Ross Stephen, Peselow Eric
Division of Alcoholism and Drug Abuse, Bellevue Hospital, NYU Langone Center of Excellence on Addiction, New York University School of Medicine, New York, NY 10016, USA.
Clin Neuropharmacol. 2009 Sep-Oct;32(5):277-89. doi: 10.1097/wnf.0b013e3181a91655.
Substance use disorders are highly prevalent in the United States and cause considerable damage to our society. They are underrecognized and undertreated despite a vast body of literature demonstrating the efficacy of treatment using both psychosocial and psychopharmacological modalities. For the last decade, research and progress into the biological basis of the addictive process has led to a rapidly growing number of pharmacological agents used to interrupt the addictive process at its various stages such as the initiation of substance abuse, the transition from abuse to dependence, and the prevention of drug reinstatement or relapse. Food and Drug Administration-approved medications exist for nicotine, alcohol, and opioid use disorders, and progress is being made to develop agents for stimulant use disorders. Regarding nicotine use disorders, nicotine replacement therapies,bupropion and varenicline, have Food and Drug Administration approval, and future options exist with endocannabinoid antagonists and immune therapy. Aversive agents, opiate antagonists, and glutamate based interventions are currently approved to treat alcohol use disorders with future promise with GABAergic, serotonergic, and endocannabinoid system agents. Opiate addiction is treated by approved agonist and antagonist mu-opioid medications with the future potential for agents that can modulate the stress systems and the iboga alkaloids. Although no pharmacotherapies are currently approved for cocaine addiction, promising lines of research include agents that affect dopaminergic, GABAergic, serotonergic,and glutamatergic systems as well as the promise for immune therapies.
物质使用障碍在美国极为普遍，给我们的社会造成了相当大的损害。尽管有大量文献表明使用心理社会和心理药理学方法进行治疗具有有效性，但这些障碍仍未得到充分认识和治疗。在过去十年中，对成瘾过程生物学基础的研究和进展导致用于在成瘾过程的各个阶段（如物质滥用的起始、从滥用到依赖的转变以及预防药物复吸或复发）打断成瘾过程的药理药物数量迅速增加。美国食品药品监督管理局（FDA）已批准用于治疗尼古丁、酒精和阿片类物质使用障碍的药物，并且在开发用于治疗兴奋剂使用障碍的药物方面也取得了进展。对于尼古丁使用障碍，尼古丁替代疗法、安非他酮和伐尼克兰已获得FDA批准，内源性大麻素拮抗剂和免疫疗法也有未来的应用前景。厌恶剂、阿片拮抗剂和基于谷氨酸的干预措施目前已被批准用于治疗酒精使用障碍，GABA能、5-羟色胺能和内源性大麻素系统药物在未来也有应用前景。阿片类成瘾通过已获批准的激动剂和拮抗剂μ-阿片类药物进行治疗，能够调节应激系统的药物和伊波加生物碱在未来具有应用潜力。尽管目前尚无治疗可卡因成瘾的药物疗法获批，但有前景的研究方向包括影响多巴胺能、GABA能、5-羟色胺能和谷氨酸能系统的药物以及免疫疗法的前景。
