Imagine that you’ve skipped the last three meals. As you’re walking down the street, you pass several vendors selling delicious, warm meals. Your brain tells you to stop what you’re doing, turn to a vendor, and buy the meal no matter the cost. You’re unable to think about anything but the scent of that delicious food.
For someone with an addiction, this story would sound familiar. The brain changes that spark an addiction can make it difficult or impossible for the person with the addiction to think about anything but that next high. All other priorities and goals fade away.
Treatment programs aim to help people control their thoughts and feelings, so they can resist the temptation to return to drug use. Programs like this can help people to change their lives for the better. But sometimes, the chemical changes caused by the addiction are so significant that it’s hard for people to truly control the urge to return to use. In addition, changes caused by addiction can cause people to feel so sick that they just don’t have the energy to fight back.
Medications used in addiction treatment programs tend to target portions of the brain damaged by addiction, according to an article published in the journal Social Work in Public Health.
For example, drugs of abuse can cause big spikes in production and uptake of dopamine. In time, brain receptors for dopamine begin to burn out, and people begin to require massive amounts of dopamine in order to fight off depression. Medications may help to regulate dopamine uptake, so people can avoid crushing depression during recovery.
Each medication works a little differently, depending on the damage it’s designed to amend. People who take these may feel healthier, calmer, and more in control of their thoughts and emotions. That can allow them to truly focus on the changes they need to make in order to maintain their sobriety.
Some people are introduced to medications during medical detox. In this phase of treatment, people are achieving sobriety for the very first time, and if they stopped using drugs abruptly, they might fall quite ill. Medications help to smooth the transition.
Other medications are used solely during the rehab portion of care. The medications help people to stave off relapse, so they have time to build up healthy habits that can persist. They may have used medications during medical detox, or they may have used them for the first time a little later in the healing process.
The National Institute on Drug Abuse (NIDA) reports that there are medications designed to help people with addictions to opioids and/or alcohol, though they are not approved for use by teenagers or children. At the moment, there are no approved medications to treat addictions to cannabis, cocaine, or meth, says NIDA.
Methadone is a synthetic substance that works on the same brain receptors targeted by opioids like Vicodin and heroin.
Opiates tend to flood the brain with sensation, and these substances are immediately available for processing. Methadone is different. It takes effect very slowly, so there is no sense of euphoric rush. Methadone is also non-sedating, which means people can do things like drive a car while under its influence.
NIDA reports that methadone has been used for more than 30 years to treat opioid addiction, and it’s considered both safe and effective. Methadone, when combined with therapy, helps people to stop abusing drugs and to build stable and productive lives, NIDA says.
Unfortunately, methadone can be abused. There are people who take doses that are larger than the doses experts recommend. There are those who also take methadone in unusual ways, cooking it down and injecting it, for example. That can lead to a euphoric rush.
When taken properly, methadone can be a valuable addition to a treatment plan. But it can also become a source of trouble when abused.
Buprenorphine is another prescription medication designed to help people with an addiction to opioids. Buprenorphine also works on receptors targeted by opioids, and when people take this long-lasting medication, they may feel a reduction in cravings for opioids. Brain cells may be fooled into believing they have access to opioids due to the presence of buprenorphine.
Buprenorphine can be abused, but there are formulations that can help to prevent abuse. One such formulation contains buprenorphine and naloxone. The naloxone component kicks in if people take large buprenorphine doses. The naloxone regulates buprenorphine uptake, so those large doses do not have a large impact. It’s a bit like a check valve. The naloxone keeps the level from rising too high.
The Substance Abuse and Mental Health Services Administration (SAMHSA) says buprenorphine doses are typically given to people in the early stages of opioid withdrawal. Doctors give the first dose based on how much opioids the person has been accustomed to taking. That dose should stave off symptoms of withdrawal, but it shouldn’t cause a high. It’s difficult to find the right dose unless the person is already in a mild state of withdrawal.
SAMHSA says people take buprenorphine as long as they need to in order to avoid relapse. Some take it for only days. Others take the drug for years. In time, if people want to stop using buprenorphine, doctors give smaller and smaller doses until people are taking no drugs at all.
