Addiction Treatment Medications | Are They Cheating?
I was speaking at a forum recently and this question came up (it actually comes up quite often), “Aren’t these addiction treatment medications sort of like cheating?” And then the person asking the question went on to say, “I mean, in AA they say you can’t take other medications because that’s being addicted to something else.”
So I thought I’d use this post to share the latest reliable research and information on the use of addiction treatment medications. Not only are they NOT cheating, they can be a tremendous help!
Sometimes medications for addiction cravings can be exactly what the doctor ordered to help with addiction treatment and recovery.
The following is a copy and paste from the NIH National Institute on Drug Abuse (NIDA), “DrugFacts: Treatment Approaches for Drug Addiction”, which is permissible with acknowledgement. And for those new to addiction research, alcohol is considered a drug, so this information covers treatment approaches for alcoholism, as well.
Before you read further, you may also wish to learn more about the brain disease of addiction, as well as the concepts of addiction cravings and relapse.
Effective Treatment Approaches
Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual’s life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person’s success in achieving and maintaining a drug–free lifestyle.
Medications
Medications can be used to help with different aspects of the treatment process.
Withdrawal. Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself “treatment”—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated.
Treatment. Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will require treatment for all of the substances that they abuse.
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Opioids: Methadone, buprenorphine and, for some individuals, naltrexone are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone works by blocking the effects of heroin or other opioids at their receptor sites and should only be used in patients who have already been detoxified. Because of compliance issues, naltrexone is not as widely used as the other medications. All medications help patients disengage from drug seeking and related criminal behavior and become more receptive to behavioral treatments.
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Alcohol: Three medications have been FDA–approved for treating alcohol dependence: naltrexone, acamprosate, and disulfiram. A fourth, topiramate, is showing encouraging results in clinical trials. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some but not all patients—this is likely related to genetic differences. Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (an unpleasant or uncomfortable emotional state, such as depression, anxiety, or irritability). It may be more effective in patients with severe dependence. Disulfiram interferes with the degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. Compliance can be a problem, but among patients who are highly motivated, disulfiram can be very effective.
To read the remainder of this piece, including a discussion of Behavioral Treatments, click here.
As with all addiction treatment – there is no one-size-fits all, a concept discussed in this related post, Addiction Recovery Therapy Options.
And one last point – often people with addiction also have a co-occurring disorder (anxiety, depression, bipolar…) and often they may need medications to help with the treatment of the co-occurring disorder. To learn more, please check out these NIDA’s resources, “Comorbid [simply means occurring simultaneously] Drug Abuse and Mental Ilness” and “How Should Comorbid Conditions Be Treated.”
As important as reading this information is finding the right doctor. One resource for this is the American Society of Addiction Medicine. “ASAM is a professional society representing over 3,000 physicians dedicated to increasing access and improving quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions.” ASAM provides a search tool to find a physician trained in addiction medicine – click here to search by criteria, country, state, location.
Lisa Frederiksen
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Thanks so much for your comment, Robert!