Journal
CLINICAL PSYCHOLOGY REVIEW
Volume 30, Issue 2, Pages 155-166Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.cpr.2009.10.006
Keywords
Opioid; Heroin; Substance use; Addiction; Pharmacotherapy; Psychosocial treatment
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Opioid dependence is a problem of national concern, especially with dramatically increased rates of abuse and dependence of prescription opioids. The current article provides an up-to-date review of the literature on opioid dependence treatment, with a focus on conclusions drawn by experts in the field (e.g., Cochrane reviews and meta-analyses) and methodologically rigorous studies (e.g., randomized controlled trials). We describe the major classes of drug treatments available, including opioid agonist (e.g., methadone, buprenorphine, LAAM), antagonist (e.g., naltrexone) and non-opioid pharmacotherapies (e.g., alpha2 adrenergic agonists). These treatments are discussed in the context of detoxification and long term treatment options such as abstinence-based and maintenance strategies. We review the state of the literature as to prevention of opioid overdose and discuss the widespread problem of comorbidity among opioid-dependent populations. We also focus prominently on evidence for inclusion of psychosocial approaches in treatment regimens, either as stand-alone or in conjunction with psychopharmacological options. (C) 2009 Elsevier Ltd. All rights reserved.
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