Akademik Veri Yönetim Sistemi
Türkiye Psikiyatri Derneği Yıllık Toplantısı ve 3. Uluslararası ve 27. Ulusal Klinik Eğitim Sempozyumu, 27-30 Nisan 2025, Antalya, Antalya, Türkiye, 27 - 30 Nisan 2025, ss.184-185, (Özet Bildiri)
Substance use disorder (SUD) remains a significant public health issue due to its chronic nature and high rates of relapse. Although important advancements have been made in pharmacological treatment approaches, craving and relapse behaviours remain some of the most treatmentresistant aspects of SUD. Agents such as naltrexone, bupropion and buprenorphine are commonly employed in the treatment of substance dependence, including alcohol, opioids and nicotine. However, these treatments may not be effective for everyone, as success in treatment is often limited by differences between individuals, psychiatric comorbidities, and environmental factors. Consequently, interest in alternative pharmacological agents has grown in recent years. One such promising agent is N-acetylcysteine (NAC), which is primarily known as a glutathione precursor and antioxidant, but is also notable for its neuromodulatory properties. NAC has been shown to reduce drug-seeking behaviour and impulsive use by regulating extracellular glutamate levels. Preclinical studies have demonstrated its efficacy in treating cocaine, methamphetamine, and cannabis use disorders, and an increasing body of evidence from human studies also suggests reductions in both substance use frequency and craving [1]. Its favourable safety and side-effect profile make NAC an attractive option for use in young adults and patients with comorbid psychiatric disorders. Another notable group of agents are glucagon-like peptide-1 receptor agonists (GLP-1RAs), which are widely used in the treatment of diabetes and obesity. It is hypothesised that these agents reshape reward processing by modulating the mesolimbic dopamine system. In animal models, GLP-1RAs have been shown to reduce conditioned place preference for substances such as cocaine, nicotine and alcohol. In humans, their effects on appetite and impulse control show promise for potential application in the field of addiction [2]. However, these findings remain preliminary and further randomised controlled trials are necessary. Finally, one increasingly explored area of addiction treatment is the use of psychedelic agents. Unlike traditional antidepressants, serotonergic hallucinogens (e.g. psilocybin and LSD) appear to produce long-lasting therapeutic effects with only short-term administration. It is believed that psychedelics enhance neural plasticity in regions such as the anterior cingulate cortex and the default mode network, potentially disrupting the circuits associated with addiction that have become maladapted [3]. Early-phase studies on nicotine and alcohol use disorders have reported that even a single dose of psilocybin can reduce cravings and decrease the frequency of substance use. However, ethical, legal and safety considerations must be carefully addressed before broader clinical application can be considered
In conclusion, alongside standard treatment approaches, emerging pharmacological agents offer new hope for cases of SUD that are resistant to treatment. NAC, GLP-1 receptor agonists and psychedelics are among the most innovative interventions currently under investigation; however, further robust studies are needed to assess their efficacy and safety in clinical populations. References 1. Smaga I, Frankowska M, Filip M (2021) N-acetylcysteine in substance use disorder: a lesson from preclinical and clinical research . Pharmacol Rep 73(5): 1205-1219. 2. Klausen MK, Thomsen M, Wortwein G ve ark. (2022) The role of glucagon-like peptide 1 (GLP-1) in addictive disorders. Br J Pharmacol179(4):625-641. 3. DiVito AJ, Leger RF (2020) Psychedelics as an emerging novel intervention in the treatment of substance use disorder: a review. Mol Biol Rep 47(12): 9791-9799.