Treatment of Nicotine Dependence

There are an increasing number of options available for the treatment of nicotine dependence. As noted above, nicotine dependence is a chronic, relapsing disorder, and treatment should be approached from this perspective. The U. S. Public Health Service’s Clinical Practice Guideline on Treating Tobacco Use and Dependence is a comprehensive review of smoking cessation research, with recommendations based on numerous meta-analyses. It is the best resource for evaluating currently available treatments, and therefore it is the basis for most of the conclusions that we present here. Pharmacotherapies To date, there are seven FDA-approved medications that reliably increase long-term abstinence rates. These includefive nicotine replacement therapies (NRT) (gum, transdermal patch, inhaler, nasal spray, and lozenge), and two non- nicotine medications (bupropion SR, and varenicline). NRTs are designed to wean smokers gradually off nicotine in a manner that reduces the severity of withdrawal symptoms and cravings to smoke. They are typically used during the first 8–12 weeks of tobacco abstinence. Although the products vary in their routes of nicotine delivery (with the patch providing the most consistent delivery and stable Read more […]

Drug-Drug Interactions of Metamfetamine

Amfebutamone (bupropion) When bupropion and metamfetamine were co-administered to 26 subjects, 20 of whom completed the protocol, there was no evidence of additive cardiovascular effects. The subjects received metamfetamine 0, 15, and 30 mg intravenously before and after randomization to bupropion 150 mg bd in a modified-release formulation or matched placebo. There was a non-significant trend for bupropion to reduce metamfetamine-associated increases in blood pressure and a significant reduction in the metamfetamine-associated increase in heart rate. Bupropion reduced the plasma clearance of metamfetamine and the appearance of amfetamine in the plasma. Metamfetamine did not alter the peak and trough concentrations of bupropion or its metabolites. These findings are relevant to the potential use of bupropion in ameliorating acute abstinence in metamfetamine users. However, the risk of seizures during bupropion treatment for metamfetamine abuse has not been estimated. Morphine There have been two new reports of the fatal combination of metamfetamine with morphine. • A 43-year-old man was found dead in bed after injecting metamfetamine and morphine the night before. An autopsy showed mild edema of the brain and Read more […]

Cocaine-Related Disorders

DSM-IV-TR describes both cocaine use disorders (cocaine dependence and cocaine abuse) and cocaine-induced disorders (cocaine intoxication, cocaine withdrawal, cocaine intoxication delirium, cocaine-induced sexual dysfunction, cocaine-induced psychotic, mood, anxiety, and sleep disorders). Epidemiological Characteristics An estimated 193,034 U.S. emergency department visits solely for cocaine use were documented in the 2001 Drug Abuse Warning Network (Office of Applied Studies 2003), and cocaine is the most frequently reported drug in emergency department visits. Frequent reasons for psychiatric consultation in the medical setting are cocaine overdose, positive results of a urine toxicological screen, cocaine-induced depression, cocaine-induced cardiac problems, and cocaine-induced psychosis. According to the 1998 National Household Survey on Drug Abuse, 1.8 million individuals in the United States had used cocaine during a 1-month period. Use of crack cocaine is especially high in poor urban areas, but its use is widespread among other populations, such as rural migrant workers. Many cocaine users are polysubstance abusers. Pharmacological Characteristics Cocaine hydrochloride is a white crystalline powder derived Read more […]

Nicotine-Related Disorders

Nicotine-Related Disorders Tobacco addiction is the most preventable health problem in the United States. In 1993, approximately 60 million Americans smoked tobacco, and 400,000 deaths and $50 billion in direct medical-care expenditures were attributable to tobacco (Medical-Care Expenditures Attributable to Cigarette Smoking 1994). In the United States, approximately 30% of men and 26% of women smoke cigarettes. The percentage of young adults smoking cigarettes significantly increased between 1994 (35%) and 1998 (42%) (Office of Applied Studies 1999). Since 1965, the prevalence of cigarette smoking among adults in the United States has declined almost half. Cigarette smoking prevalence declined in the late 1970s, leveled off in the 1980s, and increased in the 1990s. Similar trends have occurred in other Western countries, but the prevalence of smoking has been increasing in Asia. Nicotine is a psychoactive substance with euphoric and positive reinforcement properties, similar to those of cocaine and opiates. The individual develops tolerance to nicotine and experiences significant withdrawal symptoms, including craving for tobacco, irritability, anxiety, difficulty concentrating, restlessness, decreased heart rate, Read more […]

Drug Testing

Many organizations require individuals to undergo drug testing if they wish to be considered for a job and sometimes if they wish to stay on the job. In addition, individuals on probation for crimes often must undergo random drug tests and a failure — a positive drug test — is a violation of their probation and must be adjudicated in a court to determine if the individual should be given more probation or serve the jail or prison sentence that was foregone in lieu of probation. Parolees — individuals newly released from prison — often must also undergo random drug tests and a failure is grounds for return to prison. The Department of Health and Human Services recommends testing for five substances, including amphetamine, marijuana, cocaine, opiates, and phencyclidine (PCP, angel dust). Amphetamines can be tested for up to 48 hours after the drug was ingested. According to pharmacologist Karen E. Moeller and colleagues, many drugs can give a false reading for amphetamines, such as the antidepressants bupropion (Wellbutrin), desipramine (Norpramin), or fluoxetine (Prozac), as well as pseudoephedrine (an ingredient in many cough and cold remedies), the blood pressure medication labetalol (Normodyne), the Parkinsons Read more […]

Meth Treatment

Compared to other chronic illnesses, addictions are highly treatable. O’Brien and McLellan (1996) in a review of treatment research found that for alcoholism treatment success rates averaged about 50 percent (range 40-70 percent, opiate dependence 60 percent (range 50-80 percent), cocaine dependence 55 percent (range 50-60 percent), and nicotine dependence 30 percent (range 20-40 percent). One of the major myths is that treatment does not work when it comes to meth addiction. This myth has been fuelled partially by the media and the absence of systematic research on meth treatment modalities. Little systematic research has been conducted on the efficacy of treatment for or prevention of meth addiction, but this is beginning to change. The Matrix model for treating stimulant abuse is the most frequently cited systematic research. The literature has also supported cognitive-behavioral approaches in treating meth and other addictions. This is not to suggest that general data on meth treatment is not available. In congressional testimony, the Executive Director of NASADAD shared data from three states that supported services for meth addiction: • In Colorado, 80 percent of methamphetamine users were abstinent at Read more […]

Implications For Treatment

Compared to other drugs, meth does have a different effect on users. This fact has led some to conclude that treatment for meth addiction must be unique. However, a considerable amount of evidence suggests that many of the treatment approaches for cocaine addiction are equally appropriate for meth dependency. Many of these approaches will be of benefit to most meth-dependent clients, but any treatment approach will need to be modified to the special needs of meth addicts. Without question, meth has significant cognitive impacts on the meth-dependent user. A number of researchers have found evidence that the brains of chronic meth users look similar to patients with Parkinson’s disease. Individuals addicted to meth may experience high levels of paranoia, anxiety, lack of focus, and attention span difficulties. Asking for help is difficult for any addiction, and meth is no exception. In addition, meth addiction is similar to any other in that the addict initially finds it difficult to admit he or she is an addict. Prolonged use of meth causes physical damage to the brain, which alters its ability to function. In short, the brain will need time to heal. Researchers across the country are trying to better understand Read more […]