New Problems, Novel Approaches and Promising Treatments

The evolving field of addiction psychiatry has seen remarkable progress in the development of new and effective treatments for addictive disorders, as well as in our understanding of their biological basis. Indeed, it is this new recognition of addiction as a brain disease that has defined addictive disorders in the chronic medical illness model, much like medical disorders such as hypertension, diabetes and chronic lung disease.

The articles in this special report cover a broad range of topics, including the emergence of new drugs of abuse, advances in the molecular genetics of addictions and novel treatment approaches for addictions.

Addiction to Ecstasy/MDMA and marijuana have been recognized as an increasing problem, particularly in young adults. The review by Gerald Valentine, M.D., presents an overview of Ecstasy and how, in spite of its abuse potential and potentially fatal consequences, it may well have therapeutic benefits under medical supervision. Meanwhile, the article by Elena M. Kouri, Ph.D., discusses the potential existence of a marijuana withdrawal syndrome and adds to the growing clinical impression and research evidence that marijuana is an addictive drug -- like cocaine, heroin, alcohol and nicotine.

With regard to innovative treatments, Nancy M. Petry, Ph.D., reviews contingency management (CM) theory and procedures. She also presents evidence that CM, which involves giving patients increasing monetary or related rewards (e.g., vouchers) to promote prolonged drug-use abstinence, may be a useful treatment by itself or in combination with other addiction treatments (pharmacological and behavioral) for the management of a broad range of addictive disorders.

Insofar as new approaches to the study of the neurobiology of addictions, Eric J. Nestler, M.D., Ph.D., discusses the application of the latest molecular genetic methods to the study of addictive disorders and, in particular, to animal models of addiction. Compared to other psychiatric disorders like schizophrenia and major depression, we have excellent animal models of alcohol and drug self-administration, reward, dependence and withdrawal in which genetic contributions to drug use behavior can be studied. There may soon come a time when we might even be able to predict responses to various pharmacological and behavioral treatments for various drug dependencies based on an individual's genotype at relevant candidate genes.

As evidenced by these articles, this is an exciting time to be in the field of addiction psychiatry. With the fiscal pressures of managed care and the increasing prevalence of alcohol and drug addiction in psychiatric populations (i.e., dual diagnosis), it behooves all psychiatrists to be knowledgeable and effective providers of care to addicted patients. Accordingly, it is hoped that this series of articles will instill this sense of excitement and an improved knowledge base about this area to general psychiatrists, who are increasingly confronted with the challenging clinical problems posed by patients with addictive disorders.

Acknowledgement

Psychiatric Times extends a warm thank you to Dr. George for his invaluable guidance and assistance in preparing and reviewing this special report.