Medications for Addiction Treatment
Even as a drug or alcohol addiction threatens to rewrite a person’s life, treatment options exist that can address the damage done and help the person to achieve health and balance.
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.
How Do Medications for Addiction Treatment Work?
WebMD explains that addictive drugs get their addictive nature because of the way they manipulate the brain’s pleasure and reward centers, subverting how the brain perceives stimulation to become the only source of excitement or comfort in life. MedLine Plus estimates that 9 percent of the American population misuses opiates, drugs that mimic feelings of peace or relaxation (such as heroin, morphine, or prescription painkillers like OxyContin).
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.
Naltrexone and Buprenorphine
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 agonistâ€).
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.
The Drug That Could Combat the Heroin Epidemic
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.â€
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.
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.
- Bupropion was “helpful”in reducing cravings for cocaine use in one study.
- Sustained release of bupropion, and client participation in a 12-Step program, reduced cravings for methamphetamines.
A More Comprehensive Improvement Rate
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.
Other Medications Used for Addiction TreatmentSimilarly, a drug like baclofen, which is used to treat spasms caused by multiple sclerosis, can also be applied to treating opioid dependence. Anti-seizure and anticonvulsant medications like gabapentin (“effective in reducing some of the withdrawal symptoms in patients addicted to opiates,”according to the Journal of Clinical Psychopharmacology), vigabatrin (which, like gabapentin, appears to reduce alcohol withdrawal symptoms, as reported in the American Journal of Addictions), and topiramate (“well tolerated and effective in reducing alcohol craving,”according to Medscape) add new options to the toolbox of addiction treatment, working with established therapeutic methods and practices to break down the walls of substance abuse.
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