Clinical Manual Of Addiction Psychopharmacology

404 Pages·2005·3.38 MB·English

by  Henry R. Kranzler

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Clinical Manual of
Addiction
Psychopharmacology
This page intentionally left blank
Clinical Manual of
Addiction
Psychopharmacology
Edited by
Henry R. Kranzler, M.D.
Domenic A. Ciraulo, M.D.
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical standards,
and that information concerning drug dosages, schedules, and routes of administration
is accurate at the time of publication and consistent with standards set by the U.S.
Food and Drug Administration and the general medical community. As medical
research and practice continue to advance, however, therapeutic standards may change.
Moreover, specific situations may require a specific therapeutic response not included
in this book. For these reasons and because human and mechanical errors sometimes
occur, we recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views and
opinions of the individual authors and do not necessarily represent the policies and
opinions of APPI or the American Psychiatric Association.
Copyright © 2005 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
09 08 07 06 05 5 4 3 2 1
First Edition
Typeset in Adobe’s AGaramond and Formata.
American Psychiatric Publishing, Inc.
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Clinical manual of addiction psychopharmacology / edited by Henry R. Kranzler,
Domenic A. Ciraulo.—1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-132-3 (pbk. ; alk. paper)
1. Substance abuse—Chemotherapy—Handbooks, manuals, etc.
2. Psychopharmacology—Handbooks, manuals, etc.
[DNLM: Substance-Related Disorders—drug therapy. WM 270 C6413 2005]
I. Kranzler, Henry R., 1950– II. Ciraulo, Domenic A.
RC564.15.C56 2005
616.89′18—dc22
2005008196
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
1
Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Henry R. Kranzler, M.D., and Domenic A. Ciraulo, M.D.
Epidemiology of Drinking, Heavy Drinking, and
Alcohol Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Pharmacology of Ethanol and Its Relationship to
Medications Development. . . . . . . . . . . . . . . . . . . . . . . .5
Pharmacokinetics of Alcohol. . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Pharmacodynamics of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Pharmacotherapy of Heavy Drinking and
Alcohol Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . .16
Treatment of Alcohol Withdrawal. . . . . . . . . . . . . . . . . . . . . . . .17
Medications to Reduce or Stop Drinking Behavior . . . . . . . . . .19
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
2
Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Steven Epstein, M.D., John A. Renner Jr., M.D.,
Domenic A. Ciraulo, M.D., Clifford M. Knapp, Ph.D.,
and Jerome H. Jaffe, M.D.
A Brief History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Prevalence and Natural History. . . . . . . . . . . . . . . . . . . .56
Prevalence and Patterns of Opioid Use and
Dependence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Factors Influencing Course and Treatment Outcomes . . . . . . .59
Medical Complications and Life Expectancy . . . . . . . . . . . . . . .60
Pharmacology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Opioid Receptors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Mechanisms of Tolerance and Dependence. . . . . . . . . . . . . . .64
Etiology of Opioid Dependence . . . . . . . . . . . . . . . . . . .66
Clinical Aspects of Tolerance and Withdrawal. . . . . . . .68
Tolerance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Withdrawal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Treatment Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . .71
Opioid Detoxification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Agonist Replacement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Opioid Substitution Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Detoxification From Maintenance Treatment. . . . . . . . . . . . . . .83
Opioid Antagonists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Therapeutic Communities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Outpatient Drug-Free Treatment and Psychotherapy . . . . . . . .86
Opioid-Associated Problems. . . . . . . . . . . . . . . . . . . . . .87
Pregnancy and Opioids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
3
Sedative-Hypnotics . . . . . . . . . . . . . . . . . . . . . .111
Domenic A. Ciraulo, M.D., Jon A. Ciraulo, B.A.,
Brian F. Sands, M.D., Clifford M. Knapp, Ph.D.,
and Ofra Sarid-Segal, M.D.
Benzodiazepines and Selective GABA Agonists. . . .113
A1
Prevalence of Misuse, Abuse, and Dependence. . . . . . . . . . 113
Prevalence in Special Populations . . . . . . . . . . . . . . . . . . . . . 117
