Academic journal article Alcohol Health & Research World

Pharmacotherapy of Adolescent Alcohol and Other Drug Use Disorders

Academic journal article Alcohol Health & Research World

Pharmacotherapy of Adolescent Alcohol and Other Drug Use Disorders

Article excerpt

Medications are playing an increasingly important role as adjuncts to psychosocial strategies of alcoholism treatment. Although problems associated with the use of alcohol and other drugs (AODs) often appear in adolescence, most studies of AOD pharmacotherapy have been conducted in adults. Because youth may react differently from adults to both the therapeutic and potentially harmful effects of medications, the applicability of existing data to youth who abuse AODs remains unclear. This article explores strategies for using medications to treat AOD use disorders1 in youth, focusing on alcoholism when relevant data are available.

A systematic search of published research revealed 10 studies on the effects of medication for treating children or adolescents with AOD disorders. The studies differ significantly in experimental methods and in the definition and measurement of treatment outcome. Two were controlled studies, a type of study that compares the effects of the experimental medication with those of a sham medication, or placebo. Four were open trials, which evaluate experimental medication without a placebo control. Four were case reports, which describe the responses of one or a few patients to specific treatments. Treatment outcomes were evaluated using patient questionnaires; random urine screens to detect AOD use; and overall ratings of improvement in the patient's addictive behavior, cooccurring psychiatric symptoms, and psychosocial functioning. Although uncontrolled studies and case reports may suggest directions for research, controlled studies are needed to evaluate the effects of a medication.

Pharmacotherapeutic strategies for treating AOD disorders, as described in this sidebar, include craving reduction, substitution therapy, aversive therapy, and treatment of underlying psychiatric conditions (Kaminer 1995). Because subjects in all the studies discussed received concurrent nonpharmacological treatment, this article describes effects presumably attributable to the medications themselves.

Craving Reduction

Many researchers consider craving a fundamental aspect of addiction. Various definitions of craving exist based on behavioral, neurological, and subjective psychological criteria. In this article, the term "craving" refers to the urge or desire for a particular AOD. Craving can be evaluated experimentally by behavioral responses in laboratory animals or by self-reported mental states in human subjects. The reduction of craving through pharmacotherapy may help prevent relapse in patients undergoing treatment for alcoholism or other addictions.

Among the best known medications for treating alcoholism is naltrexone (ReVia(TM) or Trexan(R)). Naltrexone blocks certain communication pathways in the brain that are involved in the development of addiction to both alcohol and abused opiates (e.g., heroin). In studies of alcohol-dependent adults, naltrexone decreased alcohol consumption by approximately one-half (Volpicelli et al. 1997). The only study on the use of naltrexone in AOD-abusing youth is a case report of a 17-year-old alcohol-dependent male who remained abstinent during a brief (30-day) trial of naltrexone (Wold and Kaminer 1997). Nalmefene (a naltrexone derivative) and acamprosate also show promise for reducing alcohol craving in adults (Gastfriend et al. 1998). The efficacy of those medications in adolescents has not been determined.

Additional medications that may modify AOD craving include serotonin reuptake inhibitors (SRIs) and tricyclic antidepressants (e.g., desipramine [Norpramin(R)]), which are used to treat some psychiatric conditions in both adult and juvenile patients (Wilens et al. 1998). Studies of SRIs to reduce craving for cocaine, opiates, and alcohol in adults yielded mixed results (Gastfriend et al. 1998). In case reports, desipramine administration led to overall functional improvement in cocaine-dependent adolescents (Kaminer 1994), possibly by treating patients' underlying psychiatric disorders (see the section entitled "Treatment of Underlying Psychopathology"). …

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