ABSTRACTS - World Psychiatric Association

the drug self-administration model the animal self administers the
drug (intravenously or orally). Thus, these two animal models can be
complementary and represent, so far, the most reliable tools to investigate
neurobiology and possible therapies in drug addiction.
RS33.2.
NEW TARGETS FOR TREATING DRUG
DEPENDENCE: THE ROLE OF THE AMYGDALA
M. Cador
Université Victor Segalen, Bordeaux, France
Opiate withdrawal leads to the emergence of an aversive state that can
be conditioned to a specific environment. Reactivation of these withdrawal
memories has been suggested to be involved in relapse to drugseeking
of abstinent opiate addicts. Among the limbic areas that are
likely to mediate these features of opiate dependence, amygdala nuclei
represent critical neural substrates. Using a conditioned place aversion
paradigm (CPA), we have previously shown specific opposite patterns
of reactivity in the basolateral (BLA) and the central (CeA) amygdala,
when comparing the experience of acute opiate withdrawal with the
re-exposure to a withdrawal-paired environment. These data gave
clues about the potential mechanisms by which amygdala nuclei may
be involved in withdrawal memories. To extend these results, the present
study aimed to assess the cellular reactivity and plasticity of amygdala
nuclei during the opiate withdrawal conditioning process. For
this, we have quantified c-fos and arc expression using in situ
hybridization in rats, following each of the three conditioning sessions
during CPA, and after re-exposure to the withdrawal-paired environment.
BLA output neurons showed an increase in the expression of the
plasticity-related arc gene during conditioning that was also increased
by re-exposure to the withdrawal-paired environment. Interestingly,
the CeA showed an opposite pattern of responding, and the intercalated
cell masses (ITC), a possible inhibitory interface between the BLA
and CeA, showed a persistent activation of c-fos and arc mRNA. We
report here specific c-fos and arc patterns of reactivity in amygdala
nuclei during withdrawal conditioning. These findings improve our
understanding of the involvement of the amygdala network in the formation
and retrieval of withdrawal memories. Plasticity processes
within BLA output neurons during conditioning may participate in
increasing the BLA reactivity to conditioned stimuli, which could in
turn (by the control of downstream nuclei) reinforce and drive the
motivational properties of withdrawal over drug consumption.
RS33.3.
CLINICAL GOALS FOR DRUG ADDICTION THERAPY
W. van den Brink
University of Amsterdam, The Netherlands
Both clinical experience and neurobiological evidence indicate that
opioid dependence is a chronic relapsing disorder. Treatment objectives
depend on the pursued goals: crisis intervention, abstinence-oriented
treatment (detoxification and relapse prevention), or agonist
maintenance treatment. The high quality of solid evidence in the literature
demonstrates that there are numerous effective interventions
available for the treatment of opioid dependence. Crisis intervention,
frequently necessary owing to the high overdose rate, can be effectively
handled with naloxone. Abstinence-oriented interventions are
effective for only a few motivated patients with stable living conditions
and adequate social support. Agonist maintenance treatment is
considered the first line of treatment for opioid dependence. Numerous
studies have shown efficacy for methadone and buprenorphine
treatment, while maintenance with other agonists is also becoming
available to a greater extent. Maintenance treatment with diamorphine
should be made available for the small group of treatmentresistant,
severely dependent addicts. Other harm-reduction measures
can serve to engage individuals with opioid addiction who are
not in treatment. In conclusion, opioid dependence is a chronic
relapsing disease that is difficult to cure, but effective treatments are
available to stabilize patients and reduce harm, thereby increasing life
expectancy and quality of life.
RS33.4.
OPIOID DEPENDENCE AND PREGNANCY
G. Fischer
Department of Psychiatry and Psychotherapy, Medical University
of Vienna, Austria
The management of opioid dependence during pregnancy has
received considerable attention over the past three decades. Recent
peer-reviewed literature in the fields of pregnancy and opioid dependence
and neonatal abstinence syndrome has been evaluated and discussed.
Pregnant opioid-dependent women must be carefully managed
to minimize harm to the fetus; therefore, standardized care for
maternal health is required. In a multidisciplinary care system, opioid
maintenance therapy is the recommended treatment approach during
pregnancy. Equivalent attention must be given to the treatment of
neonatal abstinence syndrome, which occurs in 55-94% of neonates
after intrauterine opioid exposure with a 60% likelihood of requiring
treatment. Heterogeneous rating scales as well as heterogeneous
treatment approaches are often responsible for extended hospital
stays. The interpretation of available literature is confounded by several
methodological flaws. In general, there is still a lack of evidencebased
study designs for pharmacological treatment of these patients
as well as for the neonatal abstinence syndrome.
RS33.5.
PHARMACOLOGICAL VS. PSYCHOSOCIAL
INTERVENTIONS IN THE THERAPY OF ADDICTION
M. Davoli
Department of Epidemiology, Local Health Unit E, Rome, Italy
Several pharmacological approaches aimed at opioid detoxification
are effective. Nevertheless, a majority of patients relapse to heroin use,
and relapses are a substantial problem in the rehabilitation of heroin
users. Some studies have suggested that the sorts of symptoms which
are most distressing to addicts during detoxification are psychological
rather than physiological. We explored the benefit from adding psychosocial
interventions to detoxification treatments by searching the
Cochrane Drugs and Alcohol Group trials register, the Cochrane Central
Register of Controlled Trials (CENTRAL), PUBMED, EMBASE,
CINAHL, PsycINFO and a reference list of articles. Nine studies
involving people were included. These studies considered five different
psychosocial interventions and two substitution detoxification
treatments: methadone and buprenorphine. The results show promising
benefit from adding any psychosocial treatment to any substitution
detoxification treatment in terms of completion of treatment (RR
1.68; 95% CI 1.11 to 2.55); use of opiate (RR 0.82; 95% CI 0.71 to
0.93), results at follow-up (RR 2.43; 95% CI 1.61 to 3.66), and compliance
(RR 0.48; 95% CI 0.38 to 0.59). Thus, psychosocial treatments
offered in addition to pharmacological detoxification treatments are
effective in terms of completion of treatment, use of opiate, results at
follow-up and compliance. Limitations to this review are imposed by
the heterogeneity of the assessment of outcomes. Because of lack of
detailed information, no meta-analysis could be performed.
65