The Neurobiology of Opioid Dependence: Implications for Treatment

Abstract

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.

An Integrative Common Liabilities Model for the Comorbidity of Substance Use Disorders with Externalizing and Internalizing Disorders

“…The midbrain dopamine reward system is a neurobiological mechanism involved in addiction to virtually all drugs of abuse (Kosten, George, & Kleber, 2005;Nestler, 2005) that has been proposed to underlie aggressive behavior as well (Patrick, 2006), which provides further support for genetic liability shared among SUDs and antisocial disorders. Consistent with this, Gray's model of motivational systems proposes two neurologically based personality systems:…”

Opiate addiction - current trends and treatment options

“…30 Treatment with methadone reduces relapse rates as well thus enabling patients to concentrate on their day-to-day tasks, maintain relationships and holding jobs. 31 Methadone is usually well tolerated but like other opiate agonists it can cause lethal respiratory suppression when given at high doses that exceed an individual's tolerance. However for addiction treatment, higher levels of dosing supervision causes reduced mortality rates.…”

“…Also, it has less overdose potential than methadone since it blocks other opioids and even itself as the dosage increases. 31 Naltrexone is another opiate that helps patients avoid relapse after detoxification. It is a semi-synthetic mu and kappa opioid receptor antagonist used in the treatment of opiate addiction.…”

Long-term Suboxone Treatment and its Benefit on Long-Term Remission for Opiate Dependence

“…Compounding the issue of opiate dependence, habitual opiate consumption leads to opioid intoxication, a sense of euphoria and additional pleasurable feelings. Opioid intoxication results from the binding of opioids to the mu receptors and subsequent release of the neurotransmitters that influence mood to [9,10].…”