Alcohol dependence, and opiate, cocaine and other stimulant addictions, are all diseases of the brain that have behavioral manifestations and they are not due to criminal behavior alone or to antisocial or "weak" personality disorders. These observations and others will be shared during the 41st annual scientific meeting of the Research Society on Alcoholism (RSA) in San Diego June 17-21.
"Addictive diseases depend on multiple variants of multiple genes working in concert to increase an individual's vulnerability to developing an addiction and also self-exposure to alcohol, opiates, cocaine, or other drugs of abuse," said Mary Jeanne Kreek, professor and head of the Laboratory of the Biology of Addictive Diseases at The Rockefeller University. "In addition, laboratory research has shown that each of these drugs of abuse – alcohol, opiates, and cocaine – cause profound changes in gene expression of multiple genes, especially of the opioid, classical neurotransmitter, and stress-responsive systems, which result in changes in behaviors."
Kreek will make her comments at the RSA plenary on June 17.
"I also want to emphasize three points regarding the devastating current opioid crisis in the U.S.," said Kreek. "One, physicians should prescribe a maximum of one week of opiates for relief of acute pain. Only one to three days is needed in most patients, not three weeks as is currently prescribed. Two, naloxone – a safe but short-acting treatment for a suspected opiate overdose – should be available at an affordable price to not only medical personnel, but also first responders, families and others who interact with people using or addicted to opiates. Three, the two extremely effective treatments for opiate addiction – methadone maintenance pharmacotherapy and buprenorphine-naloxone maintenance – should be made far more widely available throughout our country, and the excessively stringent regulations governing methadone maintenance treatment should be relaxed at federal and state levels."
Kreek added that specific medications for treatment of specific addictive diseases should be used much more extensively. "Both naltrexone, approved in the U.S., and nalmefene, approved in Europe, are effective in 20 to 40 percent of alcoholic patients, and especially effective in alcoholic persons with one or two copies of the "A118G" variant of the mu opioid receptor," she said. While pharmacotherapeutic options for cocaine and other stimulants do not presently exist, her lab is currently synthesizing potential treatments for both alcoholism and cocaine dependency.