The medications for addictions and treatment for substance abuse has traditionally followed the 12-Step model of total abstinence. To ensure a stable recovery from a drug addiction crisis.
According to the National Institute on Drug Abuse, relapse rates are as high as 40%-60%, copying those of other chronic conditions like hypertension, asthma, diabetes. Relapse is a natural part of recovery from addiction, characterized as a persistent and regressive brain disease. As a result, medications for addictions treatment aims to reduce the extent of regression and severity.
Many drugs are currently being investigated and tested to see whether they can help avoid addiction or relapse to drug abuse after recovery. In some cases, medications for addictions can be used as a preference for total abstinence during recovery or during a medical detox regimen to safely and effectively flush toxins from the body. Certain medications can help with withdrawal effects and cravings , and several of these medications prevent narcotics from producing the same good feelings or high. These drugs can only be used for a limited period during detox or as part of a long-term maintenance program. Medications aren’t a “cure-all” or a “silver bullet” for addiction, but if it is used in conjunction with other treatment options, they can improve the chances of successful and productive rehabilitation.
AUD (Alcohol Use Disorder)
According to the National Survey on Drug Use and Health (NSDUH), In 2013, 18 million Americans aged 12 and up needed alcoholism treatment. In today’s culture, alcohol is commonly accepted and relatively easy to acquire. While binge drinking is not in and of itself a problem, binge or heavy drinking regularly can lead to alcohol tolerance development. Once you’ve formed a tolerance, feeling drunk will take more as time goes.
Alcohol alters the brain’s motivation and reward processes by causing chemical changes. Drinking alcohol makes you feel good at first because it stimulates the development of the neurotransmitter dopamine, important for feelings of satisfaction. Chronic drinking can cause the brain to become addicted to dopamine’s chemical stimulation and stop producing it naturally, promoting more alcohol consumption and cravings to feel good or happy. When alcohol becomes a central point of life and is consistently abused despite adverse emotional, physical effects, and social, this dependency may grow into an alcohol use disorder. When alcohol is withdrawn from a person with an alcohol use disorder, they are likely to experience painful and even life-threatening withdrawal symptoms.
If you have an alcohol use problem, it isn’t advisable to avoid drinking cold turkey. Instead, a weaning-off cycle may be enforced. Medications for addictions are also used to treat cravings and withdrawal symptoms during alcohol detox.
Medicines Involved in Alcohol Treatment
According to Psychiatry, the US Food and Drug Administration (FDA) Has Approved Four Medications for Addictions to Treat Alcohol Use Disorders:
- Disulfiram (Antabuse)
- Acamprosate (Campral)
- Naltrexone (ReVia)
Disulfiram has long been a medications for addictions, it is used to treat alcoholism. If disulfiram interacts with alcohol and persists in the body for a week or two, it causes headaches, nausea, and vomiting, among other things. As a result, it is supposed to prevent alcoholics from resuming their drinking. Disulfiram, on the other hand, may have unplanned or potentially dangerous health effects when an overdose occurs. Side effects include death, low blood pressure, chest pain, and shortness of breath.
While alcoholics may stop taking disulfiram before purposefully drinking, reducing its long-term efficacy in preventing withdrawal, it may still be the most successful way to avoid impulsive drinking. When family and social care networks are active and attentive in ensuring that the drug is administered on a daily basis, disulfiram is thought to have the best success rates.
Naltrexone works by blocking the brain’s receptors that produce the pleasurable effects of alcohol. It also reduces the need to consume alcohol. Naltrexone causes nausea and headaches in some people. It can be given every four weeks by injection. Naltrexone, on the other hand, is an opioid antagonist that acts by preventing opioid receptor sites from receiving the endorphins or neurotransmitters activated by alcohol, decreasing the reward.
As a result, naltrexone decreases the craving for alcohol. It has no harmful side effects even if combined with alcohol, but it would not necessarily encourage abstinence on its own. It can, however, minimize alcohol intake because it prevents drinkers from experiencing the delirious feelings that alcohol creates without the drug.
This drug helps to alleviate the mental and physical effects of alcoholism. After completing detox, recovering alcoholics may begin taking acamprosate. By avoiding unpleasant emotions like anxiety and depression, acamprosate decreases the need to drink.
According to Substance Abuse and Mental Health Services Administration (SAMHSA), naltrexone reduces the frequency and quantity of drinking and reduces relapses within heavy drinking episodes. The drug ReVia, which comes in a pill form, is taken once daily in pill form. Its dose is one pill once a day, and similarly to disulfiram, it should be taken willfully for it to work. If you feel that you do not have external support or motivation to take your naltrexone independently and would like to try Vivitrol, you may find that it is more effective. Treatment with naltrexone should include behavioural therapies, encouraging alcoholics not to rely on the drug completely.
