Prevention and Treatment of Addiction

Other examples come from research on behavioral therapies drawn from the theoretical framework of the psychological sciences. Techniques and modalities such as contingency management and motivational enhancement, alone and in combination with medications, have been shown to be highly efficacious in treating addiction.¹³ Research has also revealed brief interventions to be as effective as lengthy weekly individual or group therapies. All of these techniques are easily learned and are extremely cost-effective.¹⁴

Another innovative strategy in which NIDA is investing is immunotherapy, or the use of vaccines, to treat methamphetamine, cocaine, and nicotine(Drug information on nicotine) dependence; the latter already is in commercial development.¹⁵ Addiction immunotherapy causes the body to generate antibodies that bind to specific drugs while they are still in the bloodstream, blocking their entry into the brain. Immunotherapies such as vaccines and monoclonal antibodies are showing promise in early development in blocking priming—helping patients remain abstinent and avoid relapse—and in treating overdoses for cocaine, methamphetamine, and phencyclidine (PCP).¹⁶

Genetic studies are another area of great potential, unimaginable just a few years ago; addiction research is now routinely integrating the use of modern imaging with genetics tools to help tease the complex contributions of environmental and genetic risk factors through the life stages of childhood, adolescence, and young adulthood—periods of greatest vulnerability to drug experimentation and addiction. Many candidate genes are being zeroed in on, including the dopamine(Drug information on dopamine) and opiate family of receptors, catechol-O-methyltransferase, and brain-derived neurotrophic factor.¹⁷ Pharmacogenetic studies, although in their infancy, are yielding promising candidate genes—for example, enhanced nicotine metabolism and the cytochrome P-450 2A6 polymorphism; and the DRD₂ variant and response to nicotine replacement therapies versus bupropion in smoking cessation.¹⁸ The A118G variant of the µ-opioid receptor may be a predictor of response to naltrexone(Drug information on naltrexone) in patients who are alcohol(Drug information on alcohol)-dependent.

As with any medical illness, the ultimate goal with addiction is prevention. Research has already revealed different risk and protective factors that could lead to or shield persons from addiction. Targeted prevention programs, including school-based and family interventions, are highly promising and are already having an epidemiological effect on the use of methamphetamine and marijuana.^19,20

Where are we going?
If the past predicts the future, we will continue to see different trends in substance abuse emerge over the next decade. Marijuana potency is predicted to increase with the increased availability of sinsemilla cannabis, and world market trends are already on the rise.²¹ Prescription drug abuse is predicted to escalate to epidemic proportions and may exceed marijuana abuse as the number one problem that we will face in the next decade.

In response to the prescription drug abuse epidemic, we will need to focus research on finding out more about those who are abusing prescription drugs, their reasons, and their sources. To minimize diversion of legal drugs for illegal use, we will also need to focus on developing formulations of pain medications that have diminished abuse liability. Pharmaceutical companies are already responding to guidance from the FDA, the Drug Enforcement Administration, and the Office of National Drug Control Policy with products such as combined buprenorphine(Drug information on buprenorphine)/naloxone; combined oxycodone(Drug information on oxycodone)/ultra-low-dose naltrexone; and lisdexamfetamine, all of which have mechanisms that mitigate their abuse.²²