Browsing by Person "Nutt, David J."

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Substitution therapy for alcoholism: time for a reappraisal?
(Sage, 2012-02) Chick, Jonathan; Nutt, David J.
A number of compounds already in use as medications for various indications substitute for ethanol at clinically relevant brain pathways, in particular, at gamma-aminobutyric acid (GABA) receptors. Nevertheless, although substitute medications have been recognized for heroin and tobacco dependence, patients with alcohol dependence are rarely offered an analogous approach. Benzodiazepines may have paradoxical effects, and abuse and dependence are known. Baclofen (GABAB agonist) has not been associated with dependence or misuse and has been effective in several trials in preventing relapse, although research is required to establish the optimal dosing regimen. GABA-ergic anticonvulsants, helpful in treating withdrawal, have yet to emerge as effective in relapse prevention. Clomethiazole and sodium oxybate, the latter having been shown to be effective in relapse prevention, have incurred a reputation for dependence and abuse. However, data have emerged showing that the risk of abuse of sodium oxybate is lower than many clinicians had foreseen. For a condition where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality, the time now seems right for reappraising the use of substitute prescribing for alcohol dependence.
Through a glass darkly: Can we improve clarity about mechanism and aims of medications in drug and alcohol treatments?
(Sage, 2012-02) Nutt, David J.; Lingford-Hughes, Anne; Chick, Jonathan
The treatment of addiction and dependence on, and misuse of, alcohol and other drugs is one of the largest unmet needs in medicine today, so the development of new treatments is a pressing need. However, we have seen the development and use of different terminologies for different drug addictions, which confuses prescribers, users and regulators alike. Here we try to clarify terminology of treatment models based on the pharmacology of treatment agents. This editorial covers all drugs that are used for their pleasurable effects and which therefore can lead to harmful/hazardous use, dependence and addiction. These include nicotine, alcohol and abused prescription drugs such as benzodiazepines, as well as opioids and stimulants.