Agonist-like, replacement pharmacotherapy for stimulant abuse and dependence
Agonist-like, replacement pharmacotherapy for stimulant abuse and dependence
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DOI：
10.1016/j.addbeh.2004.06.018
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发表时间：
2004-09-01
影响因子：
4.4
通讯作者：
Negus, SS
中科院分区：
文献类型：
--
作者：
Grabowski, J;Shearer, J;Negus, SS
兴奋剂滥用和依赖问题格外严重，因为法律和社会问题加上这些疾病的严重行为和生物特征。这些问题因对家庭和社会造成的不利后果而变得更加复杂。违法性和耻辱加剧了使用的后果和提供治疗的困难。特定的行为干预已被证明在治疗物质使用障碍(SUDS)方面是有用的。药物在治疗中也发挥着重要作用。对于阿片类药物和尼古丁依赖，存在有效的激动剂和拮抗剂药物治疗以及症状治疗。激动剂和拮抗剂都没有被批准为治疗兴奋剂滥用或依赖的唯一有效药物。尽管如此，与尼古丁和阿片类药物依赖平行的激动剂或“替代”策略正在出现令人振奋的结果。从临床前和临床研究环境中都出现了支持性数据。应用类似激动剂的方法治疗兴奋剂滥用和依赖有科学、临床、社会和法律上的障碍。一些类似于过去和现在对阿片类药物替代的担忧。另一些则是兴奋剂、作用和临床特征所特有的。在这里，作者考虑(1)激动剂和拮抗剂的药物治疗策略；(2)临床前研究，包括方法学方法，阿片和尼古丁替代，以及兴奋剂依赖的激动剂；(3)可卡因依赖的兴奋剂药物的临床报告，以及苯丙胺依赖的苯丙胺替代策略；(4)激动剂类/替代策略的应用，包括临床要求和风险；以及(5)研究方向。(C)2004爱思唯尔有限公司。保留所有权利。
Stimulant abuse and dependence are disproportionately problematic due to the combination of legal and social issues added to the serious behavioural and biological features of the disorders. These problems are compounded by adverse consequences for families and society. Illegality and stigma multiply the consequences of use and difficulties in providing treatment. Specific behavioural interventions have been demonstrated as useful in treatment of substance use disorders (SUDs). Medications also have an important role in treatment. Effective agonist and antagonist pharmacotherapies as well as symptomatic treatments exist for opioid and nicotine dependence. Neither agonists nor antagonists have been approved as uniquely effective for treatment of stimulant abuse or dependence. Still, promising results are emerging for an agonist-like or 'replacement' strategy paralleling that for nicotine and opioid dependence. Supporting data have emerged from both preclinical and clinical research environments. There are scientific, clinical, social, and legal impediments to application of an agonist-like approach to stimulant abuse and dependence. Some resemble past and current concerns about opioid replacement. Others are unique to the stimulant agents, effects, and clinical features. Here, the authors consider (1) agonist and antagonist pharmacotherapy strategies; (2) preclinical research, including methodological approaches, opioid and nicotine replacement, and agonists for stimulant dependence; (3) clinical reports with stimulant medications in cocaine dependence, and the amphetamine replacement strategy for amphetamine dependence; (4) application of agonist-like/replacement strategies, including clinical requirements and risks; and (5) directions for research. (C) 2004 Elsevier Ltd. All rights reserved.