PL.01.01 New targets for the treatment of addiction

Abstract

I will discuss treatment strategies that are based on pharmacological interventions to reduce craving and relapse in drug and alcohol-dependent patients. I will first provide a historical overview about relapse prevention strategies and will then discuss the current state of the treatment situation in Europe. The presentation will mainly focus on alcohol addiction as major achievements have been made in recent years in the development of anti-relapse drugs and harm reduction in the alcohol field. Thus the development of disulfiram, naltrexone, acamprosate, and nalmefene will be described followed by a discussion of their neurobiological modes of action. This will be followed by a perspective on the introduction of substitution drugs to alcohol addicted patients and the combined use of behavioral and pharmacological interventions such as acceleration of extinction of a drug memory by D-cycloserine or the pharmacological disruption of the reconsolidation of a drug memory. Finally, the use of deep brain stimulation in treatment resistant patients will be discussed. Important conclusions of this lecture are: (i) in Europe there is a paradigmatic shift towards harm reduction in the addiction field, (ii) the substitution concept that is successfully used in opiate and nicotine dependent patients can be also introduced to alcoholic patients, (iii) matching treatment to specific genotypes (e.g. opioid receptor polymorphism) increases treatment success, (iv) a combination of behavioral and pharmacological therapies may be the optimal treatment strategy, and finally (v) the whole organism has to be taken into consideration to provide the best therapy for our patients.