Agonist-Like (Substitution) Treatment for Cocaine and Other Stimulant Dependence

John Grabowski, Marc Mooney, David Herin

Research output: Chapter in Book/Report/Conference proceedingChapter

Original languageEnglish (US)
Title of host publicationInterventions For Addiction
PublisherElsevier Inc.
Number of pages9
ISBN (Print)9780123983381
StatePublished - 2013

Bibliographical note

Funding Information:
From here forward, the premise of this presentation is first, that a number of ‘agonist-like’ medications are available and could be approved and applied to treatment. These agents differ substantially in robustness as stimulants and typically in the scope of action, some being very specific, others modulating multiple aspects of brain neurochemistry and behavior. Second, it is clear that there are differing levels of disorder severity among individuals who appear for treatment. There are some users who engage in controlled intermittent use. Some individuals are intermittent, infrequent users who nonetheless at intervals engage in persistent compulsive use to use. Others engage in chronic use, using substantial quantities of stimulant drugs many times a month. In some cases, these more severe users have multiple related or unrelated medical or psychiatric problems. Combining the two observations; first that there is a suite of agonist-like agents with different action spectra and robustness as stimulants and, second that there is a spectrum of severity of use in individuals seeking treatment, one arrives at the logical conclusion that the optimal approach may reside in matching the medication characteristics with severity of the presentation. This parallels practice in other areas of psychiatry specifically, and medicine generally. Based on this we make a hierarchical presentation combining the two features, agonist robustness and disorder severity. The bulk of the clinical research described here has been conducted by researchers at the University of Texas, University of Minnesota, and the University of Pennsylvania in the United States, at the University of Adelaide, as well as community clinics in Melbourne and Sydney, in Australia. Providing additional background and support for the agonist approach, the preclinical and human laboratory research was conducted primarily by scientists at the University of Kentucky, Columbia University, Harvard University, and the Medical College of Virginia. Virtually all of the work conducted in the United States was funded by the National Institute on Drug Abuse, one institute of the National Institutes on Health.

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