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PHARMACOLOGIC TREATMENTS FOR DRUG AND ALCOHOL DEPENDENCE

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  • Additional Information
    • Note:
      Address reprint requests to Henry R. Kranzler, MD, University of Connecticut Health Center, 263 Farmington Avenue, MC2103, Farmington, CT 06030
      This work was support by grants AA03510, AA07290, and AA00239 from the National Institute on Alcohol Abuse and Alcoholism.
    • Abstract:
      Although psychosocial methods remain the most widely used approach for the treatment of patients with substance-use disorders, pharmacotherapy has come to play an increasing role in such treatment. Individual and group counseling and 12-step programs are basic elements of most rehabilitation programs for alcohol and drug dependence. Although medications are commonly used to treat withdrawal from alcohol, sedatives, opioids, or nicotine, their role in the rehabilitation of patients dependent on these substances remains limited. Notable exceptions to this include opioid-agonist maintenance and medications used to treat comorbid psychiatric disorders in patients with a substance-use disorder. This article focuses on medications that serve to augment psychosocial therapies in the rehabilitative treatment of patients with opioid, nicotine, alcohol, and cocaine dependence. Opioid agonist maintenance treatment has long been used to improve outcomes in opioid addicts. The long-acting agonist l-α-acetylmethadol (LAAM) was recently approved by the US Food and Drug Administration (FDA) for maintenance therapy for patients with opioid dependence, and approval of the partial opioid agonist buprenorphine for this indication is expected soon. These agents have unique advantages that complement methadone for the maintenance treatment of opioid addicts. Similarly, nicotine replacement, long shown to be efficacious in enhancing smoking cessation rates, is now widely available in a variety of formulations, including the gum and the patch, both of which are approved for over-the-counter sale. The recent approval of a nicotine nasal spray provides a route of administration that may most closely mimic the effects of smoking with respect to rapid rate of nicotine delivery to the brain. Furthermore, the recent approval of bupropion for the treatment of patients with nicotine dependence provides a non-nicotine medication for this indication. With respect to the treatment of patients with alcohol dependence, naltrexone, the only medication other than disulfiram approved for the treatment of patients with alcohol dependence, has not yet had a widespread impact on clinical care. Acamprosate, an agent that is in use in several European countries, is currently being evaluated for the treatment of patients with alcohol dependence in the United States. Unfortunately, in contrast to the treatment of patients with opioid, nicotine, and alcohol dependence, and despite considerable effort, no agent has demonstrated efficacy for the treatment of patients with cocaine dependence. In the sections that follow, an effort has been made to focus on clinically relevant aspects of a variety of medications with demonstrated efficacy in the treatment of patients with substance-use disorders. The majority of the references in this article are review articles. In this regard, the authors draw most heavily on material that is presented in greater detail in reviews of opioid dependence, 3,32,34,35,39 nicotine dependence, 1,6,14 alcohol dependence, 22,26 and cocaine dependence. 28,30 The authors refer the reader to these works for a more detailed presentation of these topics and for primary references to the studies that are summarized more generally here.
    • ISSN:
      0193-953X
    • Accession Number:
      10.1016/S0193-953X(05)70084-8
    • Accession Number:
      S0193953X05700848
    • Copyright:
      Copyright @ 1999 W. B. Saunders Company Published by Elsevier Inc. All rights reserved.
  • Citations
    • ABNT:
      KRANZLER, H. R. et al. Pharmacologic Treatments for Drug and Alcohol Dependence. Psychiatric Clinics of North America, [s. l.], v. 22, n. 2, p. 401–423, 1999. DOI 10.1016/S0193-953X(05)70084-8. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S0193953X05700848. Acesso em: 24 out. 2020.
    • AMA:
      Kranzler HR, Amin H, Modesto-Lowe V, Oncken C. Pharmacologic Treatments for Drug and Alcohol Dependence. Psychiatric Clinics of North America. 1999;22(2):401-423. doi:10.1016/S0193-953X(05)70084-8
    • APA:
      Kranzler, H. R., Amin, H., Modesto-Lowe, V., & Oncken, C. (1999). Pharmacologic Treatments for Drug and Alcohol Dependence. Psychiatric Clinics of North America, 22(2), 401–423. https://doi.org/10.1016/S0193-953X(05)70084-8
    • Chicago/Turabian: Author-Date:
      Kranzler, Henry R., Hetal Amin, Vania Modesto-Lowe, and Cheryl Oncken. 1999. “Pharmacologic Treatments for Drug and Alcohol Dependence.” Psychiatric Clinics of North America 22 (2): 401–23. doi:10.1016/S0193-953X(05)70084-8.
    • Harvard:
      Kranzler, H. R. et al. (1999) ‘Pharmacologic Treatments for Drug and Alcohol Dependence’, Psychiatric Clinics of North America, 22(2), pp. 401–423. doi: 10.1016/S0193-953X(05)70084-8.
    • Harvard: Australian:
      Kranzler, HR, Amin, H, Modesto-Lowe, V & Oncken, C 1999, ‘Pharmacologic Treatments for Drug and Alcohol Dependence’, Psychiatric Clinics of North America, vol. 22, no. 2, pp. 401–423, viewed 24 October 2020, .
    • MLA:
      Kranzler, Henry R., et al. “Pharmacologic Treatments for Drug and Alcohol Dependence.” Psychiatric Clinics of North America, vol. 22, no. 2, Jan. 1999, pp. 401–423. EBSCOhost, doi:10.1016/S0193-953X(05)70084-8.
    • Chicago/Turabian: Humanities:
      Kranzler, Henry R., Hetal Amin, Vania Modesto-Lowe, and Cheryl Oncken. “Pharmacologic Treatments for Drug and Alcohol Dependence.” Psychiatric Clinics of North America 22, no. 2 (January 1, 1999): 401–23. doi:10.1016/S0193-953X(05)70084-8.
    • Vancouver/ICMJE:
      Kranzler HR, Amin H, Modesto-Lowe V, Oncken C. Pharmacologic Treatments for Drug and Alcohol Dependence. Psychiatric Clinics of North America [Internet]. 1999 Jan 1 [cited 2020 Oct 24];22(2):401–23. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S0193953X05700848