Abstract: In the recent years several drugs with an anticraving effect have been developed. These drugs should reduce the urge to drink alcohol. In the near future some of these drugs with different pharmacological profiles will be introduced to several European countries. That’s why a critical review of the psychobiological concept craving is necessary. Although widely used craving is an illdefined term. Craving has been associated with different psychological concepts that are mostly based on behavorial theories. Furthermore, some biochemical findings probably associated with craving are reviewed. However, thus far the assessment of craving is based on self-reports, since it is a subjective cognition like pain. The magnitude of craving depends on situational factors, varying with time and place. Thus, a sufficient assessment has to include the conditions and expectancies occurring together with craving.

Abstract: The efficacy of clonidine, methadone, and guanfacine in rapid detoxification of heroin inpatients was assessed in a randomized controlled clinical trial. Signs and symptoms of abstinence and of side effects were analysed in 90 heroin addicts successfully completing a 12–day inpatient trial, all patients fit DSM-III criteria for opioid dependence, the age range being 18 to 36 years. All three drugs were effective in controlling abstinence; however, the course of abstinence was different in the methadone group as compared to the adrenergic agonists, the latter showing limitations in their ability to suppress withdrawal manifestations. While mean number of withdrawal signs and symptoms was significantly tower during days 2 to 5 in the methadone group (p < 0.01), adrenergic agonists were slightly more effective at the end of the trial. Incidence of side effects was closely related to the dose administered. Hypotensive action of adrenergic agonists was more marked in orthostatic position. The present results suggest that methadone is superior to adrenergic agonists. Between these drugs clonidine appears to be less effective than guanfacine in controlling some withdrawal manifestations, and causes more side effects, mainly of cardiovascular nature.

Abstract: A Genève, de nombreuses mesures ont été prises pour améliorer la situation sanitaire des usagers de drogues: libre accès au matériel d’injection, augmentation et diversification des traitements (incluant méthadone et prescription expérimentale d’héroïne), accès aux soins de santé primaire et campagne de vaccination contre l’hépatite B. En 1993, un poste d’infirmier spécialisé en toxicodépendance a été crée à l’Hôpital Cantonal afin de mieux répondre aux besoins de soins spécifiques de ces patients. Cette étude décrit les principales caractéristiques socio-démographiques des patients toxicodépendants hospitalisés, des problèmes de santé motivant les hospitalisations ainsi que l’évolution des problèmes de santé sur cinq années (1993 -1998). Les principaux résultats montrent une augmentation importante du nombre de patients déjà suivis en milieu spécialisé au moment de l’hospitalisation, une baisse de la séroprévalence VIH et VHB et peu de changement concernant la séroprévalence de l’hépatite C. L’évolution des motifs d’hospitalisation montre une baisse relative des hospitalisations liées au Sida et aux accidents et une augmentation des hospitalisations liées aux abcès, probablement en lien avec une récente augmentation de la consommation de cocaïne par injection.

Abstract: alcohol exei.ts numerous pharmacological effects through its interaction with various neurotransmitters and neuromodulators. Among the latter, the endogenous opioids playa key role in the rewarding (addictive) properties of ethanol. Three types of opioid receptors represent the respective targets of the major opioid peptides (p-endorphin, enkephalins and dynorphins, respectively). The rewarding (reinforcing) properties of 11- and 8-receptor ligands are brought about by activation of the mesolimbic dopamine system which ascends from the ventral tegmentum of the midbrain (VTA) to rostral structures: of these, the nucleus accumbens (NAC) is of particular importance in drug addiction. In contrast, dysphoria results from activation of K-receptors. The neurochemical manifestations of these opposing effects are, respectively, increases and decreases in dopamine release in the NAC. Several lines of evidence indicate that alcohol interferes with endogenous opioid mechanisms which are closely linked with dopamine transmission in the mesolimbic pathway. The view that condensation products of dopamine and alcohol-derived aldehyde (tetrahydroisoquinolines) playa role remains controversial. There is. however, much information on the direct (acute and chronic) effects of alcohol on the binding properties of opioid receptors, as well as modulation of opioid peptide synthesis and secretion (e.g. a suggested increase in p-endorphin release). In view of the reinforcing properties of alcohol. it is relevant to consider behavioural studies involving alcohol self-administration in rodents and primates. Low doses of morphine have been found to increase. and higher doses of the opiate to decrease, alcohol consumption. Conversely, opi()id antagonists such as naloxone and naltrexone (which bind to non-selectively opioid receptors) have been shown to decrease alcohol consumption under various experimental conditions. Similar results have been reported when selective 11- or b-receptor antagonists are administered. Results obtained in genetic models of high preference for alcohol also support the view that alcohol intake depends on the activity of the endogenous opioid reward system and that alcohol consumption may serve to compensate for inherent deficits in this system. One hypothetical model proposes that reward results from activation of opioid receptors in the VTA and/or b-receptors in the NAC; both these nuclei are targets of endogenous p-endorphin. It is suggested that alcohol interferes with this reward pathway either directly or indirectly. The available experimental data accord well with those obtained from clinical studies in which opioid antagonists have been used to prevent relapse in alcoholics. Conceptual considerations concerning communalities between various forms of addictions are also discussed in this review.