Skip to main content

Currently Skimming:

Appendix C: Putting Addiction Treatment Medications to Use: Lessons Learned
Pages 125-139

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 125...
... had no formal guidelines for determining whether an addiction treatment medication was safe and effective, even though several had been widely accepted and used for many years. Among these were benzodiazepines for alcohol withdrawal, disulfiram for the prevention of relapse to alcohol dependence, phenobarbital for detoxification from sedative dependence, clonidine and methadone for detoxification from opioid dependence, methadone for opioid maintenance; naltrexone for prevention of relapse to opioid dependence, and nicotine replacement therapy for nicotine dependence.
From page 126...
... for opioid maintenance and submit the data for FDA approval, find a medication that was useful in treating cocaine dependence, and continue studies of buprenorphine for opioid detoxification and maintenance. The importance of this effort was high due to the limited number of medications available to treat addiction, the size of the target populations, the limitations of currently available therapies, and the emergence of HIV disease along with data showing that addiction treatment reduced the chances for HIV infection (Avins et al., 1997; Metzger, Navaline, and Woody, 1998; Shoptaw et al., 1997; Woody et al., 2003)
From page 127...
... . Naltrexone, initially developed to prevent relapse to opioid dependence and later found to be effective for preventing relapse to alcohol dependence, appears to be used by less than 5 percent of the target populations in the United States.
From page 128...
... It is also seen by the marked reductions in money spent on substance abuse treatment over the past 10 years. For example, in the private sector between 1988 and 1998 the value of health insurance in medium to large companies decreased by 12 percent, while there was a 75 percent decrease in funds spent for substance abuse treatment (Galanter et al., 2000)
From page 129...
... special funding was allocated by Congress for the Department of Veterans Affairs to establish addiction treatment programs. Funds for the new VA programs were protected by legislation that prevented the money from being spent on anything but specialty substance abuse treatment.
From page 130...
... The result was that for many years Alcoholics Anonymous was the only place to turn for help, and treatment became dominated by a nonmedical approach involving staff with little or no medical training. A current example of this problem was seen in an informal survey of staffing patterns in 150 addiction treatment programs that had been randomly selected from Substance Abuse and Mental Health Services Administration records.
From page 131...
... The experience with nicotine replacement therapies and buproprion treatment for nicotine dependence shares a few commonalities with the naltrexone/alcohol studies and methadone maintenance. Although nicotine in the form of tobacco has been used since early history, its use did not become highly problematic for large populations until the introduction of the cigarette.
From page 132...
... Another barrier to effective utilization of nicotine replacement therapies is that all are marketed for short-term use, thus indicating that, like other addiction treatment situations, there is general acceptance of medication for detoxification but a resistance to using it for long-term relapse prevention. However, many patients use nicotine replacement as maintenance therapy but without formal instructions or approval, implying perhaps that they are misusing the medications and "exchanging one addiction for another," which is a frequent criticism of methadone and LAAM maintenance.
From page 133...
... . Poor compliance with treatment has been particularly frustrating to treatment providers because naltrexone is, in a pharmacological sense, an ideal medication for preventing relapse to opioid dependence due to its effective blockade of mu opioid receptors.
From page 134...
... An example of the same phenomenon in the case of alcohol treatment was seen in a study in which 150 subjects who met the criteria for alcohol dependence of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) were randomly assigned to topiramate or placebo.
From page 135...
... . This resolution was followed by introduction of the Addiction Free Treatment Act of 1999, which proposed to reduce the availability of maintenance treatment using methadone and LAAM (Addiction Free Treatment Act of 1999, 106th Congress S
From page 136...
... Related to this legislation was the approval of buprenorphine/naloxone (Suboxone) for maintenance treatment of opioid dependence as a Schedule III medication.
From page 137...
... It is also related to the more general issues of parity in mental health and to attempts to hold down treatment costs that involve disproportionate cuts in funding for substance abuse treatment. Any effort that can achieve parity in mental health and addiction treatment and that can minimize the costs of effective vaccines will help, as would a political consensus that addiction is a treatable disorder.
From page 138...
... . Over view of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS)
From page 139...
... . The effects of psychosocial services in substance abuse treatment.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.