CHAPTER 2 Mental and Behavioral Health Table 21-4 Pharmacotherapies for Substance use Disorders Medication Mechanism of Action GABA agonist dent patients nhibits breakdown of acetylaldehyde: produces g:only effective if administration headache, facial flushing, and nausea/vomit pervised, otherwise patients are noncomplia distress associated with tor activity; reduces Promotes maintenance of abstinence: more effective than placebo Ondansetron Reduces serotonin receptor activity Discourages drinking; particularly effective for alcoholism with onset before age 25 Nicotine es nicotine obtained through smoking: ng recommended for short-term use only B Uncertain; presumably blocks the reinforcing Effective for promoting smoking abstinence initiation effects of nicotine Nicotine vaccine Blocks nicotine from entering brain, reducing its Currently under investigation euphoric effects Opioids Methadone all opioid agonist Effective as a maintenance medicatio Buprenorphine rtial opioid agonist Naltrexone Effective for reversing overdose Patient must be fully detoxified to begin medication; poor Under investigation for use in rapid opioid detoxification Modified from Miller WR, Carroll KM, editors: Rethinking substance abuse: what the science shows, and what we should do about it, New York, 2006, Guilford Y-Aminobutyric acid. Mimicking the effects of drugs and therefore preventing society. Research has begun to identify the shared and unique withdrawal as well as blocking their euphoric effects risk factors as well as protective factors associated with these disorders. Shared risk factors include poor parent-child a Preventing drugs from entering the brain and thereby bonding and inadequate parenting skills, parental mental Ing health problems, poverty, and stress. Unique risk factors behavioral inhibition for anxiety and depression versus dis- Although considerable research has been done to identify inhibition for behavioral disorders; anxious role models for effective pharmacotherapies for stimulants, such as cocaine, anxiety disorders; and substance-using role models for sub none has received U.S. Food and Drug Administration stance use disorders. Shared protective factors include social FDA) approval at present. However, ongoing research is support and social and emotional competence. Despite testing the efficacy of a cocaine vaccine. Moreover, there advances in the development of effective prevention and are no FDA-approved pharmacotherapies for marijuan intervention approaches, further research is needed to ens which is itself now a legal medical therapy in many states that prevention policies and interventions are grounded o In addition to interventions that increase abstin theory, are culturally-informed and relevant, and reflect and prevent relapse, other medical interventions are designed state-of-the-art (evidence-based)knowledge, to reduce the to reduce harm and prevent overdose or death. For example, burden of these disorders while improving quality of life programs in which opioid-addicted individuals are pre scribed and trained to use naloxone(opioid antagonist)are effective for reversing the effects of opiate overdose in as References many as 96% of cases. Needle exchange programs, in which I. Hosman C, Jane-Llopis E, Saxena S: Prevention of mental dis- injection drug users can safely exchange used for unused orders: effective interventions and policy options-summary hypodermic needles, are designed to prevent transmission of report, Oxford, 2005, Oxford University Press infectious diseases as well as facilitate entry into treatment. 2. American Psychiatric Association: Diagnostic and statistical revention education and HIV testing, providing condoms, manual of mental disorders, ed 4, text revision, Washington, DC, and drug substitution therapy may help reduce the spread 2000,AP of Hiv and other transmissible infections 3. Miller WR, Carroll KM, editors: Rethinking substance abuse: should do about it New York, 2006. Guilford I. SUMMARY 4. Holden C: Behavioral" addictions: do they exist? Science 294:980-982,2001 5. Grant JE, Potenza MN, Weinstein A, et al: Introduction lental health/behavioral disorders and suicide are prevalent to behavioral addictions, Am) Drug Alcohol Abuse 36: 233-241 and exact significant tolls on individuals, families, and