Naltrexone is another prescription medication doctors can use to help people overcome an opioid addiction. It works as a cap on opioid receptors, essentially rendering any hit of an opioid worthless. People who take this medication may continue to use drugs, but those drugs simply will not work.
Naltrexone can be a lifesaving medication during an overdose. Since it can render opioids ineffective almost immediately, it can bring people back from dangerous overdose symptoms. It can also be used in the treatment of an addiction.
In a study published in the New England Journal of Medicine, researchers found that a once-per-month dose of naltrexone was more effective in preventing drug relapse in prisoners than counseling and community treatment programs were. The drug seemed to help break the mental connection between drug use and reward, and that helped prisoners to recover.
Naltrexone can also help people in recovery from alcoholism. In research published in 2002 in the Addiction Treatment Forum, researchers found that naltrexone significantly reduced the euphoric feeling caused by drinking, and it helped to reduce cravings for alcohol. That means people who took naltrexone just didn’t enjoy a lapse to drinking, and they were less likely to crave a drink. That could be intensely helpful in spurring recovery. This old research has been backed up by current research, all of which suggests that naltrexone is helpful in the fight against alcoholism.
The prescription medication acamprosate helps to reduce the impact of a sip of alcohol, although research published in American Family Physician suggests that experts don’t really know how the medication works. People who take it have reduced sensations when they drink, and they feel fewer cravings for alcohol, researchers say.
Acamprosate is a pill, and it must be taken by mouth each day. That means people must continue to take the medication at home in order to take advantage of the benefits the therapy can offer. Those who do may find that they have more control over their urge to drink.
This prescription medication is a little different than the others described in this article. It does not work on the pathways accessed by alcohol. In fact, it works on completely different parts of the body.
Disulfiram reacts with alcohol molecules directly, and that reaction causes intense physical discomfort. According to SAMHSA, it’s unclear if this medication reduces cravings for alcohol, but it is clear that it makes drinking incredibly unpleasant. People who vomit after each sip may never want to drink again. Breaking that feedback loop between drinking and pleasure could help people to stay sober.
It is not at all uncommon for treatment teams to use medications during medical detox, but not all programs use them for the maintenance phase of treatment. In fact, in a study published in the Journal of Addiction Medicine, researchers found that just 34.4 percent of facilities used medications for opioid dependence, and only 24 percent used them for alcohol use disorders.
These therapies can be powerful, but for someone overwhelmed with cravings, it can be hard to focus on therapy.
Similarly, while medications can help to reduce cravings and blunt the impact of drug use, they cannot help to change behavior. People must keep taking the drugs to get the benefits they offer.
Combining medication therapy with conventional therapy is one of the best ways to ensure long-term success, says NIDA. Programs that offer both types of help allow people to make persistent changes that can lead to long-term sobriety. Using just one may not be as helpful.
In an article published in Social Work Today, authors point out that Alcoholics Anonymous and Narcotics Anonymous organizers support the use of prescription medications in addiction treatment programs. They are not considered a sign of weakness or despair. They are part of the treatment program, and people who use them can be supported for doing so.
Addictions are personal, and so is addiction treatment. Treatment teams work hard to personalize the care they offer, so people with addiction get the therapies they need to gain control of their addictions. For some, that means medications. For others, they aren’t required. Talking with a professional can help you understand if medications are right for you.
(2013) Medications for Substance Use Disorders. Social Work in Public Health. Retrieved from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767185/
(January 2014) Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. National Institute on Drug Abuse. Retrieved from from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/evidence-based-approaches-to-treating-adolescent-substance-use-disorders/addiction-medications
(August 2008) Methadone: Appropriate Use Provides Valuable Treatment for Pain and Addiction. National Institute on Drug Abuse. Retrieved from from https://www.drugabuse.gov/about-nida/directors-page/messages-director/2008/08/methadone-appropriate-use-provides-valuable-treatment-pain-addiction
(2011) The Facts About Buprenorphine for Treatment of Opioid Addiction. Substance Abuse and Mental Health Services Administration. Retrieved from from https://store.samhsa.gov/shin/content/SMA09-4442/SMA09-4442.pdf
(March 2016) Naltrexone is Alternative Treatment for Opioid Addiction, Study Finds. Science Daily. Retrieved from from https://www.sciencedaily.com/releases/2016/03/160330184240.htm