Opioid Dependence: Mechanisms and Treatment

ISBN-13: 9781468438680 / Angielski / Miękka / 2012 / 256 str.

Abraham Wikler

Opis

A major problem in the treatment of opioid dependence has been the persistence of relapse despite detoxification and enforced prolonged abstention from drug use, with or without conventional psychotherapy and other efforts at rehabilitation. Both initial addiction and subsequent relapses are usually ascribed to the quest for opioid-produced euphoria in persons with character disorders. This formulation is in accord with one-half of the common sense "pleasure-pain" principle, but it ignores the other half, namely, the long-lasting dysphoric consequences of re peated opioid use (distressing abstinence phenomena, sexual distur bances, disruption of marital status, unemployment, enmeshment in criminal activities, arrests, and imprisonment). In any case, the pleasure-pain principle is an empty tautology since it is incapable of refutation by any conceivable objective data that might seem contradic tory, inasmuch as it can be "saved" by invocation of untestable uncon scious intervening variables. Less tied to the pleasure-pain principle is the view that relapse is due to long-lasting sequelae of previous opioid addiction, resulting from complex conditioning processes, both operant and classical, involving pharmacological, environmental, social and personal variables. In this view, relapse is not simply a re-enactment of initial opioid use, but is a "disease, sui generis" a disease of its own kind. The factors contributing to this disease, sui generis are reviewed in this book."

Spis treści

1 The Problems of Opioid and Other Drug Dependencies.- Prevalence and Complications.- Nonopioid Drug-Dependence Syndromes.- Barbiturate, Nonbarbiturate Sedative, and “Minor Tranquilizer” Dependence.- Alcohol Dependence.- Amphetamine Dependence.- Cocaine Dependence.- Hallucinogen Dependence.- Cannabis (Marijuana, Hashish) Dependence.- Tobacco Dependence.- References.- 2 The Etiology of Opioid Dependence.- Definitions and Dynamics.- Personality Studies.- Socioenvironmental Studies.- Mode of Spread of Opioid Dependence.- Prognosis.- References.- 3 Opioid Analgesics and Opioid Antagonists.- Opioid Analgesics.- Morphine.- Effects of Single Doses in the Nontolerant State.- Tolerance and Physical Dependence.- Heroin.- Methadone.- Meperidine.- Codeine.- d-Propoxyphene.- Pentazocine.- Opioid Antagonists.- Nalorphine.- Effects of Single Doses in the Drug-Free State.- Tolerance and Physical Dependence.- Opioid-Antagonistic and Opioid-Blocking Actions in the Nontolerant State.- Opioid-Antagonistic and Opioid-Blocking Actions in the Tolerant State.- Cyclazocine.- Naloxone and Naltrexone.- References.- 4 Opioid Receptors and Endogenous Opioid Peptides.- Opioid Receptors.- Endogenous Opioid Peptides (Enkephalins and Endorphins).- Possible Functions of Enkephalins and Endorphins.- Analgesia.- Physical Dependence.- Mental Disorders.- References.- 5 Mechanisms of Opioid Analgesia.- The Nature of Pain and Its Relief by Morphine.- Sites of Morphine’s Antinociceptive Actions in the Central Nervous System.- Spinal Cord.- Brain Stem.- Cerebral Cortex.- References.- 6 Theories of Tolerance to and Physical Dependence on Opioids.- General Theories of Tolerance to and Physical Dependence on Morphine.- Homeostatic Counteradaptation.- Cellular Counteradaptation.- Dual Action.- Theories of the Mechanisms of Counteradaptation to the Agonistic Effects of Drugs.- Disuse Supersensitivity.- Pharmacological Redundancy.- New Receptors.- Enzyme Expansion.- Immune Mechanisms.- Learning Factors.- References.- 7 Conditioning Processes in Opioid Dependence and in Relapse.- Operant Conditioning of Opioid-Acquisitive Behavior.- Classical Conditioning of the Opioid Agonist-Abstinence Cycle and Interoceptive Conditioning of Opioid-Seeking Behavior.- Classical Conditioning of the Opioid-Antagonist-Precipitated Opioid-Abstinence Syndrome.- Occurrence of Classically Conditioned Responses in Street Addicts.- Implications of Conditioning Factors for Relapse and Treatment.- References.- 8 Diagnosis and Treatment of Opioid Dependence.- Diagnosis.- Physical Dependence.- Opioid Use.- Treatment.- Opioid Poisoning.- Opioid Dependence.- Detoxification.- Detoxification Followed by Narcotic-Antagonist Maintenance.- Methadone Maintenance (with or without Eventual Detoxification).- Levomethadyl Maintenance.- References.