Cognitive enhancers: a pharmacological intervention for the treatment of substance dependence
Wong, Philip Siva Vittozzi
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Dependence from addictive substances is a serious public health concern in the United States. Alcohol appears to be the most popular abused substance, while cigarette smoking has the highest rates of mortality. Though not as popular, illicit drugs such as cocaine and opioids are able to cause incredible damage to the lives of addicted individuals and to the people around them. The toxic injuries produced in the brain and the presence of withdrawal symptoms often result in cognitive deficits. Individuals that are able to terminate the consumption of drugs often have a hard time regaining their previous cognitive abilities. This partially contributes to the high incidence of relapse, which represents a major problem faced by the medical community. So far treatment has relied on cognitive behavioral therapy and a number of pharmacological agents. Even when combined, these approaches have not yielded satisfying results. For some types of addictions, such as the one for cocaine, there are no approved medications. Therefore research has made tremendous efforts to understand how the brain responds to addictive substances with the hope that such knowledge will lead to new pharmacological treatments. Cognitive enhancers are a promising class of drugs that is under investigation for the treatment of substance dependence. Most of them have been tested for their ability to decrease drug craving and consumption. Some of them are also being examined for their ability to reverse the cognitive deficits produced by previous drug exposure. The present thesis will examine the current literature on four cognitive enhancers: atomoxetine, reboxetine, selegiline and modafinil. Even if still in the preliminary stages, the clinical trials on reboxetine have obtained the highest rate of success. On the other hand, modafinil is the only cognitive enhancer that has been tested for reversing cognitive deficits. Compelling results in a clinical trial make modafinil one of the most exciting projects in this field of research. Atomoxetine and selegiline have mostly failed the clinical stage, but more studies are needed to determine their usefulness. In general, the potential ability to reverse cognitive deficits is not supported by the current literature and more research should be focused in this direction.
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