Overview of Neuropharmacology. . . . . . . . . . . . . . . . . . . . . . 120
Pharmacokinetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Etiologic Theories of Misuse, Abuse, and Dependence . . . . 126
Clinical Signs and Symptoms of Intoxication and
Abstinence Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Medical and Psychological Consequences of Abuse. . . . . . . 130
Protocols for Detoxification. . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Role of Psychosocial Therapy. . . . . . . . . . . . . . . . . . . . . . . . . 136
Predictors of Long-Term Discontinuation. . . . . . . . . . . . . . . . 136
Summary of Benzodiazepine Dependence Issues . . . . . . . . 137
Barbiturates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Prevalence of Dependence. . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Pharmacokinetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Clinical Uses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Tolerance and Withdrawal. . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Detoxification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Glutethimide Dependence. . . . . . . . . . . . . . . . . . . . . . .146
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
4
Cannabis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Michael Lynskey, Ph.D., and Scott E. Lukas, Ph.D.
Prevalence of Cannabis Dependence. . . . . . . . . . . . . .165
Cannabis Dependence and Withdrawal. . . . . . . . . . . .166
Research With Human Subjects. . . . . . . . . . . . . . . . . . . . . . . 166
Animal Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Treatments for Cannabis Dependence. . . . . . . . . . . . .171
Behavioral Treatments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Pharmacological Aids in Cannabis Cessation. . . . . . . . . . . . . 171
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176
5
Cocaine and Psychostimulants. . . . . . . . . . . . .183
Thomas R. Kosten, M.D., and Domenic A. Ciraulo, M.D.
Chemistry and Pharmacology . . . . . . . . . . . . . . . . . . . .186
Neurochemical Actions Mediating
Stimulant Reward. . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
Neurobiological Effects of Chronic Stimulant Abuse. .188
Behavioral Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
Treatment Guidelines for Stimulant Abuse . . . . . . . . .192
Specific Pharmacological Treatments for
Stimulant Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
Pharmacotherapy for Primary Stimulant Dependence . . . . . 194
Pharmacotherapy and Psychiatric Comorbidity . . . . . . . . . . . 199
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
6
Hallucinogens and Phencyclidine . . . . . . . . . .211
Ulrich Tacke, M.D., M.Sc., and Michael H. Ebert, M.D.
Tryptamine-Related Hallucinogens
(Indolealkylamines). . . . . . . . . . . . . . . . . . . . . . . . . . .212
History and Prevalence of Abuse . . . . . . . . . . . . . . . . . . . . . . 213
Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Acute and Chronic Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Phenylalkylamine Hallucinogens. . . . . . . . . . . . . . . . . .224
History and Prevalence of Abuse of Mescaline (Peyote) . . . 224
Pharmacology of Mescaline . . . . . . . . . . . . . . . . . . . . . . . . . . 225
History, Prevalence of Abuse, and Pharmacology of
Hallucinogenic Phenylalkylamine Derivatives . . . . . . . . . . . 226
Phencyclidine and Ketamine. . . . . . . . . . . . . . . . . . . . .231
History and Prevalence of Abuse . . . . . . . . . . . . . . . . . . . . . . 231
Pharmacology of PCP and Ketamine . . . . . . . . . . . . . . . . . . . 232
Treatment of Intoxication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Anticholinergic Plants and Synthetic Agents . . . . . . . .234
Clinical Findings in Anticholinergic Intoxication . . . . . . . . . . . 235
Treatment of Anticholinergic Intoxication. . . . . . . . . . . . . . . . 236
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237
7
Club Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
Richard N. Rosenthal, M.D., and Ramon Solhkhah, M.D.
GHB and Related Compounds . . . . . . . . . . . . . . . . . . .244
Epidemiology and Clinical Presentation. . . . . . . . . . . . . . . . . 244
Basic and Clinical Pharmacology. . . . . . . . . . . . . . . . . . . . . . . 246
Toxicology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
MDMA (Ecstasy) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
Epidemiology and Clinical Presentation. . . . . . . . . . . . . . . . . 255
Basic and Clinical Pharmacology. . . . . . . . . . . . . . . . . . . . . . . 256
Toxicology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Ketamine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258
Epidemiology and Clinical Presentation. . . . . . . . . . . . . . . . . 258
Basic and Clinical Pharmacology. . . . . . . . . . . . . . . . . . . . . . . 258