Pharmacologically Assisted Treatment of Opioid-Dependent Youth.

Pharmacologically Assisted Treatment of Opioid-Dependent Youth.

Paediatr Drugs. 2013 Aug 3;
Pecoraro A, Fishman M, Ma M, Piralishvili G, Woody GE

Opioid misuse, abuse, and dependence are global problems whose patterns vary across cultures. In the USA, the non-medical use of prescription opioids has become particularly serious because of its association with addiction and overdose death. Agonist and antagonist medications have been shown to be effective for opioid-dependent adults, and there is a growing body of data that they are also effective for youth. Here, we summarize evidence that detoxification alone results in high rates of treatment dropout and relapse but that the limited but growing data on the extended use of medication-assisted treatment for opioid-dependent youth have been positive. The implementation of medication-assisted treatment as a standard practice is feasible, easily integrated with counseling or psychotherapy, and has potential to greatly improve outcomes. Although concerns about safety and efficacy with youth require more research, and we do not advocate indefinite maintenance, we suggest that opioid-dependent youth should be considered as candidates for medication-assisted treatment delivered in a comprehensive, developmentally appropriate context, beginning at the first episode of care, with the strength of the recommendation to use medication increasing with each care episode. HubMed – addiction

Adenosine signaling in striatal circuits and alcohol use disorders.

Mol Cells. 2013 Aug 1;
Nam HW, Bruner RC, Choi DS

Adenosine signaling has been implicated in the pathophysiology of alcohol use disorders and other psychiatric disorders such as anxiety and depression. Numerous studies have indicated a role for A1 receptors (A1R) in acute ethanol-induced motor incoordination, while A2A receptors (A2AR) mainly regulate the rewarding effect of ethanol in mice. Recent findings have demonstrated that dampened A2AR-mediated signaling in the dorsomedial striatum (DMS) promotes ethanol-seeking behaviors. Moreover, decreased A2AR function is associated with decreased CREB activity in the DMS, which enhances goal-oriented behaviors and contributes to excessive ethanol drinking in mice. Interestingly, caffeine, the most commonly used psychoactive substance, is known to inhibit both the A1R and A2AR. This dampened adenosine receptor function may mask some of the acute intoxicating effects of ethanol. Furthermore, based on the fact that A2AR activity plays a role in goal-directed behavior, caffeine may also promote ethanol-seeking behavior. The A2AR is enriched in the striatum and exclusively expressed in striatopallidal neurons, which may be responsible for the regulation of inhibitory behavioral control over drug rewarding processes through the indirect pathway of the basal ganglia circuit. Furthermore, the antagonistic interactions between adenosine and dopamine receptors in the striatum also play an integral role in alcoholism and addiction-related disorders. This review focuses on regulation of adenosine signaling in striatal circuits and the possible implication of caffeine in goal-directed behaviors and addiction. HubMed – addiction

[Mental disorders in old age.]

Z Gerontol Geriatr. 2013 Aug 4;
Kinzl JF

Older adults face multiple age-related burdens. Although certain mental disorders are more common in the elderly, mental illness-in contrast to physical disorders-is less frequent than in younger individuals. Some clear differences related to gender have been identified in relation to mental disorders in these patients. Older women tend to suffer more frequently from depression and anxiety disorders, while addiction disorders, in particular alcohol abuse, and suicide are more prevalent in men. The importance of psychotherapy in addition to psychopharmacological medication in the treatment of older adults with mental disease has become increasingly clear. This particular patient group tends to be very motivated to work with their care provider; moreover, previously employed constructive coping strategies, as well as the extensive experience in handling problems can be great assets to the therapeutic process. HubMed – addiction