The Theoretical Basis of Narcotic Addiction Treatment with Narcotic Antagonists

The theoretical basis of narcotic addiction treatment with narcotic antagonists was well stated by Martin et al. (). Briefly, outpatient maintenance of a previously detoxified opioid addict on a daily oral opioid-blocking dose of a narcotic antagonist is expected to accomplish two objectives: (a) to remove the incentive for seeking and using opioid drugs; and (b), to extinguish conditioned abstinence (including “craving”) should this phenomenon occur as a response to environmental stimuli to which unconditioned abstinence had previously become conditioned (). Needless to add, such a period of out-patient maintenance on a narcotic antagonist should be used to “rehabilitate” the patient – i.e., to train him in the skills necessary for holding a socially useful job. to form new, mutually supportive relationships with non-drug using persons, and to persuade him to give up the illegal “hustling” activities which had become self-reinforcing during previous periods of opioid addiction. Such a period of out-patient maintenance on a narcotic antagonist would have advantages over detoxification followed by enforced abstention from opioids (by prison sentences with or without a subsequent probationary period) in Read more […]

A Point of View Concerning Treatment Approaches with Narcotic Antagonists

When narcotic antagonists were first introduced into the treatment of drug addiction, patients were placed on the medication without regard to selection criteria and assessments of “successes” or “failures” were made only on the basis of their retention in the program. Since that time, however, our evaluation criteria have become more refined and we have begun to look at more complex questions such as: Are these compounds “helpful” and if so, “for whom” and by what treatment techniques can we augment their usefulness? A salient aspect of our naltrexone studies, for example, is addressed to the question of “for whom?” Hopefully when our data analysis is completed, it will contribute to either affirming or negating the conceptual model that we have formulated to aid us in the differential diagnosis and treatment of opiate dependent individuals. For my presentation today I have chosen to share with you some aspects of our point of view concerning treatment approaches based on our clinical experience. As investigators, we are all committed to the rigors of science with its demand for carefully controlled data. However, I am not addressing myself to specific research data, but rather to some issues concerning the application Read more […]

Treatment of Alcohol Use Disorders

In general, treatment for substance dependence involves a combination of several psychosocial interventions, which can be combined with pharmacological interventions. Treatment of AUDs can be preceded by a detoxification, depending on severity of alcohol dependence. Personality and Substance Misuse and Pharmacotherapy of Addiction are discussed in depth in site. A short description and discussion of psychological and pharmacological interventions in AUDs are presented below. Detoxification: Symptoms, Medication The first stage of treatment for alcohol dependence often consists of alcohol detoxification, in order to prevent complications during detoxification, and to diminish symptoms and adverse effects associated with detoxification. Symptoms can develop within several hours after last alcohol use, and usually show a peak 24–36 h after abstinence. Symptoms that can be experienced during alcohol detoxification are anxiety, restlessness, sleeplessness, sweating, nausea, vomiting, tremors, heightened blood pressure, and an increased heart rate. Alcohol detoxification is estimated to take a week, although sleep disturbances and psychological withdrawal symptoms can persist much longer. Monitoring of alcohol-dependent Read more […]

Human Dependence on Tobacco and Opioids: Common Factors

Recent years have seen increasing acceptance of the notion that tobacco is an addictive or dependence-producing substance, particularly as it is used in cigarette smoking. This idea is supported by the observations that tobacco serves as a reinforcer (i.e., it maintains behavior leading to its use) and that most people who smoke cigarettes would like to quit but cannot, even in the face of well documented health risks and economic sacrifices (Surgeon General’s Report 1979). The term “drug dependence” suggests that (1) the drug serves as a reinforcer, (2) behavior occurs which is maintained by the opportunity to take the drug, and/or (3) other reinforcers are sacrificed as a consequence of taking the drug (). Many cigarette smokers in some degree satisfy these criteria for drug dependence (). Since cigarette smoking has only recently been conceptualized as an instance of drug dependence, it should be useful to systematically compare cigarette smoking with another more thoroughly studied dependence process such as opioid dependence or narcotic addiction. At first blush, cigarette smoke and opioid drugs appear to produce vastly differing pharmacological and behavioral effects: large doses of opioids can produce Read more […]

Studies of Acute Alcohol Effects in Women and Animal Models

Alcohol Effects on Basal Hormone Levels Another approach to examination of alcohol’s toxic effects on reproductive function is to administer a single acute dose of alcohol to a normal healthy woman or experimental animal and measure the effects on pituitary and ovarian steroid hormones. Through a systematic manipulation of alcohol dose and changes in hormone levels, it should be possible to establish whether alcohol primarily disrupts hypothalamic, pituitary, or ovarian function. Surprisingly, studies of acute alcohol administration have shown that alcohol has minimal effects on basal hormone levels. Alcohol did not significantly suppress LH or estradiol in normal women or in female macaque monkeys. These data suggest that a single episode of intoxication is probably not sufficient to suppress normal basal hormone levels and that repeated episodes of intoxication are required to produce the hormonal correlates of amenorrhea, anovulation, and luteal phase dysfunction observed in clinical studies. One procedural difficulty affecting all investigations of acute alcohol effects on basal hormone levels is that studies have usually been conducted during the early follicular or luteal phase of the menstrual cycle, when basal Read more […]

