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Pharmacological interventions
Clonidine: new use of an old medication to reduce stress-related substance use
  1. George Woody
  1. Correspondence to University of Pennsylvania and Treatment Research Institute, Philadelphia, Pennsylvania, USA; woody{at}tresearch.org

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ABSTRACT FROM: Kowalczyk WJ, Phillips KA, Jobes ML, et al. Lonidine maintenance prolongs opioid abstinence and decouples stress from craving in daily life: a randomized controlled trial with ecological momentary assessment. Am J Psychiatry 2015;172:760–7.

What is already known on this topic

Alcohol, marijuana and opioids can reduce anxiety, elevate one's mood and people sometimes turn to them for relief from stress.1 This self-medication can lead to a substance use disorder in someone that has never had one; precipitate a relapse; compromise treatment response; or result in a fatal overdose. Relief is typically short-lived and continued use can result in a new disorder. For example, heavy alcohol use can increase anxiety and depression; and stimulants increase anxiety, precipitate psychotic symptoms or cause depression (crashing). These issues are described in the substance use section of the Diagnostic and Statistical Manual (DSM).2

Methods of the study

The study was a randomised trial to see if clonidine decouples stress-related cocaine and heroin administration in patients maintained on buprenorphine. The investigators …

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