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[Substitution therapy in drug addictions]
Marc Auriacombe1, Mélina Fatseas, Pascale Franques-Rénéric
1Faculté de médecine Victor Pachon, Université Bordeaux 2, 33000 Bordeaux. marc.auriacombe@labopsy.u-bordeaux2.fr
La Revue Du Praticien
|August 19, 2003
Summary
Substitution treatments for addiction, including nicotine, buprenorphine, and methadone, aim to reduce cravings for maintaining abstinence, not replacing one substance with another. Success depends on clear goals, proper dosing, and sufficient time for patients.
Area of Science:
- Addiction Psychiatry
- Pharmacology
Context:
- France's "substitution treatments" for addiction include nicotine, buprenorphine, and methadone.
- The term "substitution" creates ambiguity regarding treatment objectives.
Purpose:
- Clarify the role of pharmacological treatments in maintaining abstinence.
- Investigate the use of low-reinforcement medications to reduce craving.
- Differentiate treatment goals for tobacco versus opiate dependence.
Summary:
- Addiction psychiatry views these treatments as tools for maintaining abstinence, not substituting one addiction for another.
- Effective treatment requires clear patient goals, adequate medication dosage, and sufficient treatment duration.
- Nicotine patches are distinct from other nicotine substitutes due to lower reinforcement potential and accessibility without prescription.
Impact:
- Supervised dispensing of buprenorphine and methadone can improve compliance and prevent misuse.
- Lack of medical supervision for nicotine patches may lead to frequent patient dropouts.
- Misuse of buprenorphine and methadone might stem from attempts to enhance reinforcing effects.