Substance Abuse Treatment and Medications

Substance abuse is a chronic disorder characterized by obsessive or irrepressible quest for seeking drugs and using them regardless of their detrimental outcomes. These substances may cause permanent brain modifications resulting in destructive behavioral patterns observed in people abusing drugs.

Though one starts using drugs voluntarily, over time their resolve to not indulge in drugs gets weakened due to the brain changes that take place with constant use. Drug seeking and consumption becomes a compulsive act, stemming from the constant drug exposure. The parts of the brain affected by addiction include learning and memory, reward and motivation, and control over conduct. Addiction is a disorder which affects both the behavior and the brain.

Treatment for substance abuse

Treatment for a substance use disorder (SUD) is feasible, however, complicated. This is because with long-term substance use, an addiction sets in making it exceedingly difficult for a person to stop using and embrace sobriety. An effective substance use disorder treatment program would comprise of medicines to help control the cravings and the withdrawal symptoms, detox to get rid of the accumulated toxins, counselling to help an individual identify and reverse destructive thought processes, and alternative therapies to provide a constructive medium to a person to vent their negative feelings thereby avoiding a relapse.

Addiction is a relapsing disorder, necessitating repeated or long-lasting care to help people stop using and recover completely. An effective addiction treatment program enables a person to stop using, encourages them to stay drug-free, and smoothens their rehabilitation at work, within the family, and in society.

Medication management

Medications are primarily used for the management of withdrawal symptoms and prevention of a relapse in both addiction and dual-diagnosis treatment.

Management of withdrawal symptoms

Managing withdrawal symptoms during a detoxification process can get challenging and this is where medication come in handy. Detoxification is the preliminary step in any addiction treatment process as it has been demonstrated that patients who do not seek any treatment subsequent to a detox process relapse often. A 2014 study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that treatment facilities used medicinal agents in nearly 80 percent of the detox processes. Correspondingly, in May 2018, lofexidine, a non-opioid medication intended to ease the withdrawal symptoms of opioids, received FDA approval.

Relapse prevention

Medications play a key role in preventing a relapse. These can be used to recalibrate brain function and also alleviate cravings which are the main precursor for a relapse. As of now, addiction treatment medicines are available for addiction to alcohol, tobacco (nicotine), and opioids (prescription painkillers and heroin). Research is in progress for treating addiction to marijuana (cannabis) and stimulants like methamphetamine and cocaine. People who indulge in polysubstance use need treatment for all the substances they abuse.

Medicines used for opioid use disorder

Medicines used for the management of addiction to opioids are buprenorphine, methadone, naltrexone, and lofexidine:

Buprenorphine: Buprenorphine helps manage the withdrawal symptoms and reduce cravings for opioids without causing any dangerous side effects. It is a partial opioid agonist that works by activating and blocking opioid receptors present in the brain. For administration, it is kept under-the-tongue or used alone in a sublingual formulation known as Subutex®. It can also be used in combination with naloxone which is available as Suboxone®. The naloxone combination, administered as an intravenous injection, discourages relapse or digression. Buprenorphine is often administered for maintenance therapy or for detoxification in an office setting through a physician holding a special certification. Though not yet approved by the Food and Drug Administration (FDA) for use in pediatric population, it is recommended for older adolescents based on its efficacy in this population basis some research.
Methadone: A full opioid agonist, methadone alleviates cravings and helps prevent withdrawal symptoms by activating the opioid receptors in the brains. The medicine is used for treating opioid dependence in adults and is available only through licensed treatment facilities. In a few states and some special cases, adolescents aged between 16 and 18, dependent on opioids may be treated with methadone on the condition that they have had two failed documented rounds of opioid detoxification, a drug-free treatment, or are in possession of written consent provided by a legal guardian or a parent for methadone treatment.
Naltrexone: Followed by a total detoxification of opioids, naltrexone is used for preventing relapse in adult patients. It is an approved drug and it exerts its action by blocking the opioid receptors. Hence, it is also known as an opioid antagonist. It helps the user to not feel a high and prevents withdrawal symptoms from making an appearance after a recent use of opioids. It is available orally or as an injection (Vivitrol®) to be taken once in a month provided by a doctor.
Lofexidine: Recently, FDA approved a medicinal agent known as lofexidine (Lucemyra) for treating withdrawal symptoms of opioids. Lofexidine belongs to a class of medications known as alpha-2-adrenergic agonists which act on the nervous system and induce mild pain relief, sedation, and relaxation. One of the agents in this group, clonidine, is a popular drug used during medically supervised detox procedures. Lofexidine is similar to clonidine, however, while the former may cause hypotension or low-blood pressure which could be a limiting side effect, the latter has marginal impact on blood pressure.

In spite of the availability of different kinds of medications, long-term treatment with methadone, buprenorphine, or extended-release naltrexone remain the most effective treatments for dealing with opioid withdrawal symptoms. However, lofexidine might be an important option for individuals undergoing withdrawal and who are set on starting with extended-release naltrexone.

Medicines used for alcohol use disorder

Till date, three medications have received an approval from the FDA for managing alcohol addiction. Topiramate, the fourth drug, might also receive an approval as it has shown promising outcomes in large human scale studies. Nevertheless, the already approved medications are:

Naltrexone: Naltrexone blocks the opioid receptors in the brain. These receptors activate the reward effects of consuming alcohol and generate a craving for it. Naltrexone has proved to be effective in preventing a relapse. However, its efficacy depends on the genetic variability of an individual.
Acamprosate (Campral®): Acamprosate has shown favorable results in patients who drink excessively. It helps an individual deal with the symptoms of long-lasting withdrawal like restlessness, anxiety, insomnia, feeling unhappy, and unwellness.
Disulfiram (Antabuse®): Disulfiram was the first FDA approved oral drug for the treatment of alcoholism. When consumed, alcohol gets converted into acetaldehyde through an enzyme known as alcohol dehydrogenase. The acetaldehyde gets converted into acetic acid with the help of an enzyme called acetaldehyde dehydrogenase. Disulfiram inhibits this conversion of acetaldehyde into acetic acid because of which the level of acetaldehyde build ups in the blood. This high level of acetaldehyde leads to the development of unpleasant symptoms, such as, palpitations, low blood pressure, chest pain, nausea, vertigo, thirst, flushing, and headaches These disagreeable side effects discourage people from consuming alcohol thereby treating addiction.

Seeking addiction treatment

There are multiple ways to address an addiction, and each case is different. The best approach is the one which is personalized to the specific needs of the patient with a clear goal in mind. Enrolling in the appropriate drug treatment program begins with that first interaction or a call. During that call, our admission counselors may conduct a short pre-assessment by asking a number of questions pertaining to one’s substance abuse to find the best suited treatment program for an individual.

If you or a loved one is looking for drug addiction help, get in touch with the Invictus Health Group. We can connect you with our network of facilities that offer evidence-based detox programs and treatment options for substance abuse. For more information about addiction treatment programs, call our 24/7 helpline 866-548-0190 and speak with a representative. You can also chat online with a representative for further assistance.