INTRODUCTORY REMARKS Alcohol, opioids, nicotine, and psychostimulants have different chemical structures; however, they seem to exert their actions via similar neurochemical …

Pharmacological treatment of alcohol dependence include agents that minimize the positive reinforcing effects of alcohol (such as naltrexone) and other agents used to relieve withdrawal symptoms and promote abstinence (such as Sedatives and Disulfiram) (2). Naltrexone is a mu-opioid and a delta-opioid receptor antagonist. It functions by blocking the binding of the endogenous opioid, beta-endorphin, to the mu- opioid receptor, which leads to the alleviation of positive effects (euphoria) induced by alcohol intake (3). It is administered orally, and taken 3 times/week at 100-150mg. It is generally safe, with no known interactions caused by alcohol intake and no withdrawal symptoms after drug discontinuation (3). Studies have shown that naltrexone does not lead to complete abstinence from drinking, however, it may cause a reduction in the amount of alcohol intake and a better control over drinking behaviors (4). Acamprosate exhibits a structure similar to the neurotransmitters GABA and glutamate (5). It is thought to work by stabilizing the neurotransmitter balance seen in alcohol dependent people (5). Several trials have shown that acamprosate is efficacious in the treatment of alcohol dependence and is well tolerated (5). However, approval of acomprasate is still pending in many countries. As a result, there is a need for pharmacological agents that treat alcohol dependence, maintain abstinence from alcohol, and do not exhibit adverse effects. Persistence of cigarette smoking leads to nicotine addiction. Smoking is the leading cause of death in North America, implicated in one of every five deaths (4). Unaided attempts of smoking cessation are successful in only 5% of people who attempt to quit (4). Most pharmacological agents that are available for smoking cessation are nicotine replacement agents such as nicorette (a chewing gum formulation that contains 2 mg of nicotine), and nicotine patch (6). In addition, some investigational drugs for smoking cessation include nicotine inhalers, mecamylamine, a nicotine receptor antagonist, antidepressants, clonidine, and airway sensory replacement (6). Nicorette produces adverse effects that include bad taste, difficulty with chewing, and stomach upset (6). The nicotine patch is better tolerated; however, it may lead to skin irritation and allergies in patients (6). As a result, a pharmacological agent is required that functions to cease cigarette smoking in individuals that are mild to heavy smokers, decreases craving, has no side effects and prevents relapse…

Source: http://www.iuphar.org/

Download Chapter 24. Alcohol and Nicotine Addiction