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  • Print publication year: 2012
  • Online publication date: August 2012

11 - Evidence-based pharmacotherapy of nicotine and alcohol dependence

Summary

This chapter reviews the evidence for first-line treatment of major depressive disorder (MDD), and strategies for patients with treatment-resistant depression. Many trials have investigated the efficacy of selective serotonin reuptake inhibitors (SSRIs) compared with other antidepressants. Patients with MDD are at higher risk of suicide, and guidelines indicate that patients should be assessed for suicide at the start of treatment and regularly over the course of treatment. As augmenting agents, atypical antipsychotics, lithium, and triiodothyronine (T3) have been studied the most extensively, and shown to have benefit. However, their risks and side-effect profiles may make them less attractive to patients, and patient preference and safety should determine treatment decisions for refractory or chronic MDD. The use of biomarkers, including pharmacogenetic testing, may one day provide more accurate predictors of response or adverse outcomes, allowing targeted treatments and the promise of personalized medicine.

References

Addolorato G, Caputo F, Capristo E et al. (2002). Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study. Alcohol and Alcoholism 37, 504–508.
Agrawal A, Lynskey MT (2008). Are there genetic influences on addiction: evidence from family, adoption and twin studies. Addiction 103, 1069–1081.
Andlin-Sobocki P, Rehm J (2005). Cost of addiction in Europe. European Journal of Neurology 12 (Suppl. 1), 28–33.
Anton RF, O’Malley SS, Ciraulo DA et al. (2006). COMBINE Study Research Group. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. Journal of the American Medical Association 295(17), 2003–2017.
Anton RF, Oroszi G, O’Malley S et al. (2008). An evaluation of mu-opioid receptor (OPRM1) as a predictor of naltrexone response in the treatment of alcohol dependence: results from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study. Archives of General Psychiatry 65(2), 135–144.
Arbaizar B, Diersen-Sotos T, Gómez-Acebo I, Llorca J (2010). Topiramate in the treatment of alcohol dependence: a meta-analysis. Actas Espanolas de Psiquiatria 38(1), 8–12.
Aubin HJ, Bobak A, Britton JR et al. (2008). Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax 63(8), 717–724.
Bader P, McDonald P, Selby P (2009). An algorithm for tailoring pharmacotherapy for smoking cessation: results from a Delphi panel of international experts. Tobacco Control 18, 34–42.
Baltieri DA, Daró FR, Ribeiro PL, de Andrade AG (2008). Comparing topiramate with naltrexone in the treatment of alcohol dependence. Addiction 103, 2035–2044.
Baltieri DA, Daró FR, Ribeiro PL, Andrade AG (2009). Effects of topiramate or naltrexone on tobacco use among male alcohol-dependent outpatients. Drug and Alcohol Dependence 105(1–2), 33–41.
Besson J, Aeby F, Kasas A, Lehert P, Potgieter A (1998). Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: a controlled study. Alcoholism: Clinical & Experimental Research 22, 573–579.
Cahill K, Ussher MH (2007). Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation. Cochrane Database of Systematic Reviews 4, D005353.
Cahill K, Stead LF, Lancaster T (2010). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 12, CD006103.
Caputo F, Francini S, Stoppo M et al. (2009). Incidence of craving for and abuse of gamma-hydroxybutyric acid (GHB) in different populations of treated alcoholics: an open comparative study. Journal of Psychopharmacology 23, 883–890.
Cerny EH, Cerny T (2009). Vaccines against nicotine. Human Vaccines 5, 200–205.
Chick J, Gough K, Falkowski W et al. (1992). Disulfiram treatment of alcoholism. British Journal of Psychiatry 161, 84–89.
Cornuz J, Zwahlen S, Jungi WF et al. (2008). A vaccine against nicotine for smoking cessation: a randomized controlled trial. PLoS One 3(6), e2547.
Covey LS, Glassman AH, Stetner F (1999). Naltrexone effects on short-term and long-term smoking cessation. Journal of Addictive Diseases 18, 31–40.
Crain D, Bhat A (2010). Current treatment options in smoking cessation. Hospital Practice (Minneapolis) 38(1), 53–61.
Crunelle CL, Miller ML, Booij J, van den Brink W (2010). The nicotinic acetylcholine receptor partial agonist varenicline and the treatment of drug dependence: a review. European Neuropsychopharmacology 20(2), 69–79.
