Table 5. Pharmacological treatments for substance dependence

Substance Treatment Efficacy
Alcohol Acamprosate is a synthetic substance with structural similarity to a naturally occurring amino acid. Restores the normal activity of neurons, which become hyperexcited as a result of chronic exposure to alcohol. Overall, patients treated with acamprosate exhibit a significant increase in rate of completion of treatment, time to first drink, abstinence rate and/or cumulative duration of abstinence, compared with patients treated with placebo.
Naltrexone: Blocks opioid receptors. Naltrexone is effective in reducing relapse and in helping people to remain abstinent and to decrease alcohol consumption.
Disulfiram interferes with the normal metabolism of acetyaldehyde, a metabolite of alcohol. High acetaldehyde levels produce an unpleasant reaction that is intended to render the consumption of alcohol aversive. The efficacy of disulfiram is variable, and is confounded by the need to carefully titrate the dose, and by the need for a high degree of compliance.
Nicotine Nicotine substitution with nicotine patch or gum. All nicotine-replacement therapies are equally effective in helping people to quit smoking, and, combined with increased public service announcements in the media about the dangers of smoking, have produced a marked increase in successful quitting
Bupropion: A weak norepinephrine and dopamine reuptake inhibitor, and a nicotinic receptor blocker. Bupropion improves the abstinence rates of smokers, especially if combined with nicotine replacement therapy .
Immunotherapy: Vaccines that can prevent nicotine from acting on the brain have been proposed. Vaccines are not yet ready for clinical trials. Trials with mice show promising results.
Heroin Methadone (synthetic opioid agonist). Methadone maintenance treatment is safe, and very effective in helping people to stop taking heroin, especially when combined with behavioural therapies or counseling and other supportive services.
Buprenorphine: Partial agonist at the mu opioid receptor and a weak antagonist at the kappa opioid receptor. Relatively long duration of action and good safety profile.
Levo-alpha-acetyl-methadol (LAAM): a synthetic opioid. Long-acting synthetic opioid that can be used to treat heroin dependence, but it needs only be taken three times per week, thus making it even easier for people to use this therapy.
Naltrexone blocks the effects of morphine, heroin and other opioids by acting as antagonist at the opioid receptors. This therapy begins after medically supervised detoxification, because naltrexone does not protect against the effects of withdrawal, and can in fact precipitate withdrawal symptoms in dependent people. Naltrexone itself has no subjective effects or potential for the development of dependence. Patient noncompliance is a common problem. Therefore, a favourable treatment outcome requires that there also be a positive therapeutic relationship, effective counselling or therapy, and careful monitoring of medication compliance.
Cocaine GBR 12909 is an inhibitor of dopamine uptake that antagonizes the effects of cocaine on mesolimbic dopamine neurons in rats, and blocks self-administration of cocaine in rhesus monkeys. Clinical trials of this substance were at the planning stage in 2004.
Immunotherapies: cocaine is sequestered in the bloodstream by cocaine specific antibodies that prevent its entry into the brain. Clinical trials are underway.
Sedatives/hypnotics Slow tapering of substance dose combined with behavioural therapy. Effective.

Source: WHO  Neuroscience of Psychoactive Substance Use and Dependence, Summary (2004),
Global use of psychoactive substances and burden to health, p.27-28

Related publication:
Psychoactive Drugs homePsychoactive Drugs Tobacco, Alcohol, and Illicit Substances
Other Figures & Tables on this publication:

Table 1. Prevalence of smoking among adults and youths in selected countries

Table 3. Percentage of total global mortality and DALYs attributable to tobacco, alcohol and illicit substances

Depressants – overview of effects

Table 5. Pharmacological treatments for substance dependence

Table 2. Annual prevalence estimates of global illicit substance use, 2000-2001Table 2. Annual prevalence estimates of global illicit substance use, 2000-2001

Figure 3. A terminal button and synapse

Figure 4. Two types of chemical synapses

Table 4. Summary of psychoactive substance effectsTable 4. Summary of psychoactive substance effects

Figure 5. Mesolimbic dopamine pathway

Box 3. Risk and protective factors for substance use

Figure 1. Adult (15+) Per Capita Alcohol Consumption by Development Status

Figure 2. Mechanisms relating psychoactive substance use to health and social problems

Box 4: Types of psychotherapies and behavioural interventions

Box 1: Injecting substance use and HIV/AIDS

Box 2: Criteria for substance use dependence in ICD-10