By Marcus F. Kuntze, Franz Muller-Spahn, Dieter Ladewig, Alex H. Bullinger
For the 1st time, experiences on methadone and heroin upkeep therapy with recognize to scientific perform, learn, methodological features, neuroscience and psychotherapy are introduced jointly during this quantity. They come up from a convention held in November 2001 in Basel. The Swiss technique of a hugely established outpatient therapy utilizing methadone, heroin, morphine and so on. to maintain sufferers in therapy is mentioned. facts of follow-up after heroin-assisted remedy is proven. additionally a severe dialogue of the background of therapy modalities and its clinical overview is gifted. extra vital subject matters corresponding to mind imaging, opioid withdrawal, hazards of therapy, and simple neurochemical examine are offered. the problem concludes with the narrative event of a practising psychotherapist. This topical and notable assessment comes in handy for psychiatrists, psychologists and psychotherapists, neuroscientists, physicians in addition to selection makers in public health and wellbeing, politicians, counselors and social employees an exceptional perception into stimulating and medical study.
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Extra info for Basic and Clinical Science of Opioid Addiction
Dr. O. com Rehm 38 Neurosciences Kuntze MF, Müller-Spahn F, Ladewig D, Bullinger AH (eds): Basic and Clinical Science of Opioid Addiction. Bibl Psychiatr. Basel, Karger, 2003, No 170, pp 39–45 Dopaminergic Dysfunction – A Common Final Pathway of Addiction to Alcohol, Opiates and Nicotine? Lutz G. Schmidt a, Michael N. Smolkab, Hans Rommelspacher b a b Department of Psychiatry, University of Mainz; Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany Numerous studies have shown that natural rewards, including food, drinks and sex and many drugs of abuse interact with the central brain system by enhancing dopamine turnover in certain sites following acute administration, especially the mesolimbic-mesocortical circuitry .
In the case of psychostimulants and opioids, in vivo measurements of extracellular dopamine levels have provided direct evidence that these drugs, when administered under an intermittent injection schedule, can lead to a more pronounced increase in dopamine levels than the increase seen after acute administration of these drugs . However, rats that received repeated intermittent injections of alcohol did not show sensitization of alcohol-induced dopamine release in the nucleus accumbens. Current conceptualizations of the significance of sensitization in compulsive drug-seeking behavior hold that rather than enhancing the reward, repeated drug use leads to a progressive and persistent hypersensitivity of neural systems that mediate incentive salience, possibly resulting in drug or alcohol craving and relapse [4–6].
Conclusions with Respect to Randomized Controlled Clinical Trials in Opioid-Assisted Substitution Therapy Randomized controlled clinical trials did not seem to be feasible in research on opioid-assisted substitution therapy. Specifically blinding of patients and caregivers seems to be impossible. It is thus suggested that such trials be conducted unblinded but incorporate expectations of patients and caregivers and explicitly measure content and level of the care given. With respect to other standards of control, randomization may be possible but effects of expectations should be carefully considered in design and interpretation.