Table Of ContentPharmacological
Therapies
for
Drug &
Alcohol
Addictions
edited by
Norman S. Miller
University of Illinois at Chicago
Chicago, Illinois
Mark S. Gold
University of Florida Collegeo f Medicine
Gainesville, Florida
Marcel Dekker, Inc. New York. Basel Hong Kong
Library of Congress Cataloging-in-PublicationD ata
Pharmacological therapies for drug & alcohol addictions l edited by N o m S . Miller,
Mark S. Gold.
p. cm.
Includes bibliographical references and index.
ISBN 0-8247-8979-2 (alk. paper)
1. Drug abuse-Chemotherapy. 2. Alcoholism-Chemotherapy. I. Miller,
Norman S. 11. Gold, Mark S.
[DNLM: 1. Substance Dependence-drug therapy. 2. Alcoholism-drug therapy.
3. Drug Therapy. WM 270 P5363 19941
RC564.P483 1994
616.86’061-d~20
DNLM/DLC
for Library of Congress 94-3755
CIP
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PRINTED IN THE UNITED STATES OF AMERICA
The search for alternative therapies in addictive disorders, the clinical attitudes of
physicians toward the useo fp harmacological agents, andr ecentr esearch efforts by
investigators have motivated the creation of this book.
Although pharmacological therapies have been used to treat drug and alcohol addic-
tion for some time, their use has been limited mainly to treatment of detoxification or
withdrawal states. .The recent interest in finding pharmacological therapies for the addic-
tive component is new and in the early stages.
This book is the first of its kind in which the dominant theme is pharmacological
therapies for drug and alcohol addictions. First, general aspects of biology, pharmacolo-
gy, and behavior pertaining to addictive disorders are discussed, andt hen specific
pharmacological approaches to drug and alcohol addictions are presented. The informa-
tion contained here will be useful to clinicians and researchers interested in addictive
disorders. The basic concepts and clinical guidelines are formulated for application to
clinical and research populations.
The authors comprise the leaders in clinical and basic researchi n the pharmacological
therapies of drug and alcohol addiction. Their contributions are providing great stimulus
for future research and hope for the still suffering addict. Although we have begun to
understand the underlying brain substrate for addictive use of alcohol and drugs, the
notion of developing medications tailored to specific biological targets is exciting and
appears possible.
Curiously, interest in the use of pharmacologicalt herapies in the treatment of
addictive disorders raises the credibility of their disease status, which has gained recogni-
tion in this century. Addictive behavior in relation to alcohol was described in biblical
times.C haucer’s Canterbury Tules contains manyr eferences to addictive“ Dronken-
sesse.” Alcoholics Anonymous postulated alcoholisma s a disease in The American
1935.
Medical Associationp ronouncedi n thata lcoholism is a disease that requires
1956
treatment. The disease concept of addiction was forwardedb y E. M. Jellinek in and
1960,
Vaillant defined objectively the longitudinal course of alcoholism in In the late
1983.
we now attempt to find new pharmacological solutions to an old disease. Perhaps
1990s
the next century will afford us with the medicinal relief we seek.
A major aim of the book is to show that it is possible to integrate pharmacological
iii
iV Preface
and nonpharmacological treatments for the benefit of the patient. The book explains that
we have effective treatments for drug and alcohol addiction in the form of nonpharmaco-
logical methods. A polar approach to addictive disorders is not productive.T he challenges
to the ultimate acceptance of the integration of these approaches are great. However, these
are promising times for those who wish to further the cause of treatment for addictive
disease.
Norman S. Miller
Mark S. Gold
Contents
Preface iii
Contributors ix
I. GenerAa pl proaches
1. An Introduction to the Pharmacological Therapies of Drug and Alcohol
Addictions 1
Norman S. Miller and Mark S. Gold
2. Pharmacological Therapies for Addiction, Withdrawal, andR elapse:
General Aspects 1 l
Mark S. Gold and Norman S. Miller
II. Biology of Addiction
3. The Neurobiology of Druga ndA lcoholA ddictions 3 1
Mark S. Gold and Norman S. Miller
4. BrainR eward Circuits andD ruga ndA lcoholA ddictions 45
Roy A. Wise
5. Endocrinological Effects ofD rugsa ndA lcohol 53
Gilbert0 Gerra, Rocco Caccavari, Bruno Fontanesi, Roberto Delsignore,
Giuseppe Fertonani-AfSini, and Francesca Brambilla
111. ClinicaAl pproach
6. Intoxication and Withdrawali nD ruga ndA lcoholA ddictions 77
Norman S. Miller
7. Biochemical andP sychometric Testing as DecisionalA idso nA lcoholism
Therapy 89
John P. Allen and Raye Z. Litten
8. Drug-DrugI n teraction in Pharmacological Therapies 101
Alan A. Wartenberg
V
Vi Contents
IV. PharmacologicalA pproachesi nD ruga ndA lcoholA ddictions:
Clinical and Research Findings
9. Pharmacological Therapies of AlcohoAl ddiction1 27
Raye Z. Litten and John P. Allen
10. Pharmacological Therapies of CocaineA ddiction1 43
David A. Gorelick
11P. harmacological Therapies of OpiateA ddiction1 59
Mark S. Gold
12. Pharmacological Therapies of Tranquilizersa nd Sedative Hypnotic
Addictio1n7 s5
David G. Benzer, Charles J. Engel, and Barry I. Spiegel
13. Pharmacological Therapies of Cannabis, Hallucinogens,P hencyclidine,
andV olatileS olventA ddictions2 13
Stephen H. Dinwiddie and Nuri B. Farber
14. PharmacologicalT herapies of AnabolicA ndrogenicS teroidA ddiction2 27
Donald A. Malone, Jr.