David SP, Lancaster T, Stead LF, Evins AE, Cahill K (2006). Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 4, CD003086.
de Sousa A, De Sousa A (2004). A one-year pragmatic trial of naltrexone vs. disulfiram in the treatment of alcohol dependence. Alcohol and Alcoholism 39(6), 528–531.
de Sousa A, de Sousa A (2005). An open randomized study comparing disulfiram and acamprosate in the treatment of alcohol dependence. Alcohol and Alcoholism 40(6), 545–548.
de Sousa AA, De Sousa J, Kapoor H (2008). An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence. Journal of Substance Abuse Treatment 34(4), 460–463.
Diehl A, Ulmer L, Mutschler J et al. (2010). Why is disulfiram superior to acamprosate in the routine clinical setting? A retrospective long-term study in 353 alcohol-dependent patients. Alcohol and Alcoholism 45(3), 271–277.
Etter JF, Stapleton JA (2006). Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tobacco Control 15(4), 280–285.
Feeney GF, Connor JP, Young RM, Tucker J, McPherson A (2006). Combined acamprosate and naltrexone, with cognitive behavioural therapy is superior to either medication alone for alcohol abstinence: a single centres’ experience with pharmacotherapy. Alcohol and Alcoholism 41(3), 321–327.
Flórez G, García-Portilla P, Alvarez S et al. (2008). Using topiramate or naltrexone for the treatment of alcohol-dependent patients. Alcoholism: Clinical & Experimental Research 32(7), 1251–1259.
Fowler T, Lifford K, Shelton K et al. (2007). Exploring the relationship between genetic and environmental influences on initiation and progression of substance use. Addiction 102(3), 413–422.
Frishman WH (2009). Smoking cessation pharmacotherapy. Therapeutic Advances in Cardiovascular Disease 3(4), 287–308.
Fuller RK, Branchey L, Brightwell DR et al. (1986). Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. Journal of the American Medical Association 256(11), 1449–1455.
Furieri FA, Nakamura-Palacios EM (2007). Gabapentin reduces alcohol consumption and craving: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry 68(11), 1691–1700.
Garbutt JC, Kampov-Polevoy AB, Gallop R, Kalka-Juhl L, Flannery BA (2010). Efficacy and safety of baclofen for alcohol dependence: a randomized, double-blind, placebo-controlled trial. Alcoholism: Clinical and Experimental Research 34, 1849–1857.
Garbutt JC, West SL, Carey TS, Lohr KN, Crews FT (1999). Pharmacological treatment of alcohol dependence: a review of the evidence. Journal of the American Medical Association 281(14), 1318–1325.
Glover ED, Laflin MT, Schuh KJ et al. (2007). A randomized, controlled trial to assess the efficacy and safety of a transdermal delivery system of nicotine/mecamylamine in cigarette smokers. Addiction 102, 795–802.
Gonzales D, Rennard SI, Nides M et al. (2006). Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs. sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. Journal of the American Medical Association 296(1), 47–55.
Gonzales DH, Nides MA, Ferry LH et al. (2001). Bupropion SR as an aid to smoking cessation in smokers treated previously with bupropion: a randomized placebo-controlled study. Clinical Pharmacology & Therapeutics 69(6), 438–444.
Gourlay SG, Forbes A, Marriner T, Pethica D, McNeil JJ (1995). Double blind trial of repeated treatment with transdermal nicotine for relapsed smokers. British Medical Journal 311(7001), 363–366.
Gourlay SG, Stead LF, Benowitz N. (2004). Clonidine for smoking cessation. Cochrane Database of Systematic Reviews 3, CD000058.
Gunnell D, Irvine D, Wise L, Davies C, Martin RM (2009). Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database. British Medical Journal 339, b3805. doi: 10.1136/bmj.b3805.
Han ES, Foulds J, Steinberg MB et al. (2006). Characteristics and smoking cessation outcomes of patients returning for repeat tobacco dependence treatment. International Journal of Clinical Practice 60(9), 1068–1074.
Hays JT, Ebbert JO (2010). Adverse effects and tolerability of medications for the treatment of tobacco use and dependence. Drugs 70(18), 2357–2372.
