While counseling and aftercare support address various mental and emotional hurdles, medications for addiction treatment can assist with breaking the physical chains of dependency cultivated by the abuse. Such medications are not without risk, but they can be very useful for helping clients overcome the pain of withdrawal in detox and giving them a less harmful alternative to the illicit drugs to which they were addicted.
To help counter an opiate addiction, a client can be prescribed medications that are either specifically designed to work against substance use or that were designed for some other purpose but have “off-label”uses that make them noteworthy.
Examples of both kinds of drugs include:
The National Institute on Drug Abuse explains that naltrexone works by blocking the receptors in the brain that opiates seek out, rendering those drugs incapable of providing the addictive high. Naltrexone is safest when used after the person has completed medically supervised detox, because using it when opioids are still in the body may cause exceptionally severe withdrawal symptoms.
Naltrexone is considered to be an ideal medication for treating opioid abuse, because of the ease of administration, minimal side effects, and low addictiveness and potential for abuse.
While naltrexone works by completely shutting down the opioid receptors in the brain, a drug like buprenorphine functions by partially blocking them; that is why naltrexone is referred to as an opioid antagonist, and buprenorphine is called a partial opioid agonist; (meaning that it activates the brain’s opioid receptors but not to the extent that heroin does, which is why heroin is considered a “full opioid agonist).
Since buprenorphine is a partial opioid antagonist, it does not cause the same highs as a full opioid agonist would. According to the Substance Abuse and Mental Health Services Administration, this lowers the potential for abuse, as well as the severity of the withdrawal effects once the buprenorphine works its way out of the person’s body. Used this way, buprenorphine can wean individuals off their dependence to full opioid agonists.
On the other end of the spectrum of partial opioid antagonists like buprenorphine are pure opioid antagonists, like the drug naloxone. As Drugs.com puts it, pure opioid antagonists reverse the effects of opioids; contrasted to opioid antagonists like naltrexone that simply deny opiates access to the brain’s opioid receptors, naloxone actively undoes the narcotic effects of full opioid agonists.
This undoing can be very dangerous for patients whose addiction and dependence on opioids is severe, potentially increasing the effect of the inevitable withdrawal symptoms they will endure as they are weaned off opioids. For this reason, naloxone is often bundled with buprenorphine into a drug called Suboxone, which the Washington Post described as “the drug [that] could combat the heroin epidemic.
Naltrexone has also found applicability as a tool to treat alcoholism. An injectable, extended-release form of naltrexone known as Vivitrol has been called; the most important breakthrough in addiction treatment in the past 25 years.”A medical director tells the New York Daily News that while naltrexone requires a pill to be taken once every day or two days, Vivitrol is administered via injection once a month. According to the director, patients find this method of administration helps them remain sober.
Other drugs that are used to help clients struggling with alcoholism include disulfiram and acamprosate.Disulfiram (trade name Antabuse) causes a very unpleasant reaction when the individual consumes even a small amount of alcohol, by preventing the body from chemically breaking down the alcohol. Reactions can include headache, nausea, vomiting, chest pain, sweating, blurred vision, and breathing difficulty, among others. Eventually, the person begins to associate drinking with those effects and is less likely to drink because of the firsthand knowledge of the unpleasant experiences.
Disulfiram is not a cure for alcoholism, and should not be treated as such; it is very dangerous if given to a person who is intoxicated, and it should instead be administered at least 12 hours after alcohol consumption. Disulfiram should be taken daily until the compulsion to drink alcohol is absent.
Acamprosate (brand name Campral) is specifically designed to maintain the chemical balances in the brain that are disrupted by a client withdrawing from alcohol. It is another drug of choice to assist in the treatment of alcoholism. Acamprosate works by protecting the neurons in the brain that would be otherwise damaged (or even destroyed) by the process of alcohol withdrawal.
A study published in the journal Alcohol and Alcoholism of 296 alcohol-dependent patients who were randomized into groups that received acamprosate and a placebo found that abstinence was 19 days longer in the acamprosate group than the placebo group. Continuous abstinence was achieved by 35 percent of the patients who received acamprosate, while only 26 percent of the placebo patients achieved abstinence.
Another antidepressant that has proven useful in the treatment of alcoholism and alcohol withdrawal is Paxil. Paxil works by restoring the balance of the neurotransmitter norepinephrine in the brain, which is released as a response to stress. The Journal of Neuropsychiatric Disease and Treatment explains that an imbalance of norepinephrine in the brain is a key factor in the development of major depression.
