Medications for the Treatment of Addiction – A Neurobiological Perspective

Summary

Tremendous breakthroughs in the basic neurobiology of addiction provide a framework for medication development that is unparalleled in biological psychiatry. Medications currently on the market for the treatment of addiction open a window on the opportunities to facilitate treatment and provide a means for evaluating future medications. The potential for the development of future medications for the treatment of addiction is significant on a number of fronts. A combination of excellent, validated animal models of addiction and an enormous surge in our understanding of the neurocircuits and neuropharmacological mechanisms involved in the development and maintenance of addiction reveal numerous possible targets. Such targets will be derived from this basic research on addiction, with a focus on the neuroadaptive changes that account for the transition to dependence and vulnerability to relapse, possibly within a genetic context. An interactive, iterative process called the Rosetta Stone approach can be established whereby existing medications are used to validate and improve animal and human laboratory models and then predict viable candidates for novel medications.

The development of medications for the treatment of addiction has been a priority in the United States. Similar efforts in the private sector and other countries are being encouraged. Areas of success include the successful development and validation of pharmacological aids to treatment of addiction (e.g., buprenorphine, naltrexone, varenicline, and acamprosate) and the necessary infrastructure for some aspects of drug development. For example, the National Institute on Drug Abuse (part of the United States National Institutes of Health) has established an extensive clinical trials network (http://www.nida.nih.gov/ctn/; accessed February 18, 2014). Nevertheless, despite the tremendous resources that have been devoted to the development of pharmacotherapies for cocaine addiction, little or no success has yet been reported. The burgeoning use of human laboratory studies and the Rosetta Stone approach to link human and animal studies may yield better success. To aid medication development for addiction, the pharmaceutical industry would need to consider addiction as a disease with a therapeutic drug target that is potentially profitable. Recent success with acamprosate, naltrexone, varenicline, and buprenorphine should provide some indication that expanded directions are merited in the addiction field.

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