Cocaine dependence pharmacotherapy and methodology of early clinical trials  One of the major unmet needs in the treatment of addiction is the pharmacotherapy for cocaine dependence. The Division of Substance Abuse has a very active program to develop medications for this condition. Small N clinical trials can offer initial data on the efficacy and the mechanism of action of promising medications. Dr. Bisaga and his colleagues are interested in improving the design of clinical trials to test specific, laboratory-derived hypotheses about the potential spectrum of medication efficacy and to screen for new medication. This research group is particularly interested in the effectiveness of medication that acts on inhibitory and excitatory neurotransmission to modulate effects of cocaine.

Opioid dependence treatment trials: improving effectiveness of naltrexone maintenance The number of new prescription opioids and heroin users and associated has increased steadily over the past several years. While methadone maintenance remains the most effective treatment for opioid dependence, it has several limitations and is controversial. Naltrexone maintenance is an alternate treatment for opiate dependence that is promising, but currently has limited usefulness due to poor patient compliance and low patient acceptability. Dr. Bisaga and his colleagues are interested whether adding additional medications, such as glutamatergic antagonists will improve the effectiveness of naltrexone to prevent relapse in detoxified heroin-dependent individuals.

Development of human laboratory models of addictive disorders and testing novel compounds using these models Laboratory models of addictive disorders can offer unique opportunity to study mechanisms of disease and to screen for potential pharmacotherapies. Medications that block subjective effects, withdrawal symptoms, drug craving, or drug self-administration in the non-treatment-seeking volunteers who participate in the laboratory study may be effective in the treatment of addictive disorders. Currently Dr. Bisaga and colleagues are developing laboratory models of alcohol and nicotine dependence. These models will then serve to evaluate the contribution of inhibitory and excitatory neurotransmission.