There have been headaches, nausea, stomach pain, fatigue, and sometimes liver damage from Naltrexone use. If you take a narcotic drug within the last two weeks, do not take this medication. Alcohol consumption increases levels of Gamma-aminobutyric acid (GABA), also known as an inhibitory neurotransmitter. One of the newest medications approved to treat alcoholism is acamprosate. By inhibiting the transmission of GABA to the brain, it produces a calming and relaxing effect on the brain and a reduction in alcohol cravings. The drug is not an aversion medication and does not produce any negative effects when mixed with alcohol as naltrexone does.
Neither does it cause adverse side-effects when taken in combination with alcohol. Also, acamprosate acts as an oral medication that should be taken up to three times a day. Compliance is important for the effectiveness of this medication. In addition to reducing heavy drinking episodes, Acamprosate can also improve quality of life in combination with psychotherapy. In addition to headaches and diarrhea, acamprosate may cause memory loss and kidney problems.
As part of an alcohol treatment regimen that includes naltrexone and behavioral therapy, Acamprosate may lead to better long-term recovery. Alcohol use disorders can also be treated with medications not designed specifically to treat alcohol dependency. In addition to treating epilepsy, topiramate, also known as Topamax, may help control impulsiveness and alcohol dependency. A medication that prevents withdrawal symptoms from alcohol may also be incorporated into alcohol treatment programs; it may be designed to combat the effects of alcohol on pleasure and reward circuitry in the brain, helping maintain a healthy balance in the brain.
Opioid Dependence Medical Management
Opioid addiction, like alcohol abuse, induces chemical changes in the brain and disrupts normal reward pathways. Opioids include both illegal medications such as heroin and prescription opioids such as Vicodin, OxyContin, Percocet, and morphine.
According to the Centers for Disease Control and Prevention, prescription medication addiction has garnered considerable attention in the United States, with drug abuse becoming the leading cause of injury mortality in 2012, with 51.8 per cent of overdose deaths involving pharmaceuticals and 71.3 per cent of fatal pharmaceutical overdoses involving opioid analgesics.
These medications are highly addictive, and withdrawal symptoms can be painful on both a physical and emotional level. Several medications for addictions have been licensed to help with withdrawal symptoms and cravings and help with detox and long-term maintenance therapy.
- Buprenorphine (Subutex)
- Buprenorphine and naloxone (Suboxone)
Methadone is an opiate prescribed to people who have mild to severe opiate addictions. Methadone operates by binding to the same brain receptors as heroin and painkillers, but it does not make the patient heavy—this aids in reducing cravings and withdrawal symptoms. Methadone are medications for addictions that must be used with caution because certain people have developed an addiction to it when it is used instead of opioids or painkillers. To deter misuse, methadone clinics dispense the drug regularly. Methadone is a drug that is used to treat addiction.
Buprenorphine functions similarly to methadone, but it is less tightly controlled due to its reduced addiction risk. Instead of going to a doctor every day to get buprenorphine, users will also take it home with them.
Naltrexone treats opiate abuse in the same manner as it treats alcoholism. It suppresses the ability to use. Since alcohol and opiates stimulate some of the brain’s same receptors, it works with both addictions.
Other Medications for Addictions
Other Isolated Examples of Research Into Additional Pharmacotherapeutic Agents Include:
- Baclofen, a skeletal muscle relaxant used to treat muscle spasticity, has been studied for its possible function in opioid dependency maintenance care.
- There is some evidence that the anticonvulsant drug gabapentin can help people going through methadone-assisted detox handle such withdrawal symptoms.
- The anticonvulsant vigabatrin, like gabapentin, can help with alcohol withdrawal symptoms
- When used in the treatment of alcohol dependency, low-dose topiramate may help alleviate alcohol cravings, anxiety, and depression, suggesting that it may help prevent relapse.
While no official approval for medications for addictions has been issued in these cases, they serve as examples of how researchers are still searching for new prescription solutions to add to the addiction treatment toolbox. With ongoing research, we expect to supplement our validated clinical approaches and procedures to make more progress in drug abuse treatment shortly.
Principles of Effective Treatment
The Following Main Concepts, Which Have Been Based on Empirical Evidence Since the Mid-1970s, Should Form the Foundation of Every Successful Treatment Program:
- Addiction is a disorder that affects brain function and actions. It is a complex but treatable disease.
- There is no single treatment that is suitable for all.
- People need urgent access to care.
- Effective care considers all of the patient’s needs, not just their substance use.
- It is essential to stay in care for a sufficient amount of time.
- The most popular types of therapy are counseling and other behavioral treatments.
- Medications are often used in conjunction with behavioral treatments and are an integral component of recovery.
- Treatment plans must be revised and updated regularly to meet the patient’s changing needs.
- Other suspected psychiatric conditions should be treated during therapy.
- Detoxification with medical aid is just the first step of treatment.
- Treatment doesn’t need to be voluntary in order to be successful.
- The use of drugs during treatment must be closely controlled at all times.
- Patients should be screened for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases and trained on how to reduce their risk of contracting these illnesses.
Strategies for Reducing Harm
Regarding opioid replacement treatment, the word “harm reduction” is sometimes used. Although generally embraced in other countries, it remains divisive in the United States. Harm reduction is a public health approach that recognizes substance use and violence as natural and focuses on mitigating the adverse effects rather than arguing for total abstinence. Harm reduction, for example, uses needle exchange services and community outreach centers to reduce criminal violence and the spread of infectious diseases.
