Treatment-refractory substance use disorder: Focus on alcohol, opioids, and cocaine.

摘要: Substance use disorders are common, but only a small minority of patients receive adequate treatment. Although psychosocial therapies effective, relapse is common. This review focusses on novel pharmacological and other treatments for with alcohol, opioid, or cocaine who do not respond to conventional treatments. Disulfiram, acamprosate, the opioid antagonist naltrexone have been approved treatment alcoholism. A novel, "as needed" approach mu-opioid partial kappa agonist nalmefene reduce alcohol consumption. Other approaches include GABA-B receptor baclofen, anticonvulsants such as topiramate gabapentin, nicotine varenicline, drugs. For dependence, therapy methadone buprenorphine first-line option. options oral depot naltrexone, morphine sulfate, implant formulations, heroin (diacetylmorphine) in treatment-refractory patients. To date, no has addiction; however, 3 potential being studied, disulfiram, methylphenidate, modafinil. Pharmacogenetic may help optimize response otherwise identify which more likely treatment, neuromodulation techniques repeated transcranial magnetic stimulation deep brain also play role substance disorders. magic bullet sight patients, some medications enrich at least