Gold M S
Department of Neuroscience, University of Florida College of Medicine, Gainesville.
Psychiatr Clin North Am. 1993 Mar;16(1):61-73.
Detoxification from opiate addiction has been a medical problem for as long as opiate drugs have been available. Treatment before the discovery of clonidine involved giving another opioid drug with less dangerous consequences of chronic use, such as the long-acting and orally administered once a day methadone, for another opioid mu agonist like heroin, which must be taken intravenously many times a day, thus making rehabilitation, work, and avoidance of hepatitis, HIV, and other illnesses difficult. Although methadone has proved to be very beneficial, it still has significant abuse potential. Naltrexone, because it blocks the effects of all opiates, has facilitated the transformation from addiction to a drug-free state for many recovering addicts. By alleviating withdrawal symptoms and by lessening the detoxification period, clonidine similarly has improved the prospect of recovery from opiate addiction. Relapse, whether withdrawal is treated with clonidine or other new agents or not, occurs with great regularity because repeated opiate use can induce a new acquired drive state--the drive for opiates. In addition, with powerful withdrawal symptoms during abstinence, opiate relapse is difficult to prevent without an adequate treatment program. The efficacy of clonidine and other medical magic bullets for withdrawal distress needs to be given as part of a long-term recovery program which not only allows the brain to re-establish normal homeostatic changes in the drug-free state but also provides sufficient motivation for new approaches to achieving and sustaining pleasurable existence.
自从有了阿片类药物，阿片类药物成瘾的脱毒就一直是个医学问题。在可乐定被发现之前，治疗方法是给予另一种慢性使用后果危险性较小的阿片类药物，比如长效且每日口服一次的美沙酮，来替代像海洛因这样的另一种阿片μ激动剂，海洛因必须每天静脉注射多次，这使得康复、工作以及避免感染肝炎、艾滋病毒和其他疾病变得困难。尽管美沙酮已被证明非常有益，但它仍有很大的滥用潜力。纳曲酮由于能阻断所有阿片类药物的作用，已帮助许多康复中的成瘾者从成瘾状态转变为无药状态。通过减轻戒断症状并缩短脱毒期，可乐定同样改善了从阿片类药物成瘾中康复的前景。无论戒断是否用可乐定或其他新药治疗，复吸都经常发生，因为反复使用阿片类药物会诱发一种新的后天驱动状态——对阿片类药物的渴望。此外，在禁欲期间出现强烈的戒断症状时，如果没有适当的治疗方案，阿片类药物复吸很难预防。可乐定和其他治疗戒断痛苦的神奇药物的疗效需要作为长期康复计划的一部分，该计划不仅能让大脑在无药状态下重新建立正常的稳态变化，还能为实现和维持愉悦生活的新方法提供足够的动力。