Heinälä P, Alho H, Kiianmaa K et al. (2001). Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. Journal of Clinical Psychopharmacology 21(3), 287–292.
Hughes JR, Stead LF, Lancaster T (2000). Anxiolytics for smoking cessation. Cochrane Database of Systematic Reviews 4, CD002849.
Hughes JR, Stead LF, Lancaster T (2007). Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 1, CD000031.
Johnson BA (2008). Update on neuropharmacological treatments for alcoholism: scientific basis and clinical findings. Biochemical Pharmacology 75(1), 34–56.
Johnson BA, Ait-Daoud N, Bowden CL et al. (2003). Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 361(9370), 1677–1685.
Johnson BA, Roache JD, Javors MA et al. (2000). Ondansetron for reduction of drinking among biologically predisposed alcoholic patients: a randomized controlled trial. Journal of the American Medical Association 284, 963–971.
Johnson BA, Rosenthal N, Capece JA et al. (2007). Topiramate for treating alcohol dependence: a randomized controlled trial. Journal of the American Medical Association 298(14), 1641–1651.
Johnson TS (2010). A brief review of pharmacotherapeutic treatment options in smoking cessation: bupropion versus varenicline. Journal of the American Academy of Nurse Practitioners 22, 557–563.
Jorenby DE, Hays JT, Rigotti NA et al. (2006). Varenicline Phase 3 Study Group. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs. placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. Journal of the American Medical Association 296(1), 56–63.
Jorenby DE, Leischow SJ, Nides MA et al. (1999). A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. New England Journal of Medicine 340(9), 685–691.
Karhuvaara S, Simojoki K, Virta A et al. (2007). Targeted nalmefene with simple medical management in the treatment of heavy drinkers: a randomized double-blind placebo-controlled multicenter study. Alcoholism: Clinical & Experimental Research 31(7), 1179–1187.
Kastelic A, Dubajic G, Strbad E (2008). Slow-release oral morphine for maintenance treatment of opioid addicts intolerant to methadone or with inadequate withdrawal suppression. Addiction 103(11), 1837–1846.
Kendler KS, Myers J, Prescott CA (2007). Specificity of genetic and environmental risk factors for symptoms of cannabis, cocaine, alcohol, caffeine, and nicotine dependence. Archives of General Psychiatry 64, 1313–1320.
Kendler KS, Prescott CA, Myers J, Neale MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60(9), 929–937.
Kenna GA (2010). Medications acting on the serotonergic system for the treatment of alcohol dependent patients. Current Pharmaceutical Design 16(19), 2126–2135.
Kiefer F, Helwig H, Tarnaske T et al. (2005). Pharmacological relapse prevention of alcoholism: clinical predictors of outcome. European Journal of Addiction Research 11(2), 83–91.
Kiefer F, Jahn H, Tarnaske T et al. (2003). Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Archives of General Psychiatry 60, 92–99.
Kiefer F, Witt SH, Frank J et al. (2011). Involvement of the atrial natriuretic peptide transcription factor GATA4 in alcohol dependence, relapse risk and treatment response to acamprosate. Pharmacogenomics Journal 11(5), 368–374.
King A, de Wit H, Riley RC et al. (2006). Efficacy of naltrexone in smoking cessation: a preliminary study and an examination of sex differences. Nicotine and Tobacco Research 8(5), 671–682.
Koob GF, Volkow ND (2010). Neurocircuitry of addiction. Neuropsychopharmacology 35(1), 217–238.
Kranzler HR, Modesto-Lowe V, Van Kirk J (2000). Naltrexone vs. nefazodone for treatment of alcohol dependence. A placebo-controlled trial. Neuropsychopharmacology 22, 493–503.
Kranzler HR, Pierucci-Lagha A, Feinn R, Hernandez-Avila C (2003). Effects of ondansetron in early- versus late-onset alcoholics: a prospective, open-label study. Alcoholism: Clinical & Experimental Research 27(7), 1150–1155.
Kranzler HR, Tennen H, Armeli S et al. (2009). Targeted naltrexone for problem drinkers. Journal of Clinical Psychopharmacology 29(4), 350–357.
Krishnan-Sarin S, Krystal JH, Shi J, Pittman B, O’Malley SS (2007). Family history of alcoholism influences naltrexone-induced reduction in alcohol drinking. Biological Psychiatry 62(6), 694–697.
