Pharmacotherapy for Craving

  • I. Maremmani
  • O. Zolesi
  • L. Daini
  • M. R. Capone
  • M. Aglietti
  • P. Castrogiovanni


The term craving derives from common language and its use in scientific literature is still under discussion. Nevertheless it seems appropriate for describing the very essence of “addiction” as compulsion. The various clinical forms of craving have two main features: a potent reinforcing effect which is at the base of drug addiction and a negative reinforcement mechanism linked to phobic feelings aimed at avoiding withdrawal symptoms. Anticraving therapy should act on both of these aspects. After discussing the results obtained with the principal anticraving drugs, such as methadone, GHB, dopamine agonists (bromocriptine), desimipramine, mood stabilizers, and serotoninergic drugs, the results of personal studies in progress are discussed.


Dopamine Agonist Bulimia Nervosa Cocaine Abuse Cocaine Dependence Heroin Addict 
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  1. 1.
    Marlatt A. Craving notes. Br J Addict 82:42–44, 1987.CrossRefGoogle Scholar
  2. 2.
    Wikler A. Opioid Dependence, Plenum, New York, NY, 1980.Google Scholar
  3. 3.
    Shaikh M B, Brutus M, Siegel H E, Siegel A. Differential control of aggression by the mid brain. Exp Neurol 83:436–442, 1984.PubMedGoogle Scholar
  4. 4.
    Koob G F, Bloom F E. Cellular and molecular mechanism of drug dependence. Science 242: 715–723, 1988.PubMedCrossRefGoogle Scholar
  5. 5.
    Risner M E, Jones B E. Role of noradrenergic and dopaminergic processes in amphetamine self-administration. Pharmacol Biochem Behav 5:477–482, 1976.PubMedCrossRefGoogle Scholar
  6. 6.
    Koob G F. The dopamine anhedonia hypothesis: a pharmacological phrenology. Behav Brain Sci 5:63–64, 1982.CrossRefGoogle Scholar
  7. 7.
    Risner M E, Jones B E. Intravenous self-administration of cocaine and norcocaine by dogs. Psychopharmacology 71:83–89, 1980.PubMedCrossRefGoogle Scholar
  8. 8.
    Bozart M A, Wise R A. Involvement of the ventral tegmental dopamine system in opioid and psychomotor stimulant reinforcement. In: Problems of drug dependence, edited by Harris L S. N.I.D.A., Washington, DC, 1985, pp 190–196.Google Scholar
  9. 9.
    Zito K A, Vickers G, Roberts D C S. Disruption of cocaine and heroin self administration following kainic acid lesions of the nucleus accumbens. Pharmacol Biochem Behav 25:1029–1036, 1985.CrossRefGoogle Scholar
  10. 10.
    Philiphs A G, Broekkamp C L E, Fibiger H C. Strategies for studying the neurochimical substrates of drug reinforcement in rodents. Prog Neuro-psychopharmacol & Biol Psychiat 7:585–590, 1983.CrossRefGoogle Scholar
  11. 11.
    Ettenberg A, Camp C H. Haloperidol induces a partial reinforcement extinction effects in rats: implication for a dopamine involvement in food reward. Pharmacol Biochem Behav 25:813–821, 1986.PubMedCrossRefGoogle Scholar
  12. 12.
    Ettenberg A, Camp C H. A partial reinforcement extinction effect in water-reinforced rats intermittently treated with haloperidol. Pharmacol Biochem Behav 25:1231–1235, 1986.PubMedCrossRefGoogle Scholar
  13. 13.
    Aghajanian G K. Tolerance of Locus Coeruleus neuron to morphine and suppression of withdrawal response by clonidine. Nature 276:186–188, 1978.PubMedCrossRefGoogle Scholar
  14. 14.
    Gold M S, Kleber H D. Clinical utility of clonidine in opiate withdrawal; a study of 100 patients. In: Pharmacology of clonidine, edited by Harbans L, Fielding S. Alan Liss, New York, NY, 1981, pp 299–306.Google Scholar
