1.
Translating the Neurobiology of
Addiction Into New Treatments:
Medication Assisted Recovery
Barbara J. Mason, Ph.D.
Pearson Family Professor, Committee on the Neurobiology of Addictive Disorders
Co-Director, The Pearson Center for Alcoholism and Addiction Research
SAB Malibu Beach
Sept. 29 & 30, 2013

2.
Source: SAMHSA National Survey on Drug Use and Health, 2010
Numbers in Thousands

3.
Medication Targets in the
Cycle of Alcoholism and Addiction
Protracted
Withdrawal
Binge/
Intoxication
Acute
Withdrawal

4.
Opioid Dependence
 naltrexone (ReVia, Vivitrol): $41M **
 methadone (Dolophine): $44M
 buprenorphine (Suboxone) $1.2B
Nicotine Dependence
 varenicline (Chantix): ~$710M
 nicotine patch, nicotine gum: OTC $3.4B
 bupropion (Zyban): ~$550M **
Alcohol Dependence
 naltrexone (ReVia, Vivitrol): $41M **
 acamprosate (Campral): $81M
* From: http:www.evaluatepharma.com
** Includes all indications

5.
Nucleus Accumbens (Binge-intoxication) — Structure in the front bottom of the brain involved in the
rewarding effects of drugs of abuse that is a key part of the binge/intoxication stage of addiction.
Contains reward neurotransmitters dopamine and opioid peptides that are involved in the
euphoric effects of addiction.
Extended Amygdala (Withdrawal-negative affect) — A set of structures in the front middle of the brain
that include the central nucleus of the amygdala, bed nucleus of the stria terminalis, and part of
the nucleus accumbens. Contains brain “stress” neurotransmitter corticotropin-releasing factor
that produces dysphoria during withdrawal in addiction.
Prefrontal Cortex (“Craving”)— Structure in the front top of the brain involved in executive function
that plays a key role in relapse to addiction. Executive function combines elements of delay in
gratification and inhibition to allow healthful choices and decisions. Contains the major
excitatory neurotransmitter glutamate that reawakens “craving”.

6.
Existing medications
• disulfiram
• naltrexone
• methadone
• varenicline
• buprenorphine
Future targets
• partial agonists (intoxication blockers)
• drug vaccines (intoxication blockers)

7.
Existing medications
• methadone
• nicotine patch
• buprenorphine
• varenicline
Future targets
• GABA modulators (homeostatic resetters)
• CRF1 antagonists (stress reducers)
• κ opioid antagonists (dysphoria reducer)

8.
Existing medications
• acamprosate
• buproprion
Future targets
• GABA modulators (homeostatic resetters)
• CRF1 antagonists (stress reducers)
• Glutamate modulators (habit reducers)

9.
Substance abuse treatment has proven efficacy, is cost effective, and
has gained parity with other medical disorders for reimbursement by
3rd
party payors
Identify and pre-clinically validate novel targets
Re-purpose available drugs and shelved investigational drugs for
other indications
Develop vaccines and novel routes of administration
•Use human laboratory studies for proof of concept
•Increase addiction medicine training programs and fellowships to
expand the network of prescribers

10.
Substance abuse treatment has proven efficacy, is cost effective, and
has gained parity with other medical disorders for reimbursement by
3rd
party payors
Identify and pre-clinically validate novel targets
Re-purpose available drugs and shelved investigational drugs for
other indications
Develop vaccines and novel routes of administration
•Use human laboratory studies for proof of concept
•Increase addiction medicine training programs and fellowships to
expand the network of prescribers