One form of harm reduction is opioid replacement therapy, which involves opioid medications like methadone in federally funded facilities to prevent the usage of more potent street drugs like heroin. Methadone is a synthetic opioid that is taken orally and has a long half-life. It has the same effect on opioid receptors as other opioids, but with less effectiveness and a lower peak. Methadone is a medication that can help with withdrawal symptoms and cravings, but it’s most widely used for lengthy maintenance.
Research published in the New England Journal of Medicine found that improved availability of opioid replacement drugs, including methadone, resulted in a 50% reduction in heroin overdose deaths between the year 1995 and 2009. People who used methadone instead of methamphetamine were less likely to commit crimes or contract blood-borne diseases, and they had a greater chance of surviving in the community. Methadone, on the other hand, is an addictive drug that can be abused and lead to addiction. Psychosocial support is needed for methadone-assisted treatment to be successful.
The FDA approved buprenorphine for opioid addiction treatment due to the Substance Abuse Treatment Act (DATA) of 2000. Suboxone and Subutex were the first narcotic drugs administered in doctors’ offices under the DATA. Buprenorphine is a partial opioid agonist, meaning it sticks to opioid receptor sites but doesn’t cause euphoria. Subutex is an effective drug to use during opioid detox and the early stages of withdrawal since it can control cravings and avoid withdrawal symptoms. Buprenorphine is typically given in a sublingual tablet or strip, which dissolves in the mouth. Buprenorphine has a ceiling effect, which means that after a certain amount is taken, a peak is reached, preventing any further results.
Suboxone is a mixture of buprenorphine and naloxone, an opioid blocker that blocks opioid receptor sites and prevents opioid abuse. You will experience withdrawal symptoms and no high if you take one opioid while on Suboxone. The drug naloxone is often used to relieve an overdose’s effects on its own. It can only be given to treat addiction to opioids after all other opioids have been completely dissolved. Suboxone is used most often during the rehabilitation and maintenance phases of treatment.
In the same way, as naltrexone is used to treat alcohol addiction, it can also be used in treating opioid addiction. Naltrexone is often used in a more concentrated approach on days where the patient is at a higher risk of abusing opioids or alcohol; however, this shortcut is not commonly prescribed or proven successful. Naltrexone can also be administered under general anaesthesia as part of a “rapid detox” procedure, but this isn’t always advised or shown to be successful in the long run. Other medications, such as LAAM or Levo-alpha acetylmethadol, were once used to replace methadone in opioid replacement therapy because they required less frequent dosing. However, owing to the risk of life-threatening ventricular rhythm disorders, the product LAAM drug Orlaam was taken off the market in the United States.
When used in combination with therapies, counselling, and peer support as part of a recovery plan, drugs can help alleviate the pressure and also increase success rates. The emotional and physical aspects of addiction must all be taken care of during substance abuse treatment. While medications cannot cure addiction, they may aid in rehabilitation when used as part of a larger strategy.
According to the National Institute on Drug Abuse (NIDA), In terms of violence, lost jobs, and treatment expenses, substance abuse costs society $524 billion per year. Drugs can help minimize these costs by minimizing relapse and illegal drug-seeking activity. As a condition of recovery, most 12-Step plans demand complete abstinence. Although some groups and services are softening their stance to promote usage of some pharmaceuticals, the majority of people still oppose the use of mood-altering medications. Most recovery programs aim for long-term reintegration into communities, societies, and both maintenance and abstinence therapies can help with this.
Recovery also necessitates a comprehensive care plan, including frequent examinations and assessments. Medical professionals will assist you in determining which course of treatment works best for your condition and will ensure that you have the potential to succeed and longevity during your recovery.
Medications for addictions may be more beneficial for some individuals more than other people due to genetic or environmental factors. Many of these drugs for alcohol recovery are relatively new and underutilized. According to the New England Journal of Medicine, only about 34.4 per cent of drug abusers currently enrolled in services undergo medication-assisted therapy (MATs). To obtain the best outcomes, drugs used in opioid or alcohol treatment can be combined.
Furthermore, according to the National Alliance on Mental Illnesses (NAMI), half of all opioid addicts and one-third of all alcoholics have a mental illness. When a psychiatric disorder is diagnosed, drugs may be required to manage effects, and these drugs must be carefully watched by someone who is also dealing with drug abuse. Dual diagnosis refers to the presence of two conditions in a person simultaneously , and the most common treatment models include systematic, evidence-based, coordinated, and concurrent care.
Treatment for mental health disorders, dual diagnoses, and drug use disorders is available at FRN treatment centers. Our care team collaborates to ensure a long and stable treatment. there are programs and medications available to treat addiction, and we’re here to help you and your friends or family. Give us a call right now 615-490-9376 to know more about medications for addictions.
Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. He is a freelance medical writer specializing in creating content to improve public awareness of health topics. We are honored to have Ben writing exclusively for Dualdiagnosis.org.