Paxil’s effectiveness in calming anxiety and stress in patients makes it of interest in the field of addiction science. PsychCentral reports on a study where 42 people who were diagnosed with alcoholism and social anxiety were given Paxil or a placebo for 16 weeks. Patients who received the Paxil had less anxiety and relied less on alcohol to socially engage.
Sometimes, the weapons in the fight against addiction come from unexpected places. In 1998, the U.S. Food and Drug Administration approved modafinil (under the brand name Provigil) as a treatment for narcolepsy. Modafinil is a eugeroic, which is a drug designed to keep users awake and mentally active. It is prescribed for those who struggle to function in their day-to-day lives because they have irregular or diminished sleep patterns, due to long work shifts, sleep apnea, or some other cause. Additionally, the Environmental Health and Toxicology journal reports that modafinil has been found useful for cancer patients who are rendered chronically fatigued by their chemotherapy, or for soldiers who have to remain awake and mentally alert for long periods of time.
Modafinil’s properties have also drawn attention for possible use as treatment for a cocaine addiction. The clinical effects of modafinil generally run counter to the symptoms of cocaine withdrawal, so much so that researchers writing in the journal Drug and Alcohol Dependence studied 210 patients who were diagnosed with cocaine dependence. Of the participants, 138 were randomly administered modafinil, and the remaining 72 were assigned to a placebo group. The researchers published their study under the title “Modafinil for the Treatment of Cocaine Dependence,” wherein they reported that a combination of modafinil with individual behavioral therapy increased the number of days that the study participants did not use cocaine and reduced their cocaine cravings.
Like Paxil, the drug desipramine has been used for the treatment of depression, as it also works by restoring the balance of norepinephrine in the brain. The New York Times reports that some doctors have experimented with the idea of using antidepressants to help cocaine users endure the overwhelming symptoms of cocaine withdrawal. The Times refers to studies that suggest antidepressants may even “blunt”the pleasurable effects of cocaine, reminiscent of how disulfiram is given to patients to help turn them off alcohol. Doctors have speculated that the effects of desipramine to treat depression may also prove useful in countering the depressive effects of cocaine withdrawal, such as fatigue, a lack of energy and motivation, and the inability to experience pleasure.
While initial results of using desipramine for the treatment of cocaine addiction were encouraging, the biggest success came in a study that was reported on in the Archives of General Psychiatry. Seventy-two cocaine users were assigned to a study where 33 percent received desipramine, 33 percent received a placebo, and 33 percent received lithium (which has also been used for cocaine addiction treatment). The New York Times reports that approximately 50 percent of the cocaine abusers who received desipramine did not use cocaine for six weeks; only 20 percent of the placebo or lithium users exhibited abstinence. Another antidepressant that has joined the fight in treating addictions is bupropion. Designed to treat depression and seasonal affective disorder, its antidepressant qualities have also proven useful in helping patients with attention deficit disorder. Bupropion has also found use in helping smokers quit their habit, and it has been prescribed for anxiety and bipolar disorder.
In fact, The Primary Care Companion of the Journal of Clinical Psychiatry published an article entitled (in part) “ The Many Uses of Bupropion,”wherein the author discussed two cases of bupropion being used in the treatment of substance abuse:
Similarly, mirtazapine (sold under the brand name Remeron) is also primarily used to help patients who are suffering from major depression or depressive disorder, but its additional quality as an appetite stimulant might be useful in addiction treatment. As withdrawal and detoxification can sometimes cause a loss of appetite, a supervised dose of mirtazapine can help people to continue to nourish their bodies as they make it through the next stages of getting clean.
To that effect, an article entitled “Mirtazapine Improves Alcohol Detoxification”published in the Journal of Psychopharmacology set out to test whether a combination of therapy and medication helped clients through alcohol detoxification, what the article’s authors called “a decisive stage in treatment.”Thirty-three patients went through standard detoxification procedures, while 35 received mirtazapine in addition to standard treatment. While both groups benefitted from the intervention, clients in the second group (with mirtazapine) had a faster and more comprehensive improvement rate than the clients in the first group.
The article’s authors concluded that mirtazapine, in conjunction with therapy, can be a benefit to clients undergoing detoxification, “by minimizing physical and subjective discomfort.”Therefore, wrote the authors, mirtazapine could potentially include patient participation in alcoholism treatment programs.