Kleber H D
NIDA Res Monogr. 1985;58:83-99.
This paper has examined the possibilities of applying significant pharmacologic help to a variety of psychiatric problems that may accompany narcotic addiction. It has been shown that many of the patients do have such difficulties, with affective disorders being most common. As far as the various psychotropic drugs are concerned, neuroleptics for schizophrenia and lithium for manic disorders are generally agreed upon. A more extensive trial of lithium in a variety of situations seems indicated. Minor tranquilizers for anxiety and MAO-inhibitors for depression are both seen as problematic in this population--the former because of the possibility of abuse, the latter because of the danger of drug interaction associated with the addict's careless lifestyle. Tricyclic antidepressants may clearly have a role in treating major depression in opiate addicts on or off methadone, but the lability of the syndrome over time with frequent spontaneous remission argues against their routine use until it is clear that depression has persisted 3-6 months into methadone. Disulfiram appears to be a useful adjunct for drug abusers with serious alcohol problems. Psychotropic agents are most helpful to opiate addicts when used to treat coexisting psychopathology. While there is no clear evidence that such agents will reduce or affect the addiction itself, they may help keep patients available for rehabilitation efforts. Failure to intervene may make treatment dropout and recidivism more likely. Given the relative frequency of potentially treatable psychiatric disorders in these patients and the consequences of undiagnosed and untreated conditions, it is important for clinicians to maintain a high index of suspicion for concomitant psychiatric illness and for programs to have a mechanism for routinely diagnosing either all patients or, at a minimum, all patients not doing well. If programs used a standard instrument such as the SADS, it would be possible to compare various programs on this factor; in addition, it would provide a rich source of data for outcome studies.
本文探讨了运用重要药物手段治疗各类伴随麻醉品成瘾出现的精神问题的可能性。研究表明，许多患者确实存在此类困难，其中情感障碍最为常见。就各类精神药物而言，治疗精神分裂症的抗精神病药物以及治疗躁狂症的锂盐已得到普遍认可。似乎有必要在更多情况下对锂盐进行更广泛的试验。治疗焦虑的小剂量镇静剂和治疗抑郁症的单胺氧化酶抑制剂在这类人群中都存在问题——前者是因为有被滥用的可能性，后者是因为与成瘾者粗心的生活方式相关的药物相互作用风险。三环类抗抑郁药在治疗服用或未服用美沙酮的阿片类成瘾者的重度抑郁症方面可能有明确作用，但鉴于该综合征随时间的易变性以及频繁的自发缓解情况，在明确抑郁症在美沙酮治疗过程中持续3至6个月之前，不主张常规使用这类药物。双硫仑对于有严重酒精问题的药物滥用者似乎是一种有用的辅助药物。精神药物用于治疗共存的精神病理状况时，对阿片类成瘾者最有帮助。虽然没有明确证据表明这类药物会减少或影响成瘾本身，但它们可能有助于使患者能够接受康复治疗。不进行干预可能会增加治疗中断和复发的可能性。鉴于这些患者中潜在可治疗的精神障碍相对常见，以及未诊断和未治疗疾病的后果，临床医生对伴随的精神疾病保持高度怀疑指数很重要，并且各项目要有常规诊断所有患者或至少所有治疗效果不佳患者的机制。如果各项目使用诸如情感障碍和精神分裂症日程表（SADS）这样的标准工具，就有可能在此因素上对不同项目进行比较；此外，这将为结果研究提供丰富的数据来源。
