quitlines. Behavioral approaches complement
most tobacco addiction treatment programs. They can
amplify the effects of medications by teaching people
how to manage stress, recognize and avoid high-risk
situations for smoking relapse, and develop alternative
coping strategies (e.g., cigarette refusal skills, assertiveness,
and time management skills) that they can practice in
47 46
is generally poor. However, among patients who are
highly motivateo, oisulnram can be ellective, ano some
patients use it episodically for high-risk situations, such as
social occasions where alcohol is present. It can also be
administered in a monitored fashion, such as in a clinic or
by a spouse, improving its elncacy.
Topiramate
Topiramate is thought to work by increasing inhibitory
(GABA) neurotransmission and reducing stimulatory
(glutamate) neurotransmission, although its precise
mechanism of action is not known. Although topiramate
has not yet received FDA approval for treating alcohol
addiction, it is sometimes used off-label for this purpose.
Topiramate has been shown in stuoies to signincantly
improve multiple drinking outcomes, compared with a
placebo.
Combined With Behavioral Treatment
While a number of behavioral treatments have been
shown to be effective in the treatment of alcohol
addiction, it does not appear that an additive effect exists
between behavioral treatments and pharmacotherapy.
Studies have shown that just getting help is one of the
most important factors in treating alcohol addiction; the
precise type of treatment received is not as important.
Further Reading:
Anton, R.F.; OMalley, S.S.; Ciraulo, D.A.; Cisler, R.A.;
Couper, D.; Donovan, D.M.; Gastfriend, D.R.; Hosking,
J.D.; Johnson, B.A.; LoCastro, J.S.; Longabaugh, R.;
Mason, B.J.; Mattson, M.E.; Miller, W.R.; Pettinati, H.M.;
Randall, C.L.; Swift, R.; Weiss, R.D.; Williams, L.D.;
and Zweben, A., for the COMBINE Study Research
Group. Combined pharmacotherapies and behavioral
interventions for alcohol dependence: The COMBINE
study: A randomized controlled trial. The Journal of the
American Medical Association 295(17):20032017, 2006.
Smith, S.S; McCarthy, D.E.; Japuntich S.J.; Christiansen,
B.; Piper, M.E.; Jorenby, D.E.; Fraser, D.L.; Fiore, M.C.;
Baker, T.B.; and Jackson, T.C. Comparative effectiveness
of 5 smoking cessation pharmacotherapies in primary
care clinics. Archives of Internal Medicine 169:21482155,
2009.
Stitzer, M. Combined behavioral and pharmacological
treatments for smoking cessation. Nicotine & Tobacco
Research 1:S181S187, 1999.
Alcohol Addiction
Naltrexone
Naltrexone blocks opioid receptors that are involved in
the rewarding effects of drinking and the craving for
alcohol. It has been shown to reduce relapse to problem
drinking in some patients. An extended release version,
Vivitroladministered once a month by injectionis
also FDA-approved for treating alcoholism, and may offer
benents regaroing compliance.
Acamprosate
Acamprosate (Campral