  15. 15.
    Maremmani I, Castrogiovanni P. Manuale del Trattamento Ambulatoriale con Metadone, SIMS, CN-MPC, Pisa, 1992.Google Scholar
  16. 16.
    Gallimberti L, Fern M, Ferrara S D, Fadda F, Gessa G L. Gamma-hydroxybutyric acid in the treatment of alcohol dependence: A double-blind study. Alcohol Clin Exp Res 16:673–676, 1992.CrossRefGoogle Scholar
  17. 17.
    Fadda F, Argiolas A, Melis M R, et al.. Differential effect of acute and chronic ethanol on dopamine metabolism in frontal cortex, caudate nucleus and substantia nigra. Life Sci 27:979–986, 1980.PubMedCrossRefGoogle Scholar
  18. 18.
    Gessa G L. Nascita di un farmaco per l’alcoolismo: l’acido gamma-idrossibutirrico. In: Il GHB nel trattamento della dipendenza alcoolica, edited by Gallimberti L, Ferrara S D, Gessa G L. Addiction Research Foundation of Italy, Padova, 1992, pp 3–4.Google Scholar
  19. 19.
    Tunnicliff G. Significance of gamma-hydroxybutyric acid in the brain. Gen Pharmacol 23:1028–1034, 1992.Google Scholar
  20. 20.
    Serra M, Sanna E, Foddi C, Concas A, Biggio G. Failure of gamma-hydroxybutyrate to alter the function of the GABA(A) receptor complex in the rat cerebral cortex. Psychopharmacology 104:351–355, 1991.PubMedCrossRefGoogle Scholar
  21. 21.
    Mamelak M. Gamma-hydroxybutyrate: an endogenous regulator of energy metabolism. Neurosci Biobehav Rev 13:187–198, 1989.PubMedCrossRefGoogle Scholar
  22. 22.
    Ferrara S D, Gessa G L, Gallimberti L. Farmacotossicologia e farmacocinetica del GHB. In: Il GHB nel trattamento della dipendenza alcoolica, edited by Gallimberti L, Ferrara S D, Gessa G L. Addiction Research Foundation of Italy, Padova, 1992, pp 5–14.Google Scholar
  23. 23.
    Crosby G, Ito M, Kaufman E, et al.. Naloxone pretreatment alters the local cerebral metabolic effect of gamma-hydroxybutyrate in rats. Brain Res 275:194–197, 1983.PubMedCrossRefGoogle Scholar
  24. 24.
    Zolesi O, Daini L, Capone M R, Aglietti M, Nardini C F, Maremmani I, Castrogiovanni P. The use of GHB in anticraving therapy. Preliminary data in alcoholic depressed patients, in alcohol and polydrug use of heroin addicts during MMTPs and in heroin craving during opioid antagonist therapy, Second European Symposium on Drug Addiction & AIDS, Siena, 1993.Google Scholar
  25. 25.
    Malcolm R, Hutto B R, Phillips J D, Ballenger J C. Pergolide mesylate treatment of cocaine withdrawal. J Clin Psychiatry 52:39–40, 1991.PubMedGoogle Scholar
  26. 26.
    Extein L, Allen S, Gold M S, Morales A, Goodnick P J, Gross D A. Comparison of bromocriptine and desimipramine in cocaine withdrawal. Ann Clin Psychiatry 1:193–197, 1989.CrossRefGoogle Scholar
  27. 27.
    Kumor K, Sherer M, Jaffe J. Effects of bromocriptine pretreatment on subjective and physiological responses to IV cocaine. Pharmacol Biochem Behav 33:829–837, 1989.PubMedCrossRefGoogle Scholar
  28. 28.
    Teller D W, Devenyi P. Bromocriptine in cocaine withdrawal-Does it work? Int J Addict 23:1197–1205, 1988.PubMedGoogle Scholar
  29. 29.
    Dackis C A, Gold M S, Sweeney D R, et al.. Single dose bromocriptine reverses cocaine craving. Psichiat Res 20:261–264, 1987.CrossRefGoogle Scholar
  30. 30.
    Berg G, Laberg J C, Skutle A, Ohman A. Instructed versus pharmacological effects of alcohol in alcoholics and social drinkers. Behav Res Ther 19:55–66, 1981.PubMedCrossRefGoogle Scholar
  31. 31.
