Current drug abuse reviews
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Curr Drug Abuse Rev · Nov 2008
ReviewBehavioral pharmacology of cannabinoids with a focus on preclinical models for studying reinforcing and dependence-producing properties.
Cannabis preparations as recreational drugs are the most widely used illicit drugs in the world. Although cannabis derivatives produce clear subjective motivational responses in humans leading to drug-seeking behavior and in a specific proportion in repeated drug use, the reinforcing/rewarding attributes of these subjective effects are difficult to define in experimental animals. This led to the notion of cannabinoids being considered as "atypical" or "anomalous" drugs of abuse. ⋯ The aim of the present article is to review from a preclinical perspective the current status of what is known about the behavioral pharmacology of cannabinoids including the recently identified cannabinoid neurotransmission modifiers with a particular emphasis on their motivational/reinforcing and dependence-producing properties. We conclude that cannabinoids exhibit reinforcing/rewarding properties in experimental animals mostly under particular experimental conditions, which is not the case for other drugs of abuse, such as opiates, psychostimulants, alcohol and nicotine. The paper will discuss these findings critically and also point to open questions that should be addressed in the future in order to improve our understanding of these specific actions of cannabinoids that will also impact drug discovery and development efforts of related compounds as therapeutics in the clinic.
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Curr Drug Abuse Rev · Nov 2008
ReviewOpioid antagonists for pharmacological treatment of alcohol dependence - a critical review.
Alcohol dependence is a widespread psychiatric disorder. While relapse prevention therapy in alcoholism was exclusively dominated by social and psychological treatments for many years, in the last decades the benefits of pharmacological agents for the rehabilitation treatment in alcoholism have become increasingly evident. Naltrexone, an opiate receptor antagonist, blocks the pleasant and reinforcing effects of alcohol by preventing the stimulation of opioid receptors and the reduction of dopamine release in the ventral tegmental area (VTA). ⋯ The review at hand gives on overview of the current evidence on opioid antagonists for the treatment of alcohol dependence regarding the possible mechanism of action, the substances' safety profiles and their effectiveness. The corresponding evidence is critically reviewed taking into consideration the influence of the study design on the magnitude and consistency of effect sizes as well the impact of patient characteristics on the response to the treatment with opioid antagonists. Future studies on the role of different subtypes of alcoholics according to their genetic or psychological profile to explain or even predict the effects of opioid antagonists in the treatment of alcohol dependence are needed.
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Curr Drug Abuse Rev · Nov 2008
ReviewWhat constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations.
Many medications with sedative, anxiolytic, analgesic, or stimulant properties have the potential to be inappropriately used. However, because these substances have beneficial effects, many issues pertinent to understanding prescription drug misuse may differ from those associated with other misused substances. There is currently a lack of consensus about what constitutes prescription misuse and a wide range of operational criteria have been proposed. ⋯ In addition, in some cases there are a number of potential ways that a single operational criterion can be met and many of these may be associated with substantially different risks, harms, and predictors. Due to considerable variability in the classification of medication misuse both within and between studies, it is currently difficult to interpret the clinical significance of existing findings or to determine the true magnitude of problems associated with any particular form of misuse. In the present review many of the problems and challenges for adequately defining prescription drug misuse will be overviewed and recommendations will be made on how to better characterize this phenomenon.