Realistic goals for antagonist therapy.

Abstract

This paper has been prepared to discuss the realistic benefits that may be obtained from the use of narcotic antagonists in treating narcotic addicts. The reasons for these deliberations are twofold. (1) The full impact of chronic administration of narcotic antagonists is coming to be recognized, and we are finding that narcotic antagonists, like all drugs, have undesirable side effects, and if this toxicity is to be avoided, they must be used with some caution. (2) Further, it has become apparent that only a small portion of addicts will elect an antagonist mode of therapy. When cyclazocine was first [ 11 proposed for the treatment of narcotic addiction, it was our feeling, based on experiences on the wards of the Addiction Research Center, that only highly motivated patients who had some compelling reason for wishing to remain abstinent would accept this modality of treatment. There are such patients, and they do benefit from antagonist therapy. The question of whether there should be a continuing effort to develop narcotic antagonists for the treatment of narcotic addicts requires a thoughtful answer. What are the advantages that may accrue to patients and to society as a consequence of antagonist therapy? For those patients who wish to remain abstinent, the antagonists protect them from their own impulsivity and the consequences of drug-seeking behavior in times of stress and in