Addiction: the clinical interface.
This review gives an overview of what we see as the key issues in the human pharmacology of drugs of addiction. We review evidence of efficacy and mechanisms by which treatments act and point out areas where further work is needed. The role of agonist, partial agonist and antagonist treatments for opioid addiction is detailed and current issues relating to the mechanisms of actions at the receptor level and how to improve on compliance are discussed. The role of the brain dopamine and GABA-A systems in drug dependence is considered in relation to the growing pharmacology of these receptor systems, and the current status of novel preclinical targets reviewed. In addition, the different roles of dynamic and kinetic factors in both addiction and its treatment are discussed in relation to the underlying neuropharmacology of the disorders as defined from human and preclinical studies. Finally, some pointers to future research and especially to drug development by pharma are elaborated.
Nutt
D
D
Psychopharmacology Unit, University of Bristol, Bristol, UK. David.J.Nutt@bristol.ac.uk
Lingford-Hughes
A
A
D000818:Animals; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000378:metabolism; D001921:Brain / Q000187:drug effects* / Q000378:metabolism; D004298:Dopamine / Q000378:metabolism; D015195:Drug Design; D054333:Drug Partial Agonism; D006801:Humans; D008032:Limbic System / Q000187:drug effects / Q000378:metabolism; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D018377:Neurotransmitter Agents / Q000494:pharmacology / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D018079:Receptors, GABA / Q000187:drug effects / Q000378:metabolism; D011957:Receptors, Opioid / Q000187:drug effects / Q000378:metabolism; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D005680:gamma-Aminobutyric Acid / Q000378:metabolism
D009292:Narcotic Antagonists; D009294:Narcotics; D018377:Neurotransmitter Agents; D018079:Receptors, GABA; D011957:Receptors, Opioid; D005680:gamma-Aminobutyric Acid; D004298:Dopamine