Laaksonen E, Koski-Jännes A, Salaspuro M, Ahtinen H, Alho H (2008). A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol and Alcoholism 43(1), 53–61.
Lancaster T, Stead LF (1998). Mecamylamine (a nicotine antagonist) for smoking cessation. Cochrane Database of Systematic Reviews 2, CD001009.
Laniado-Laborín R (2010). Smoking cessation intervention: an evidence-based approach. Postgraduate Medicine 122(2), 74–82.
Leone MA, Vigna-Taglianti F, Avanzi G, Brambilla R, Faggiano F (2010). Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses. Cochrane Database of Systematic Reviews 2, CD006266.
Martinotti G, Di Nicola M, Di Giannantonio M, Janiri L (2009). Aripiprazole in the treatment of patients with alcohol dependence: a double-blind, comparison trial vs. naltrexone. Journal of Psychopharmacology 23(2), 123–129.
Martinotti G, Di Nicola M, Romanelli R et al. (2007). High and low dosage oxcarbazepine versus naltrexone for the prevention of relapse in alcohol-dependent patients. Human Psychopharmacology 22(3), 149–156.
Morrison MF, Ceesay P, Gantz I, Kaufman KD, Lines CR (2010). Randomized, controlled, double-blind trial of taranabant for smoking cessation. Psychopharmacology (Berlin) 209(3), 245–253.
Nava F, Premi S, Manzato E, Lucchini A (2006). Comparing treatments of alcoholism on craving and biochemical measures of alcohol consumption. Journal of Psychoactive Drugs 38(3), 211–217.
Nides M (2008). Update on pharmacologic options for smoking cessation treatment. American Journal of Medicine 121(4 Suppl. 1), S20–S31.
Nides M, Oncken C, Gonzales D et al. (2006). Smoking cessation with varenicline, a selective alpha4beta2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up. Archives of Internal Medicine 166(15), 1561–1568.
Nutt DJ, King LA, Phillips LD (2010). Independent Scientific Committee on Drugs. Drug harms in the UK: a multicriteria decision analysis. Lancet 376(9752), 1558–1565.
Nutt DJ, King LA, Saulsbury W, Blakemore C (2007). Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 369(9566), 1047–1053.
O’Malley SS, Cooney JL, Krishnan-Sarin S et al. (2006). A controlled trial of naltrexone augmentation of nicotine replacement therapy for smoking cessation. Archives of Internal Medicine 166(6), 667–674.
Ooteman W, Naassila M, Koeter MW et al. (2009). Predicting the effect of naltrexone and acamprosate in alcohol-dependent patients using genetic indicators. Addiction Biology 14(3), 328–337.
Orman JS, Keating GM (2009). Buprenorphine/naloxone: a review of its use in the treatment of opioid dependence. Drugs 69(5), 577–607.
Oslin DW, Berrettini W, Kranzler HR et al. (2003). A functional polymorphism of the mu-opioid receptor gene is associated with naltrexone response in alcohol-dependent patients. Neuropsychopharmacology 28(8), 1546–1552.
Parsons A, Ingram J, Inglis J et al. (2009). A proof of concept randomised placebo controlled factorial trial to examine the efficacy of St John's wort for smoking cessation and chromium to prevent weight gain on smoking cessation. Drug and Alcohol Dependence 102(1–3), 116–122.
Rehm J, Mathers C, Popova S et al. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 373(9682), 2223–2233.
Rehm J, Taylor B, Room R (2006). Global burden of disease from alcohol, illicit drugs and tobacco. Drug and Alcohol Reviews 25, 503–513.
Rigotti NA, Gonzales D, Dale LC, Lawrence D, Chang Y; CIRRUS Study Group. (2009). A randomized controlled trial of adding the nicotine patch to rimonabant for smoking cessation: efficacy, safety and weight gain. Addiction 104(2), 266–276.
Rohsenow DJ, Miranda R Jr, McGeary JE, Monti PM (2007). Family history and antisocial traits moderate naltrexone's effects on heavy drinking in alcoholics. Experimental and Clinical Psychopharmacology 15(3), 272–281.