    Gawin F, Kleber H. Pharmacological treatments of cocaine abuse. Psychiatr Clin North Am 9:573–583, 1986.PubMedGoogle Scholar
  32. 32.
    Halikas J A, Crosby R D, Carlson G. Valproate in the treatment of cocaine addiction: A preliminary report. Ann Clin Psychiatry 4:65–66, 1992.CrossRefGoogle Scholar
  33. 33.
    Kosten T R, Gavin F, Rounsaville B J, Kleber H D. Cocaine abuse among opioid addicts. Amer J Drug Alcohol Abuse 1987.Google Scholar
  34. 34.
    Jasinski D R, Nutti J G, Haertzen C A, Griffith J D. Lithium: Effects on subjective functioning and morphine-induced euphoria. Science 195:582–584, 1977.PubMedCrossRefGoogle Scholar
  35. 35.
    Snyder S H, Simantox R. The opiate receptor and opiate peptides. J Neurochem 28:13–20, 1977.PubMedCrossRefGoogle Scholar
  36. 36.
    Jensen J. The effect of prolonged lithium ingestion on morphine actions in the rat. Acta Pharmacol Toxicol 35:395–402, 1974.CrossRefGoogle Scholar
  37. 37.
    Judd L L, Hubbard B, Janowsky D S, et al.. The effect of lithium carbonate on affect, mood and personality of normal subjects. Arch Gen Psychiatry 34:346–351, 1977.PubMedGoogle Scholar
  38. 38.
    Minn S R, Meyer R E, McNamee B. Psychopathology and mood duration in heroin use: Acute and chronic effects. Arch Gen Psychiatry 33:1503–1508, 1976.Google Scholar
  39. 39.
    Gawin F H, Ellinwood E H. Cocaine dependence. Annu Rev Int Med 40:149–162, 1989.CrossRefGoogle Scholar
  40. 40.
    Gawin F H, Kleber H D. Cocaine abuse treatment: open pilot trial with desimipramine and lithium carbonate. Arch Gen Psychiatry 41:903–909, 1984.PubMedGoogle Scholar
  41. 41.
    Mello N K, Mendelson J H, Kuehnle J C, Sellers M S. Operant analysis of human heroine self-administration and the effects of naltrexone. J Pharmacol Exp Ther 216:45–54, 1981.PubMedGoogle Scholar
  42. 42.
    Gorelick D A, Paredes A. Effect of fluoxetine on alcohol consumption in male alcoholics. Alcohol Clin Exp Res 16:261–265, 1992.PubMedCrossRefGoogle Scholar
  43. 43.
    Pollack M H, Rosenbaum J F. Fluoxetine treatment of cocaine abuse in heroin addicts. J Clin Psychiatry 52:31–33, 1991.PubMedGoogle Scholar
  44. 44.
    Wurtman J J, Wurtman J R, Mark S, et al.. D-fenfluramine selectively suppresses carbohydrate snacking by obese subjects. Int J Eating Disord 4:89–99, 1985.CrossRefGoogle Scholar
  45. 45.
    Wurtman J J, Wurtman J R, Reynolds S, et al.. D-fenfluramine suppresses snack intake among carbohydrate cravers but not among non carbohydrate cravers. Int J Eating Disord 6:687–699, 1987.CrossRefGoogle Scholar
  46. 46.
    Levine L R, Pope H G J, Enas G G, Wilson M G, Ballenger J C, Blinder B J, Dixon K, Dunlop S R, Ferguson J M, Goldbloom D S, Halikas J, Herzog D B, Hsu L K G, Hudson J I, Powers P S, ReimherrF W, Yates W R. Fluoxetine in the treatment of bulimia nervosa: A multicenter, placebo-controlled, double-blind trial. Arch Gen Psychiatry 49:139–147, 1992.Google Scholar
  47. 47.
    Maremmani I, Daini L, Zolesi O, Castrogiovanni P. Use of Fluoxetine in heroin addiction. Br J Psychiatry 160:570–571, 1992.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 1995

Authors and Affiliations

  • I. Maremmani
    • 1
  • O. Zolesi
    • 1
    • 2
  • L. Daini
    • 1
    • 2
  • M. R. Capone
    • 1
  • M. Aglietti
    • 1
  • P. Castrogiovanni
    • 1
    • 2
  1. 1.Dependence-Psychiatry Unit, Psychiatric InstituteUniversity of PisaItaly
  2. 2.Ph.D. Research Program SienaCagliari & Pisa UniversitiesItaly

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