Recent Advances in Treatment
Recent Advances in Treatment
Psychiatric Times February 2005
Mental disorders and substance use disorders (SUDs) represent a major public health problem, and when these disorders are left untreated, they have devastating consequences for affected individuals, their families and society. While not widely known, a number of important advances have been made in the past decade toward understanding and treating SUDs and SUD-related disorders. For example, one of the more recent innovations in treating specific SUDs has been the addition of pharmacotherapy to improve treatment response, beyond what patients obtain from psychotherapy or counseling. The benefit of pharmacotherapy has now been well documented in the treatment of nicotine, alcohol, opiate and, just recently, cocaine dependence disorders.
Historically, addictive behaviors were considered a "deficiency in self-control" or the "result of ineffective thinking" (Steigerwald and Stone, 1999). While such perspectives are not widely held today, they have generated a number of useful and important remedial interventions that focused on spirituality, motivation and cognitive skill learning. The 12-step philosophy, typified by Alcoholics Anonymous, remains the most prevalent approach for changing alcoholic behaviors in the United States (Owen et al., 2003). Nonetheless, relapse rates in some settings remain high, and further investigation of alternative or adjunctive treatment options, such as pharmacotherapy, is of paramount importance.
In the past decade, the scientific community has come to better understand the neurobiological actions of excessive alcohol and drug use in the brain and the potential neurochemical disruptions associated with chronic, uncontrollable and excessive drug use. The scientific comprehension that an SUD is a chronic, biological disease (McLellan et al., 2000) has led to a conceptual mapping of drug-related constructs like craving, reward and high onto neurological substrates. This, in turn, has driven the investigation of the usefulness of pharmacological agents to reduce these constructs (Anton, 1999; Pickering and Liljequist, 2003; Swift, 1999; Volpicelli et al., 1995). In addition, we have learned that the etiology and course of SUDs are influenced by genetic heritability, biology, personal choice and environmental factors. Currently, further areas in the study of addictive behaviors have been identified that may be directly or indirectly related to substance dependence. These areas of study are summarized in this issue of Psychiatric Times.
Kyle M. Kampman, M.D., begins this Special Report with both data and optimism in identifying investigative pharmacotherapies for treating cocaine dependence. For the first time in over two decades of clinical trial research, there are several published controlled trials of various types of medications that have proven to be an advantage over counseling. Interestingly, the action of these medications varies widely. Among the brief list of proven medications is disulfiram (Antabuse), which is approved by the U. S. Food and Drug Administration for treating alcohol dependence. The author also describes an exciting and novel direction in treating cocaine dependence: a vaccine under development that is capable of stimulating the production of cocaine-specific antibodies that prevent the typical high or reinforcement from cocaine use.
Judith A. Richman, Ph.D., and Kathleen M. Rospenda, Ph.D., bring further into focus hidden alcohol or drug use as a coping response to the trauma experienced as a victim of sexual harassment. In this article, the authors describe the consequential substance abuse and dependency that can result from being a victim of sexual harassment.