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Therapy of Withdrawal Syndromes, Addiction Disorders, and Substitution Therapies

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NeuroPsychopharmacotherapy

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Abstract

In this chapter the authors focus explicitly on pharmacological treatments of alcohol addiction only. We deliberately omit psycho-, socio-, and other modalities of therapy, knowing that, e. g., the degree of social integration is a major sticking point of abstinence.

The heterogeneity of alcohol addiction is worldwide accepted. Variants are mostly referred to as “subtypes”; though being developed everywhere, they are not amply used. If researchers have 100 subjects for a study, they need 400 if they apply a typology of, e.g., four subtypes to get reliable results – an example, that could clarify why international research still might be reluctant to use subtyping concepts. Here we will focus on treatment according to Lesch’s four-types-concept.

Further we want to introduce the idea of alcohol cut down, opposing the “law” of absolute abstinence. Already in 1995 the FDA accepted Sinclair’s concept of “pharmacological extinction.” The idea is a stepwise reduction of alcohol intake, together with a naltrexone treatment.

Thirdly, the authors will put emphasis on the concept of alcohols´ substitution. Why should it not be possible to give way to the idea of substitution concepts for a disease, resulting in three million deaths worldwide per year?

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Abbreviations

ADH:

Alcohol dehydrogenase

ALDH:

Aldehyde dehydrogenase

CAD:

Cumulative abstinence duration

CIWA-Ar:

Revised clinical institute withdrawal assessment for alcohol scale; AE: adverse event

DSM5:

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

FDA:

US Food and Drug Administration

GHB:

Gamma-hydroxybutyric acid

LAT:

Lesch Alcoholism Typology, www.lat-online.at

N/A:

Not applicable

NMDA:

N-methyl-d-aspartate receptor

PDA:

Percentage of Days Abstinent

RCT:

Randomized controlled trial

SAE:

Serious adverse event

SMO:

Sodium oxybate

TAC:

Total alcohol consumption

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  1. Clinical Department of Social Psychiatry, Medical University Vienna, Vienna, Austria

    Otto Lesch & Henriette Walter

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  1. Otto Lesch
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  2. Henriette Walter
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Correspondence to Otto Lesch or Henriette Walter .

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  1. Dept Psychiatry , Psychosomatics & Psychotherapy, University of Würzburg, Medical School Clinical Neurochemistry, Würzburg, Germany

    Peter Riederer

  2. Inst für Psychologische Medizin, Haag, Bayern, Germany

    Gerd Laux

  3. Fujita Health University School Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Bayern, Germany

    Christian Riederer

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  1. Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany

    Peter Riederer

  2. Center for Research Promotion and Support, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

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Lesch, O., Walter, H. (2021). Therapy of Withdrawal Syndromes, Addiction Disorders, and Substitution Therapies. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_256-1

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