Medication-assisted therapies refers to the practice of using a combination of counseling, behavioral therapy and medication to treat alcoholism and drug addiction. Although there is still no magical cure for addiction, studies show that this combination offers most patients the greatest chance of attaining and sustaining lasting sobriety.
Use of medications during addiction recovery is geared toward reducing the painful withdrawal symptoms that would otherwise lure the patient back to using the substance while, at the same time, reducing the patient’s cravings. During the time that the withdrawal symptoms are kept at bay by the medication, it is expected that the patient will participate in counseling and behavior therapy in order to address the underlying issues that lead to substance abuse or dependence. The most popular medication-assisted therapies are used to treat addiction to opiates and alcohol. Medication-assisted therapies are not widely accepted by all addiction professionals, however, as the wisdom of replacing one drug with another has been called into question.
Medication-assisted therapies for alcohol
After an alcoholic has stopped actively drinking, they will likely experience withdrawal symptoms for some time afterward. Some of these symptoms, including insomnia and anxiety, can actually cause a person to relapse in order to stop the symptoms. Alcohol has also been shown to physically alter brain chemistry and function and, without medical intervention, these changes can be slow or impossible to undo. There are several medications currently approved by the US Food and Drug Administration (FDA) for the treatment of alcoholism.
- Antabuse (generic name disulfiram) is based on the Pavlovian model of punishment and reward. When an Antabuse user drinks alcohol, he will very quickly feel sick (headache, nausea). Although Antabuse does not help reduce alcohol cravings, the user will learn to equate alcohol use with the feeling of sickness and his chances of relapse will fall dramatically. Disulfiram disrupts the body’s processing of acetaldehyde (derived directly from alcohol) into acetic acid, leaving the body with a greater amount of acetaldehyde than is advisable. This high level of acetaldehyde produces the uncomfortable symptoms.
- Campral (generic name acamprosate) is one of the newer drugs approved for treatment of alcoholism. During active alcoholism, the brain’s neurotransmitter systems become altered and require a continual supply of alcohol in order to function properly. Failure to keep these cells supplied with alcohol results in brain hyperacitivty and symptoms such as insomnia and anxiety. Because alcohol will both put a person to sleep and reduce anxiety, these patients are at great risk of relapse. Campral works by returning the brain to a state of chemical balance, especially in the GABA and glutamate systems. Because Campral is not metabolized by the liver, even people with liver failure or cirrhosis can use the drug. Patients will not become addicted to Campral while using it, nor will they experience many negative side effects.
- Naltrexone is the final medication routinely prescribed for alcoholics who are undergoing medication-assisted therapies. Unlike Antabuse and Campral, naltrexone actually reduces cravings for alcohol. Since it blocks the brain’s opioid receptors, a person who has taken naltrexone will also not experience many of the pleasurable effects that alcohol would normally generate. This reduces the likelihood of full-blown relapse when a recovering alcoholic slips up and has a drink.
Medication-assisted therapies for heroin
Heroin is the most dangerous form of opioid available in the US today; the risk of overdose from heroin ingestion is extremely high. Although naltrexone can also be used to treat opioid addiction, methadone is still the leading drug for medication-assisted heroin treatment. Methadone reduces the painful symptoms associated with opiate withdrawal by producing an effect that is similar to how opiates act on the body. When taken in higher doses, methadone will effectively block the pleasurable effects of any ingested opioids. Methadone Maintenance Treatment is intended to reduce cravings for opioids and prevent relapse long enough so that more conventional addiction treatment — such as counseling and behavior modification — can set the patient up for lasting sobriety. Although the stated goal of methadone maintenance treatment is to enable the patient to eventually live a substance-free life, the vast majority of methadone patients never cease taking the drug.