Prevention of relapse to addiction: information for the practitioner

The purposes of this review are to convey the current distinction between pathological drug dependence and voluntary drug abuse; to provide an overview of the anatomy and biochemistry of dependence; to discuss the rationale for attempting to prevent relapse by using therapeutic agents; and to describe effective agents that reduce relapse in alcohol- and opioid-dependent people. Drug dependence (formerly called "addiction") has as its essential characteristic "impaired control over use of the drug." Impaired control occurs when pathways are sensitized within the emotional brain, (usually) in genetically predisposed individuals. At the nerve cell level, impaired control occurs because of a type of neural adaptation (change in synaptic plasticity) within the pathway's nerve cells that alters their chemistry. Relapse in alcohol-dependent patients can be prevented by any of several agents that reduce craving for alcohol: naltrexone (ReVia), ondansetron (Zofran), and acamprosate (Campral, not yet available in the United States). Relapse in opioid-dependent patients can be prevented by the full agonists methadone and L-alpha-acetyl-methadol (LAAM) and the partial opioid agonist buprenorphine (Subutex and Suboxone). No other universally effective anti-relapse medications exist for other chemical dependencies.