15. PharmacologicaTl herapiesN: icotineA ddiction2 39
Robert M. Keenan, Murray E. Jarvik, and Jack E. Henningfield
V. PharmacologicalT herapiesi nC linicalP opulations
16. Pharmacological Therapies inP regnantW omenw ithD ruga ndA lcohol
Addictio2n6 s5
Laura J. Miller and Valerie D. Raskin
17. Pharmacological Therapies inS urgicalP atientsw ithD ruga ndA lcohol
Addictio2n8 s7
Robert A. Littrell and Gordon L. Hyde
18. Pharmacological Therapies in MedicalP atientsw ithD rug andA lcohol
Addictio3n0 s7
Jerome E. Schulz
19. Pharmacological Therapies andA cuteM anagemento fP sychiatric
Symptomsi nD ruga ndA lcoholA ddictions3 19
James Fine
20. Pharmacological Therapies andC hronicM anagement of Psychiatric
Symptoms inD ruga ndA lcoholA ddictions3 27
Norman S. Miller
21. PharmacologicalT herapies for Druga ndA lcoholA ddictionsi n
Emergency Settings 341
Gary L. Swart and Stephen W. Hargarten
22. Pharmacological Therapies of Paini nD ruga ndA lcoholA ddictions3 73
Seddon R. Savage and Jerome Schofferman
Contents vii
23. Methadone Maintenance for OpioidA ddiction 41I
William W. Weddington
VI. NonpharmacologicalT herapyA pproach
24. Recognition and Therapy of Alcohol Use and Addiction:
Research Findings 419
Margaret E. Matrson, John P. Allen, Fulton Caldwell, Joanne B. Fertig,
Raye Z. Litten, Cherry Lowman, Lisa A. Marshall, and Cynthia Nickless
25. Contemporary Therapy Drug ind AlcoholA ddictions
of 433
Gregory B. Collins
Index 451
This Page Intentionally Left Blank
Contributors
JohnP . Allen, Ph.D.,M .P.A. TreatmentR esearchB ranch,N ational Institute on
Alcohol Abuse and Alcoholism, Rockville, Maryland
David G. Benzer, D.O. McBride Center for the Professional, Milwaukee Psychiatric
Hospital, Wauwatosa, Wisconsin
FrancescaB rambilla, M.D. Psychoneuroendocrinology Center, P. Pini Psychiatric
Hospital, Milan, Italy
Rwco Caccavari, M.D. Servizio Tossicodipendenze,U nith Sanitaria Locale n. 4,
Parma, Italy
Fulton Caldwell, Ph.D. TreatmentR esearchB ranch,N ational Institute onA lcohol
Abuse and Alcoholism, Rockville, Maryland
Gregory B. Collins, M.D. Department of Psychiatry, Alcohola ndD rugR ecovery
Center, The Cleveland Clinic Foundation, Cleveland, Ohio
Roberto Delsignore, M.D. Director of the Chair of Medical Therapy, University of
Parma, Panna, Italy
Charles J. Engel, M.D. Addiction Medicine Service, Milwaukee Psychiatric Hospital,
Wauwatosa, Wisconsin
Nuri B. Farber, M.D. Department of Psychiatry, -Washington University, St. Louis,
Missouri
Joanne B. Fertig, Ph.D. Treatment Research Branch, National Institute on Alcohol
Abuse and Alcoholism, Rockville, Maryland
Giuseppe Fertonani-Afini, M.D. Servizio Tossicodipendenze, Unith Sanitaria Locale
n. 4, Parma, Italy
