Henry R. Kranzler – Clinical Manual of Addiction Psychopharmacology

Автор: Henry R. Kranzler
Название книги: Clinical Manual of Addiction Psychopharmacology
Формат: PDF
Жанр: Медицина
Страницы: 403
Качество: Изначально компьютерное, E-book

The past two decades have witnessed dramatic advances in neuroscience,
including a substantially improved understanding of the neural basis of addictive
disorders and their treatment. For example, developments in neurogenetics
and neuroimaging have provided new insights into the etiology and pathophysiology
of dependence on a variety of substances. Concomitant with this
increased knowledge base, there has been renewed interest in the pharmacological
treatment of substance use disorders. Initially driven in the United States
by support from the National Institutes of Health, more recently the pharmaceutical
industry has shown increased interest in developing new medications
to treat these disorders, particularly dependence on opioids, nicotine, and alcohol.
The high prevalence of these disorders and the limited pharmacological options
in their treatment (compared with, e.g., a saturated market in therapies for
other psychiatric disorders such as mood, anxiety, and psychotic disorders)
have increased awareness within the pharmaceutical industry of the enormous
market potential for such medications. Given the extensive resources at the
command of the pharmaceutical industry, such interest is likely to be a harbinger
of continued progress in the identification of candidate compounds and their
evaluation for use in the treatment of addictive disorders.
In addition to their commercial interest, however, these developments are
relevant to the care of patients with addictive disorders and of public health
significance. If past experience in the treatment of major depressive disorder
is an indicator, one important effect of the availability of efficacious treatments
for addictive disorders will be that these disorders will become less stigmatized
than they are currently. This will result in greater numbers of individuals with
such disorders seeking treatment and finding practitioners who are willing to
provide such treatment. As has been seen with the diagnosis and treatment of
depression, it is likely that the care of addictive disorders will progressively be
come the province of primary care practitioners rather than being largely restricted
to addiction specialists, as is currently the case. Identification and treatment
of nicotine dependence is already occurring commonly in primary care
settings, driven in part by the availability of a growing number of efficacious
medications to treat the disorder, combined with a growing awareness of the
serious health consequences of smoking.
As suggested above, however, developments in the pharmacotherapy of
addictive disorders have not occurred uniformly across substances. There are
multiple medications approved by the U.S. Food and Drug Administration
(FDA) to treat nicotine dependence, including a variety of nicotine formulations
for replacement therapy that are available for over-the-counter purchase.
There are also a growing number of FDA-approved treatments for opioid and
alcohol dependence. However, despite a number of promising developments,
there are no FDA-approved treatments for dependence on the other substances
discussed in this volume, and this underscores the need for additional research
aimed at the identification and testing of new agents for such indications. The
substantial insights into the pharmacology of the various abused substances,
which are discussed in detail in this volume, provide a basis for medications development,
as well as an improved understanding of the etiology and pathophysiology
of these disorders.