Roozen HG, de Waart R, van den Brink W (2007). Efficacy and tolerability of naltrexone in the treatment of alcohol dependence: oral versus injectable delivery. European Addiction Research 13(4), 201–206.
Rose JE, Behm FM, Drgon T, Johnson C, Uhl GR (2010). Personalized smoking cessation: interactions between nicotine dose, dependence and quit-success genotype score. Molecular Medicine 16(7–8), 247–253.
Rose JE, Behm FM, Westman EC (1998). Nicotine-mecamylamine treatment for smoking cessation: the role of pre-cessation therapy. Experimental and Clinical Psychopharmacology 6(3), 331–343.
Rose JE, Behm FM, Westman EC et al. (1994). Mecamylamine combined with nicotine skin patch facilitates smoking cessation beyond nicotine patch treatment alone. Clinical Pharmacology & Therapeutics 56(1), 86–99.
Rösner S, Hackl-Herrwerth A, Leucht S et al. (2010 a). Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews 12, CD001867.
Rösner S, Hackl-Herrwerth A, Leucht S et al. (2010 b). Acamprosate for alcohol dependence. Cochrane Database of Systematic Reviews 9, CD004332.
Rubio G, Jiménez-Arriero MA, Ponce G, Palomo T (2001). Naltrexone versus acamprosate: one year follow-up of alcohol dependence treatment. Alcohol and Alcoholism 36(5), 419–425.
Scharfenberg G, Benndorf S, Kempe G (1971). [Cytisine (Tabex) as a pharmaceutical aid in stopping smoking]. Das Deutsche Gesundheitswesen 26(10), 463–465.
Sellers EM, Toneatto T, Romach MK et al. (1994). Clinical efficacy of the 5-HT3 antagonist ondansetron in alcohol abuse and dependence. Alcoholism: Clinical & Experimental Research 18(4), 879–885.
Shah SD, Wilken LA, Winkler SR, Lin SJ (2008). Systematic review and meta-analysis of combination therapy for smoking cessation. Journal of the American Pharmaceutical Association 48(5), 659–665.
Sood A, Ebbert JO, Prasad K et al. (2010). A randomized clinical trial of St. John's wort for smoking cessation. Journal of Alternative and Complementary Medicine 16(7), 761–767.
Stead LF, Hughes JR (1997). Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 3, CD000124.
Stead LF, Perera R, Bullen C, Mant D, Lancaster T (2008). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 1, CD000146.
Tidey JW, Monti PM, Rohsenow DJ et al. (2008). Moderators of naltrexone's effects on drinking, urge, and alcohol effects in non-treatment-seeking heavy drinkers in the natural environment. Alcoholism: Clinical & Experimental Research 32(1), 58–66.
Toll BA, White M, Wu R et al. (2010). Low-dose naltrexone augmentation of nicotine replacement for smoking cessation with reduced weight gain: a randomized trial. Drug and Alcohol Dependence 111(3), 200–206.
Tonstad S, Tønnesen P, Hajek P et al. (2006). Varenicline Phase 3 Study Group. Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. Journal of the American Medical Association 296, 64–71.
Tsukahara H, Noda K, Saku K (2010). A randomized controlled open comparative trial of varenicline vs. nicotine patch in adult smokers: efficacy, safety and withdrawal symptoms (the VN-SEESAW study). Circulation Journal 74(4), 771–778.
Tyacke RJ, Lingford-Hughes A, Reed LJ, Nutt DJ (2010). GABAB receptors in addiction and its treatment. Advances in Pharmacology 58, 373–396.
Uhl GR, Liu QR, Drgon T et al. (2008). Molecular genetics of successful smoking cessation: convergent genome-wide association study results. Archives of General Psychiatry 65(6), 683–693.
Unger A, Jung E, Winklbaur B, Fischer G (2010). Gender issues in the pharmacotherapy of opioid-addicted women: buprenorphine. Journal of Addictive Diseases 29(2), 217–230.
van Amsterdam J, Opperhuizen A, Koeter M, van den Brink W (2010). Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population. European Journal of Addiction Research 16(4), 202–207.
Verheul R, Lehert P, Geerlings PJ, Koeter MW, van den Brink W (2005). Predictors of acamprosate efficacy: results from a pooled analysis of seven European trials including 1485 alcohol-dependent patients. Psychopharmacology (Berlin) 178(2–3), 167–173.