There are a number of medicines that have been approved for treating substance use disorder and this begs the question can addiction be treated with medication. How effective is medication for the treatment of addiction? Giving a person medication alone is of little benefit for treating addiction, but when medication is prescribed alongside rehab treatment it can improve outcomes both in the short-term (for detox) and long-term (including to prevent cravings). Medication can help clients with difficulties in treatment and to remain clean and sober after treatment.
This is blog number 17 in the series 20 things you should know about rehabilitative treatment: What works. This list was compiled by the European Association for the Treatment of Addiction, according to the latest evidence.
Medications for detox and withdrawal
When clients enter treatment, they often need to be detoxed in order to safely rid the drugs or alcohol from their systems and to safely manage withdrawal symptoms. Detox and withdrawal can last from a few days to several weeks and it can be mild, severe and even life-threatening.
Certain medications can mimic the affect of the addictive substance used by the client and can therefore relieve withdrawal symptoms and cravings.
Common withdrawal symptoms include anxiety, depression, nausea, insomnia, muscle aches, shaking and sweating.
Different medications are used to treat different withdrawal symptoms but some common medicines prescribed in detox include:
Benzodiazepines
These drugs reduce anxiety and irritability but they are themselves addictive and should be used with caution. But short-term use of benzodiazepines is life-saving in cases of severe alcohol and GHB withdrawal. If a person enters treatment with a benzodiazepine addiction they are usually given smaller and smaller doses of benzodiazepines over a period of time to avoid the potential life-threatening symptoms of severe benzodiazepine withdrawal.
Antidepressants
Addicted persons have altered brain chemistry as a result of protracted alcohol or drug use. Often clients have relied on substances to produce brain chemicals responsible for positive feelings. When these substances are taken away, many people experience profound depression. Antidepressants are often prescribed for short and long-term relief of depression until brain chemistry starts to return to normal. However, some people will need to remain on these drugs for long periods of time, sometimes for life, in order to control symptoms of depression.
Sleep aids
Insomnia is a common withdrawal symptom and drugs that aid sleep are often prescribed during detox. A range of different medications are used for this purpose but include atypical antipsychotics, old antidepressants and antihistamines. Popular sleeping tables like zolpidem are usually avoided because they are addictive.
Clonidine
Clonidine is a high blood pressure medication that has been found to help with alcohol and opiate withdrawals by reducing sweating, cramps, muscle aches and anxiety. It is also helpful in preventing and stopping tremors and seizures.
Baclofen
Baclofen is a muscle relaxant that has been found to help people suffering from alcohol and GHB withdrawal by reducing symptoms and preventing life-threatening events such as seizures.
NAC
N-acetylcysteine is an antioxidant and does not require a prescription to be bought. Although it has not been approved by regulatory bodies for the treatment of addiction and withdrawal, there is growing evidence that is an effective add-on treatment for these issues. It is thought to reduce withdrawal symptoms and cravings for a wide range of drug classes. It is not only being used for detox, but also for the long-term treatment of addiction as it is thought to help prevent relapse. It is also popular because of its low cost and because it has little to no negative side-effects.
Medications for alcohol addiction
A number of medications have been approved for treating alcohol addiction. These medicines can reduce cravings, reduce withdrawal symptoms and even block the effects of alcohol if it is consumed.
These medications include:
Naltrexone
Naltrexone blocks receptors in the brain that produce alcohol’s pleasurable effects and can also reduce urges or cravings to drink.
Acamprosate
This drug has been found to reduce the emotional and physical distress associated with alcohol addiction, including feelings of anxiety and depression. Acamprosate is prescribed for recovering alcoholics after they have completed detox.
Disulfiram
Disulfiram, commonly known as Antabuse, causes a severe adverse reaction if a person consumes alcohol and acts as a deterrent. It is thought that people will avoid consuming alcohol while on this drug in order to prevent symptoms like nausea and vomiting.
Medications for opiate addiction
Common opiates include heroin, morphine, codeine and some other prescription painkillers.
A number of medications have been approved to treat opiate addiction including:
Methadone
Methadone is used in opioid substitution therapy as it is a synthetic prescription opioid. It relieves drug cravings and withdrawal symptoms by acting on the same opioid receptors in the brain as other opiates. It activates these receptors much more slowly than other opioids and, in a person addicted to heroin or morphine, methadone is thought not to produce a euphoric high. If it is stopped abruptly withdrawal symptoms will return.
Suboxone (buprenorphine)
Buprenorphine is a partial opioid antagonist meaning that it activates the opioid receptors less strongly than other opiates. It reduces drug cravings and withdrawal symptoms without providing the user with a euphoric high. Stopping suboxone abruptly will lead to withdrawal symptoms.
Naltrexone
Naltrexone works to block the opioid receptors and thereby prevent the euphoric and sedative effects of opiate drugs. It also reduces drug cravings. It is not addictive and does not cause withdrawal symptoms if stopped abruptly like methadone or Suboxone.
Medications for co-occurring or underlying mental health conditions
Up to 50% of people suffering from addiction to drugs or alcohol also have at least one other psychiatric condition.
Sometimes this mental health condition was apparent before the drug or alcohol use and other times it is triggered by substance abuse.
It is important these conditions are treated by a professional, like a psychiatrist, at the same time that the addiction is treated.
There is a wide range of psychiatric medications used in treatment and prescriptions will depend on the diagnosis of co-occurring mental health conditions.
At Changes clients are assessed by an experienced psychiatrist and GP to identify their unique medication needs. Contact us today.