Dieckmann Luiz Henrique Junqueira, Ramos Anna Carolina, Silva Eroy Aparecida, Justo Luis Pereira, Sabioni Pamela, Frade Iracema Francisco, de Souza Altay Lino, Galduróz José Carlos Fernandes
Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
Eur Neuropsychopharmacol. 2014 Aug;24(8):1196-202. doi: 10.1016/j.euroneuro.2014.06.001. Epub 2014 Jun 12.
Cocaine use affects approximately 13.4 million people, or 0.3% of the world's population between 15 and 64 years of age. Several authors have described drug addiction as a disease of the brain reward system. Given that the cholinergic system impacts reward mechanisms and drug self-administration, acetylcholine (ACh) might play an important role in the cocaine addiction process. We evaluated the efficacy of biperiden (a cholinergic antagonist) in reducing craving and the amount used, and in increasing compliance with treatment for cocaine/crack addiction. It was a study double-blind, randomised, placebo-controlled, 8-week trial of 111 cocaine or crack addicted male patients between 18 and 50 years old. Two groups were compared: placebo (n=55) or biperiden (n=56) combined with weekly sessions of brief group cognitive-behavioural therapy. The efficacy of treatment was evaluated according to the patients' compliance and several instruments: the Minnesota Cocaine Craving Scale, the Beck Depression and Anxiety Scales and a questionnaire assessing the amount of drug used. All of the patients attended weekly sessions for two months. We analysed the data considering the patients' intention to treat based on our last observation. Of the 56 patients in the biperiden group, 24 completed the treatment (42.8%) compared with only 11 patients in the placebo group (20%), which was a significant difference (p=0.009). Compliance with treatment was 118% higher in the biperiden group, which was also the group that presented a statistically significant reduction in the amount of cocaine/crack use (p<0.001). There was statistically significant difference between the craving score in the biperiden group. Pharmacological blockade of the cholinergic system with biperiden is a promising alternative to treat cocaine/crack addiction, helping patients to reduce the amount used and improving compliance with psychotherapy treatment.
可卡因使用影响了约1340万人，占全球15至64岁人口的0.3%。几位作者将药物成瘾描述为大脑奖赏系统的一种疾病。鉴于胆碱能系统影响奖赏机制和药物自我给药，乙酰胆碱（ACh）可能在可卡因成瘾过程中发挥重要作用。我们评估了比哌立登（一种胆碱能拮抗剂）在减少渴望和使用量以及提高对可卡因/快克成瘾治疗依从性方面的疗效。这是一项针对111名年龄在18至50岁之间的可卡因或快克成瘾男性患者的双盲、随机、安慰剂对照的8周试验。比较了两组：安慰剂组（n = 55）或比哌立登组（n = 56），两组均结合每周一次的简短团体认知行为疗法。根据患者的依从性和几种工具评估治疗效果：明尼苏达可卡因渴望量表、贝克抑郁和焦虑量表以及一份评估药物使用量的问卷。所有患者参加了为期两个月的每周一次的治疗。我们根据最后一次观察，按照患者的意向性分析数据。比哌立登组的56名患者中，24名完成了治疗（42.8%），而安慰剂组只有11名患者完成治疗（20%），这是一个显著差异（p = 0.009）。比哌立登组的治疗依从性高出118%，该组在可卡因/快克使用量上也有统计学意义的显著减少（p < 0.001）。比哌立登组的渴望评分有统计学意义的差异。用比哌立登对胆碱能系统进行药理学阻断是治疗可卡因/快克成瘾的一种有前景的替代方法，有助于患者减少使用量并提高对心理治疗的依从性。