Psychotherapy and Naltrexone in Opioid Dependence

An issue of current importance to psychiatry is the efficacy of psychotherapy and phamacotherapy in comparison to one another and in combination. In addiction treatment, the importance of individual counseling for the successful use of opioid antagonists such as naltrexone has often been suggested but as yet there is insufficient data to support this contention. Furthermore, naltrexone efficacy studies have not controlled for the type or degree of patients’ involvement in interpersonal aspects of treatment. The present pilot study evaluated the effectiveness of naltrexone in conjunction with a high intervention treatment that included individual counseling as compared with a low intervention treatment that excluded such counseling. Method Sixty-six opioid-dependent volunteers were randomly assigned at intake to either a low intervention (N=31) or high intervention (N=35) treatment group. All subjects were over 18 years of age, had been addicted to opiates for at least one year, were free of serious medical and psychiatric illness and signed an informed consent. An attempt was made to match the two groups for level of opioid dependence immediately prior to entering the study and number of subjects who entered the study Read more […]

Measurement and Extinction of Conditioned Withdrawal-Like Responses in Opiate-Dependent Patients

As O’Brien has reviewed elsewhere in this volume (), there has been much experimental work on opiates and Pavlovian conditioning processes since Wikler’s original observations of withdrawal-like responses in drug-free patients (). Several studies have found evidence of conditioned withdrawal-like and opiate-like responses in rats, monkeys, and humans (). Addict patients viewing slides or videotapes of drug-related stimuli () or handling drug objects in a preparation ritual () experience subjective craving and withdrawal-like changes in physiological measures of skin temperature, heart rate, pupillary dilation, etc. Research from our own laboratory has demonstrated that opiate withdrawallike responses in humans can be conditioned to an arbitrary conditioned stimulus (). These studies leave little doubt that conditioned withdrawal-like phenomena exist and can be both reliably elicited and measured. They do not, however, address the clinical significance of these responses. Though Wikler (1948) proposed conditioned withdrawal as the primary cause of relapse in drug-free patients, this link has not been clinically tested and is still controversial. Based on interviews with Baltimore street addicts, McAuliffe () had recently Read more […]

Buprenorphine, Heroin, and Methadone: Comparison of Relative’ Reinforcing Properties

Buprenorphine is a partial agonist of the morphine type. It is both a long-acting opiate antagonist, like naltrexone, and a potent opiate agonist with respect to analgesia, physiological and subjective reactions in man (). However, buprenorphine does not induce physical dependence in several species and appears to produce only minimal physical dependence in man (). Buprenorphine’s positive morphine-like agonist effects combined with its antagonist potency, low toxicity, and minimal capacity for producing physical dependence, suggested that it should be valuable for the treatment of opiate addiction (). Clinical studies have shown that buprenorphine maintenance (8 mg/ day s.c.) significantly suppressed self-administration of heroin (21 to 40.5 mg/day) by male heroin addicts over 10 days of heroin availability in comparison to buprenorphine placebo (). Buprenorphine (0.282 to 0.789 mg/kg/day i.v.) also significantly suppressed opiate self-administration in the rhesus monkey drug self-administration model (). Recent clinical studies have shown that sublingual administration of buprenorphine (1-2 mg) should be suitable for daily maintenance for the treatment of narcotic addiction (). The opiate agonist effects of Read more […]

Benzodiazepines: Drug Discrimination and Physiological Dependence

The benzodiazepines are among the most widely used of all prescribed drugs. Concern about abuse of these drugs has prompted the development of preclinical methods for assessing various pharmacological effects of diazepam-like drugs which are relevant to their abuse and dependence liability. This abstract describes results from a series of ongoing experiments to assess discriminative stimulus effects and physiological dependence-producing properties of benzodiazepines. Drug discrimination: In drug discrimination procedures, animals are trained to respond differentially depending on the nature of drug pretreatment. The procedure can provide information analogous to a human testing situation in which subjects categorize drugs with respect to their subjective effects. In ongoing drug discrimination experiments, four baboons were trained to discriminate lorazepam (1.0 mg/kg) and two baboons were trained to discriminate pentobarbital (5.6 mg/kg) in a two-lever drug versus no-drug discrimination procedure. Food delivery depended on 20 consecutive responses on one lever in sessions preceded by an intramuscular injection of the training drug (60-min pretreatment time), and on 20 consecutive responses on the other lever Read more […]

Treatment of Behavioral and Psychiatric Problems Associated With Opiate Dependence

Diverse problems and challenges confront the staff members of programs/clinics intended to treat individuals with histories of opiate use and associated problems. The clinic sponsored and staffed by the Philadelphia Veterans Administration Medical Center and University of Pennsylvania provides numerous examples of the merits and problems of such treatment programs. The clinic’s patient population over the past decade has varied from two to four hundred patients. A range of services is provided along with pharmacological interventions including opiate-specific treatments such as methadone, LAAM, naltrexone, and a variety of psychotherapeutic agents administered in treatment of diverse presenting disorders. It should be noted that the clinic differs in some respects from “standard” clinics insofar as it includes numerous associated ongoing basic and applied research projects. There may therefore be more options and staff available from time to time but there may also be considerable variability uncharacteristic of other clinics. In any case the clinic appears to have many of the problems reported to prevail in other nonresearch clinics. It can therefore be used as a reference in the sorts of issues which do arise. Patients Read more […]