Preclinical Development and Clinical Implementation of Treatments for Substance Abuse Disorders

Substance abuse continues to be a major source of morbidity and mortality around the world. Preclinical research on substance abuse continues to focus on determining the neurobiological substrates underlying this disorder and using this information to develop new and more efficacious treatment strategies. Studying drug self-administration in laboratory animals is a powerful approach with clear-cut and dynamic links between preclinical findings and substance abuse in humans. It has been and will continue to be a valuable procedure for developing pharmacological and nonpharmacological treatment modalities for substance abuse. Currently, pharmacological treatment of substance abuse disorders includes drugs for replacement therapy, drugs that produce aversive effects, or drugs that alter or modulate neurotransmission in systems involved in the rewarding effects of abused drugs. Pharmacological agents are in various stages of testing or are now available for the treatment of nicotine, opioid, ethanol, and stimulant dependence. The most effective treatments of substance abuse disorders also include psychosocial interventions. Cognitive behavior therapy has been found to be efficacious and comparable to other psychosocial intervention approaches, including 12-step facilitation and motivational enhancement therapy. Family therapy and 12-step involvement appear to have positive incremental effects on treatment outcomes, and motivational interventions promote improvement in substance use largely through their effects on treatment adherence. The development and implementation of more successful treatments for substance abuse disorders will involve new discoveries on the fundamental mechanisms underlying substance abuse combined with the refinement of psychosocial interventions.