Addiction specific agents

Efforts to identify the specific compounds responsible for the psychotropic effects of volatile solvents are complicated by the fact that many of these products contain more than one potentially psychoactive ingredient. Another factor obscuring the identity of the psychoactive ingredients of these agents is that patients addicted to these compounds frequendy seek the effects not of the product s primary ingredient but of a secondary ingredient such as the propellant gas (e.g., nitrous oxide). To date, the best-studied psychoactive compounds identified in volatile solvents include toluene, 1,1,1-trichloroethane, and trichloroethylene. However, other less well studied compounds, such as benzene, acetone, and methanol, also appear to have significant psychoactive effects. 

Studies have been conducted in animals to attempt to clarify the role of varying rates of drug metabolism in humans and animals and the likelihood for development of addiction/dependence to narcotics. Hydromorphone has been studied in several animal models because it is metabolized in humans by specific cytochrome P450 isoenzymes. So far, studies have looked at administration of agents that either block or promote P450 isoenzymes responsible for hydrocodone metabolism and the impact of enhanced or degraded metabolism of hydrocodone on those animal models. Results in rats and rhesus monkeys have demonstrated little effect from modifying hydrocodone metabolism. 

Several selective serotonin reuptake inhibitors (SSRIs), including escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline (Fig. 22.21), are effective as first-line treatment cf seme anxiety disorders, with the purported advantage that they lack the addictive preperties cf benzediazepines (135). Specifically, the SSRIs have been shown to be effective in obsessive-ccmpulsive diserder (139), panic disorder (140), and social phobia (141). The mechanism of action of these agents in anxiety may differ with their role in the treatment of depression however,... 

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