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Heroin Addiction and Related Clinical Problems: 2004, 06, 2 (pages: 5 - 52)

Craving in Opiate, Cocaine and Alcohol Addiction

Kreek M. J., Zhon Y., Schussman S.

Summary: In this overview, we have very briefly covered our basic clinical research studies, as well as a few of our molecular, neurobiological, and behavioural laboratory studies, each of which have given insights into the possible contributors to the neurobiological basis of craving and “drug hunger”. We have also proposed recently that specific medications might be directed at each of these disrupted components of physiology to achieve a “steady-state” and thus normalization of physiological function. We hypothesized years ago, and renew the hypothesis now ,with respect to long-acting opioid agonist treatment of heroin addiction, specifically and primarily methadone maintenance, but also more recently LAAM maintenance and bupernorphine-naloxone treatment, each by the oral (or sublingual) route, that these treatments may achieve normalization of disrupted functions and, at the same time, lead to a reduction of elimination of “drug hunger,” “drug craving,” drug-seeking behavior, and drug self-administration. Future studies, especially studies looking at the interface of genetic factors and environmental factors, combined, of course, with the profound drug-induced factors, may allow us to develop further insights into the biological substrates of craving, and thus enhance our capability of developing both behavioural and pharmacological early interventions, as well as treatments for those with chronic diseases of specific types (see Figure 32 and Figure 33).