Medications for Addiction

Substance Use Disorder (SUD) has been recognized as a chronic medical illness that is accompanied by relapses and remissions. A strong genetic component has also been identified. When the brain’s reward center is affected by a behavior or substance, it changes the motivation and memory systems with an excess release of dopamine. Addiction is complex and is characterized by continuing a behavior that is having a negative impact on health, relationships, and finances. Whatever the addiction, people tend to exhibit similar symptoms — including loss of interest in activities once enjoyed, no longer hanging out with friends and family or attending social activities, and not being able to stop using the substance even when they truly have the desire.

Most addicts must reach rock bottom before recognizing that they need to stop using drugs, whether they have watched a partner walk out the door or woken up in the emergency room. No one takes that first hit and decides that they will become an addict; however, it happens to millions of people. There is always hope for those who want to get their lives back on track, and it can be found in the professional setting of an alcohol or drug treatment facility. There are a variety of programs available with differences that match specific situations, and while only a small percentage of those programs use MAT (medication-assisted treatment), it is one of the most effective methods of helping someone conquer their SUD when used in combination with appropriate psychotherapies. We are going to discuss how medications help.

How do medications break the cycle of addiction?

When someone consistently consumes a substance, it will change the way the brain performs. The chemicals in the drug cause a release of dopamine, which causes pleasure. The effects branch out to the location of the brain with the highest functions. This causes intense focus on everything related to that particular drug. It is a reversible state; however, it took time to grow the addiction and will take time undoing the damage that it caused. The drugs that are used to stop addictions generally are responsible for three functions:

• Easing the discomfort of withdrawal symptoms
• Reducing the intensity of the cravings by adjusting the chemical imbalances that were caused by the addictive drug
• Blocking the euphoric and sedative effects of the abused drug

With each drug making their own unique changes to the body, there is no one drug that resolves every drug’s modifications. There are three classifications of medications for SUD that use different methods to help someone recover:

• Full agonist medications
  • These bind directly to and stimulate the opioid receptor in the same way that heroin does. Used as a replacement for the abused drug and reduced over time.
• Partial agonists
  • These do not stimulate the opioid receptor to the same degree as the full agonists. Used mostly during drug detox treatment but not after.
• Antagonist medications
  • These bind to the opioid receptor to prevent agonists from binding but do not stimulate it.

Isn’t using medication in rehab just swapping addictions?

The short answer is no. The drug that is used to either help someone wean off of their highly addictive drug does not deliver a euphoric feeling as long as it is taken as directed. They are only given their daily dose and typically return to a clinic on a daily basis as part of aftercare and maintenance. There are also long-lasting medications where the previous user may not need to return as often once they prove that they do not need as much monitoring. These medications are evidence-based treatments that lend to a successful recovery with less relapses.

What medications are used for addiction treatment?

The prescription medication that will help restore balance is different for each class of drugs. It is important to remember that medication is not a cure but is a powerful part of an effective plan when combined with behavioral therapies. Some of the most common addictions and their medication options include:

• Alcohol Use Disorder (AUD)
  • Acamprosate – Helps people in recovery who do not want to drink. It eases withdrawal symptoms, but it does reduce the patient’s urge to drink. 
  • Disulfiram – Typically used early in a MAT program to create unpleasant side effects if someone consumes even a small amount of alcohol.
  • Naltrexone – This antagonist blocks the euphoric effects of alcohol so the user will not feel intoxicated, helping to motivate them to stay sober.
• Opioid Addiction – Opioids are particularly dangerous as they can be laced with fentanyl. They are one of the biggest causes of overdoses and have resulted in an epidemic of heroin and other opioid deaths in the United States.
  • Methadone – A full agonist that reduces withdrawal symptoms during detox, binding to the opioid receptors to block euphoric effects. The length of time someone is on this depends on the severity of their addiction. Methadone clinics can help support those in recovery with aftercare as well. This must be weaned off of as it will cause its own withdrawal symptoms
  • Suboxone (buprenorphine) – The only opioid therapy that can be prescribed in settings outside of opioid treatment programs. This partial agonist reduces someone’s physical dependency, withdrawal symptoms, and cravings, all lowering the potential for misuse. Suboxone clinics can help support those in recovery with aftercare and maintenance as well. This may cause withdrawal symptoms if not weaned off of properly.
  • Naltrexone – Can be used to reverse overdose. When administered as a part of a MAT, it blocks the patient’s ability to feel euphoria, or high. This is one of the only drugs that is not addictive and will not cause withdrawal symptoms when stopped. It also suppresses the cravings for the opioid. It has been proven to help those trying to quit drinking alcohol as well.
  • Naloxone – Used to prevent opioid overdose by reversing their toxic effects.

There are many other substances to which people can become addicted, and there are other prescription medications that are used to help break those addictions. For example, nicotine is another of the most commonly abused chemicals. Studies have shown that someone who stops smoking nicotine will more easily find their way to abstinence from alcohol and other illicit drugs, so smoking cessation could be an important step in the process of recovering from drug use. Nicotine replacement therapies (NRT), Zyban, and Chantix have proven themselves to be highly effective.

While medication that help someone recover from their addiction to drugs may seem like it offers an easier solution to break away from drug abuse, it is not typically successful when used alone. Whether your drug of choice is legal, like alcohol and cigarettes, or illegal, like heroin and meth, it has already changed the way your brain processes stimuli from the outside world. It has not only transformed the way your reward system is adapting, but it has also altered your ability to reason and focus on thoughts. It may take a while for your brain to catch up with the fact that others have been suggesting you need help for your addiction, but it is never too late. Choosing a treatment facility can be overwhelming, so asking questions can help make the choice an effective one. Studies have shown that when someone takes advantage of MAT, they have an increased chance of success in achieving and maintaining their sobriety.