Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Box 410, Gothenburg 405 30, Sweden.
Center for Social and Affective Neuroscience, Linköping University, Campus US, Entrance 65, Linköping 581 85, Sweden.
Alcohol Alcohol. 2021 Feb 24;56(2):127-138. doi: 10.1093/alcalc/agaa139.
Despite a general decline in tobacco use in the last decades, the prevalence of tobacco smoking in individuals with alcohol use disorder (AUD) remains substantial (45-50%). Importantly, the co-use of both substances potentiates the adverse effects, making it a significant public health problem. Substantial evidence suggests that AUD and Tobacco use disorder (TUD) may share common mechanisms. Targeting these mechanisms may therefore provide more effective therapy. Numerous studies describe a potential role of the endogenous opioid system in both AUD and TUD. Reviewing this literature, we aim to evaluate the efficacy of molecules that target the opioid system as promising therapeutic interventions for treating alcohol and tobacco co-use disorders.
We provide a synthesis of the current epidemiological knowledge of alcohol and tobacco co-use disorders. We evaluate clinical and preclinical research that focuses on the regulation of the endogenous opioid system in alcohol, nicotine, and their interactions.
The epidemiological data confirm that smoking stimulates heavy drinking and facilitates alcohol craving. Pharmacological findings suggest that treatments that are efficacious in the dual addiction provide a beneficial treatment outcome in comorbid AUD and TUD. In this regard, MOP, DOP and NOP-receptor antagonists show promising results, while the findings prompt caution when considering KOP-receptor antagonists as a treatment option in alcohol and tobacco co-use disorders.
Existing literature suggests a role of the opioid system in sustaining the high comorbidity rates of AUD and TUD. Molecules targeting opioid receptors may therefore represent promising therapeutic interventions in 'heavy drinking smokers.'
尽管在过去几十年中，烟草使用总体呈下降趋势，但患有酒精使用障碍（AUD）的个体中仍有相当大比例（45-50%）的人吸烟。重要的是，这两种物质的共同使用会增强不良反应，这是一个重大的公共卫生问题。大量证据表明，AUD 和烟草使用障碍（TUD）可能具有共同的机制。针对这些机制可能会提供更有效的治疗方法。许多研究描述了内源性阿片系统在 AUD 和 TUD 中的潜在作用。回顾这些文献，我们旨在评估靶向阿片系统的分子作为治疗酒精和烟草共同使用障碍的有前途的治疗干预措施的疗效。
我们提供了酒精和烟草共同使用障碍的当前流行病学知识的综合。我们评估了重点研究内源性阿片系统在酒精、尼古丁及其相互作用中的调节作用的临床前和临床研究。
流行病学数据证实，吸烟会刺激大量饮酒，并促进对酒精的渴望。药理学研究结果表明，在双重成瘾中有效的治疗方法在共病 AUD 和 TUD 中提供了有益的治疗效果。在这方面，MOP、DOP 和 NOP 受体拮抗剂显示出有希望的结果，而这些发现提示在考虑 KOP 受体拮抗剂作为酒精和烟草共同使用障碍的治疗选择时需要谨慎。
现有文献表明阿片系统在维持 AUD 和 TUD 的高共病率方面发挥作用。因此，靶向阿片受体的分子可能是“重度饮酒吸烟者”的有前途的治疗干预措施。
