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Cited by 49Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentNeurotransmitter Receptor Influence on Behavior

Treatment-refractory substance use disorder: focus on alcohol, opioids, and cocaine

Soyka, Michael, Mutschler, Jochen·2016·Progress in Neuro-Psychopharmacology and Biological Psychiatry
DOI 10.1016/j.pnpbp.2015.11.003
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Abstract

Substance use disorders are common, but only a small minority of patients receive adequate treatment. Although psychosocial therapies are effective, relapse is common. This review focusses on novel pharmacological and other treatments for patients with alcohol, opioid, or cocaine use disorders who do not respond to conventional treatments. Disulfiram, acamprosate, and the opioid antagonist naltrexone have been approved for the treatment of alcoholism. A novel, "as needed" approach is the use of the mu-opioid antagonist and partial kappa agonist nalmefene to reduce alcohol consumption. Other novel pharmacological approaches include the GABA-B receptor agonist baclofen, anticonvulsants such as topiramate and gabapentin, the partial nicotine receptor agonist varenicline, and other drugs. For opioid dependence, opioid agonist therapy with methadone or buprenorphine is the first-line treatment option. Other options include oral or depot naltrexone, morphine sulfate, depot or implant formulations, and heroin (diacetylmorphine) in treatment-refractory patients. To date, no pharmacological treatment has been approved for cocaine addiction; however, 3 potential pharmacological treatments are being studied, disulfiram, methylphenidate, and modafinil. Pharmacogenetic approaches may help to optimize treatment response in otherwise treatment-refractory patients and to identify which patients are more likely to respond to treatment, and neuromodulation techniques such as repeated transcranial magnetic stimulation and deep brain stimulation also may play a role in the treatment of substance use disorders. Although no magic bullet is in sight for treatment-refractory patients, some novel medications and brain stimulation techniques have the potential to enrich treatment options at least for some patients.

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Authors
Soyka, M., & Mutschler, J.
Affiliations
  • Privatklinik Meiringen (CH)
  • University of Zurich (CH)
Corresponding author
Soyka, Michael
ORCID
Venue
Progress in Neuro-Psychopharmacology and Biological Psychiatry
Publisher
Elsevier BV
Published
2016-10
Volume
70
Pages
148-161
ISSN
0278-5846 (ISSN-L)
DOI
10.1016/j.pnpbp.2015.11.003
OpenAlex
W2221682865
Cited by
49
References
300
Citations by year
2026: 4 · 2025: 5 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 6 · 2017: 3 · 2016: 12 · 2015: 1
FWCI
0.95
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Progress in Neuro-Psychopharmacology and Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Sanofi
  • H. Lundbeck A/S
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
alcoholism, opioid use disorder, cocaine dependence, pharmacotherapy, naltrexone, nalmefene, baclofen, topiramate, gabapentin, varenicline, methadone, buprenorphine, disulfiram, acamprosate, methylphenidate, modafinil, pharmacogenetics, transcranial magnetic stimulation, deep brain stimulation, relapse
MeSH terms
Animals, Central Nervous System Agents, Drug Resistance, Humans, Substance-Related Disorders

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