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Pharmacology: Yesterday, Today, and Tomorrow

Pharmacology: Yesterday, Today, and Tomorrow. Carlton Erickson, Ph.D. Director, Addiction Science Research and Education Center University of Texas at Austin 2003. There once was a disease…. • people who had it were disgraced • sufferers felt isolated and alone

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Pharmacology: Yesterday, Today, and Tomorrow

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  1. Pharmacology: Yesterday, Today, and Tomorrow Carlton Erickson, Ph.D. Director, Addiction Science Research and Education Center University of Texas at Austin 2003

  2. There once was a disease….. • • people who had it were disgraced • • sufferers felt isolated and alone • • sufferers had permanent psychological damage • • the disease had insufficient funding for treatment • • there was poor understanding about the cause

  3. That disease was… • POLIO • (50 years ago) • If we had continued to onlytreat polio, today we would have computerized iron lungs! • But now polio is only a memory

  4. We face a challenge….. • • we’re trying hard to help people with drug problems, but we can’t help them all • • why? • - we hang on to outmoded beliefs • - we don’t have all the answers (research!) • - stigma, prejudice against addicts • - medical disease component unappreciated

  5. Early “medical” treatments • • detoxification with comforting medications (e.g., Librium for DTs, clonidine for heroin withdrawal) • • disulfiram (Antabuse) • • methadone • • LAAM (off market)

  6. Strange “addictions” • • cell phone • internet • • Thomas Kincaid • A.A. meetings • • television • shoes • • Ben & Jerry’s • cars • • exercise • rugs • • “other people” • chocolate

  7. The Medical Illness • …is NOT intentional abuse (as seen with alcohol use in college students) • …IS a pathological dependence on drugs, due to neurotransmitter dysregulation in the brain’s “reward pathway”

  8. Neurotransmitters Involved in Dependence • Probable functional dysregulation (MDS): • • Dopamine (DA) • • Serotonin (SER) • • Endorphins (END) • • Gamma-aminobutyric acid (GABA) • • Glutamate (GLU) • • Acetylcholine (ACh)

  9. Drugs Associated wth Neurotransmitters • Why do people have “drugs of choice”? • • Dopamine - amphets, cocaine, ETOH • • Serotonin - LSD, ETOH • • Endorphins - opioids, ETOH • • GABA - benzos, ETOH • • Glutamate -ETOH • • Acetylcholine - nicotine, ETOH • (Marijuana?)

  10. Logic: Fix the Neurotransmitter Problem • alcohol • • naltrexone (END) • • acamprosate (GABA/glutamate) • • ondansetron (SER) • • topiramate (???) • • these combined with talk therapy • • combinations of two medications

  11. Logic: Fix the Neurotransmitter Problem • heroin • • methadone (END) • • buprenorphine (Subutex, • Suboxone) (END) • • many medications for withdrawal comfort, including “rapid detox”

  12. Today and Tomorrow • • current medications reduce withdrawal discomfort and/or reduce craving for the drug, especially with “talk” therapy • (another example: bupropion - Zyban) • • future medications will be designed based upon genetic knowledge • • effectiveness will be judged by brain scan changes and symptom reduction

  13. Why Should Clinicians be Aware of New Medications?

  14. Today’s Treatment Options (It’s all about options….) • • 12 step programs (abstinence) • • inpatient/outpatient/aftercare (insurance?) • • new meds to enhance abstinence • • harm reduction, Moderation Management, RRT • • brief motivational counseling, CBT, MET, • SO-involved therapy • • vouchers, vaccines • (RRT = rational recovery therapy, CBT= cognitive behavioral therapy, • MET= motivational enhancement therapy, SO = significant other)

  15. New Brain Scan Research… • • Psychotherapy and meds work on the basal ganglia in treatment of depression (Martin et al., 2001) • • CBT and meds work on the same brain areas in treating social anxiety (Furmark et al., 2002) • • CBT appears to modify “bad circuits” associated with anxiety disorders (Paquette et al., 2003)

  16. Why Should Clinicians be Aware of New Medications? • • medications will help more people • • medications add credibility to the fact of drug dependence as a medical illness • • medications reduce stigma against the disease • • clinicians can influence physicianinvolvement in treating this illness

  17. Day Two • • we’ll be discussing strategies for transferring technologies such as this • • how to transfer knowledge, change beliefs, change behaviors • • overcoming resistance to new knowledge, increasing confidence in being able to understand and use it • • ATTCs are perfect for this challenge!

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