1 / 18

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

idania
Télécharger la présentation

Pharmacology: Yesterday, Today, and Tomorrow

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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!

More Related