Treatment: abstinence models

Carroll et al. (2004) conducted another study examining psychotherapy and disulfiram treatment for cocaine dependence. In this randomi2ed, doubleblind, placebo-controlled study, patients (iV=121) were assigned to one of four conditions 1) disulfiram plus CBT 2) disulfiram plus interpersonal therapy (IPT), which addressed adherence to a medical model of psychiatric problems, interpersonal functioning, and supportive therapeutic exploration 3) placebo plus CBT or 4) placebo plus IPT. The patients who received disulfiram reduced their cocaine use, relative to those who received placebo, and the patients who received CBT reduced their cocaine use, relative to those who received IPT. Cocaine abstinence among the patients who received CBT plus placebo was not statistically different from that of the patients who re-... 

As mentioned in Chapter 1, treatment success is defined differently depending on which model of recovery and treatment you believe (also see Chapter 5). For example, in traditional Minnesota-model treatment modalities, treatment success is defined by a period of sustained abstinence. This period of abstinence is... 

Relapse prevention, as mentioned, is compatible with a variety of treatment models. For example, many Minnesota-model facilities have incorporated aspects of cognitive behavioral relapse prevention into their treatment and aftercare programs. There have been efforts to combine the relapse prevention model with disease-model instructions to maintain abstinence after treatment is completed. Minnesota-model relapse prevention is generally begun late in treatment and then continued into aftercare. There are numerous books and manuals that have incorporated relapse prevention methods into this particular model. 

An advantage of the hedonic allostasis hypothesis is that it provides a basis for the strong comorbidity of drug addiction and depression. However, this relationship with depression is also the limit of the hypothesis. Thus, anhedonia induced by cocaine withdrawal has been proposed as a model of depression also on the basis of the observation that antidepressants reverse withdrawal-induced anhedonia yet, antidepressants do not provide a treatment for drug addiction. Therefore it would appear that anhedonia is a condition associated to drug addiction but is not the factor that sustains its maintenance or its resumption after a long period of abstinence. 

Other abstinence symptoms, induced by naloxone was prevented when this dose of CUSO4 was given to morphine-dependent mice. Finally, Marzullo and Hine [212] demonstrated that intracerebral (i.c.) injection of CuClj (ED50 = 4.8 nmol) produced naloxone-reversible analgesia in the tail-flick pain model. Intracerebral treatment with 10-25 nmol dithiothreitol, but not its disulphide, reversed analgesia produced by CuClj and also antagonized morphine analgesia. 

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