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Addiction treatment has grown significantly in its ability to provide safe medical treatments that can benefit someone just starting their recovery journey or help support someone who has already made significant strides in their recovery.
Medication management options have grown extensively from treating only withdrawal symptoms for those in acute detox, to helping with non-narcotic (non-addictive) medications designed to give people their lives back from substances like alcohol or Opioids.
Certain medications can mimic the effects of addictive drugs, which relieves withdrawal symptoms and cravings.
Medications for addiction treatment may be prescribed as part of an inpatient (residential) or outpatient treatment program. Medical providers may adjust dosages during treatment to ensure that those with a substance use disorder (SUD) have the best chance of achieving and maintaining recovery.
Medications are a very common part of addiction treatment. However, many people are unaware that there are medications available for their substance use disorder. Dr. Ashish Bhatt, MD discusses the use of medications during addiction treatment, and how medically assisted treatment can help maintain sobriety.View All Videos
During the initial stages of starting treatment, the primary goal is to reduce the occurrence of life-threatening medical events related to acute substance withdrawal. This process is called acute detoxification and is commonly referred to as the detox process. Detox can last several days to several weeks depending on many factors, including the substance(s) used, frequency of use, method of use, patient age, and other medical conditions that can impact the detox process.
The detox process is generally considered to be uncomfortable at the minimum to potentially life-threatening in the most serious of cases, which highlights the importance of working with medical professionals. In addition, most of those seeking detoxification services often struggle with significant substance use, resulting in withdrawal symptoms that can be quite difficult to manage without assistance. Some examples of common withdrawal symptoms include:
The medications utilized in treatment for acute withdrawal symptoms will depend on the substances used and the potential risk associated with the symptoms observed. Therefore, there are a variety of different medication options depending on the stage of treatment.
These medications are used for short periods to reduce symptoms of anxiety and irritability. Anxiety is a common symptom of withdrawal from many substances, including alcohol, Opioids, Stimulants, as well as Benzodiazepines themselves. Benzodiazepines help sedate the patient by working on chemical receptors in the brain, similar to how alcohol impacts chemical receptors.
This similarity allows medical providers to utilize Benzodiazepines to safely detox those struggling with alcohol withdrawal. This also assists with reducing the chance of seizures occurring that are commonly associated with alcohol detox.
Due to the highly addictive nature of sedatives such as Benzodiazepines, when used long term, they are closely monitored by medical providers and seldomly prescribed to those in early recovery after the detox is completed.
When struggling with alcohol or Benzodiazepine use – it is highly recommended to seek out a medically monitored detox program to ensure no life-threatening conditions occur during the detox process.
Buprenorphine, more commonly known as Suboxone, is a medication approved by the FDA to treat Opioid use disorder (OUD). It is often used at the start of the detox process to reduce the severity of symptoms from developing. In other instances, Suboxone can also be used to help support a long-term approach to OUD treatment.
Suboxone can be helpful with various Opioids, such as OxyContin, Heroin, and Fentanyl. There are multiple forms of this medication, and it is often included in long-term medication management strategies in many treatment programs.
This medication is used to treat many symptoms experienced during detox from various substances. For example, Clonidine is a well-known medication used to treat blood pressure; however, it can assist with reducing sweating, cramps, muscle aches, anxiety, and the flu-like symptoms commonly experienced during detox.
Methadone is an Opioid used for moderate to severe OUD. Methadone works by binding to the same receptors in the brain as Heroin and pain medications, but Methadone does not cause euphoria when used at an appropriate dosage. This helps with managing withdrawal symptoms and cravings that occur.
Methadone is a medication with risks attached due to its addictive properties. Methadone is traditionally found at treatment centers connected with onsite counseling and services to assist with detox.
Naloxone, also referred to as Narcan, is a medication used to rapidly reverse an Opioid-related overdose by spraying it in the nose or through an injection directly into the individual suspected of overdose. This medication is often provided by emergency medical professionals and has been offered to close friends or family members of Opioid users, in case of suspected overdose.
The severity of withdrawal symptoms varies based on past drug use. Those who were taking drugs in high doses for an extended time have the worst symptoms.
Some helpful medications during detox can come from simple over-the-counter medications for nausea, constipation, vomiting, headaches, and other symptoms. Often these medications will be provided along with the prescribed treatment to help alleviate most withdrawal symptoms.
Sometimes there are prescription strength medications for some symptoms, such as nausea (e.g., Zofran), that can be provided if the symptoms appear to require it. It is best to discuss what medication options are available at the start of the detox process so you know what your options are to feel as comfortable as possible.
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Medication management will often expand past the first couple of weeks of the initial detox phase. It will help to support the individual through the next stage, called post-acute withdrawal syndrome (PAWS), which can last between 6 months to up to 2 years, depending on variables.
This medication relieves some emotional and physical distress that can occur during early recovery from an alcohol use disorder (AUD). It has been shown to help reduce urges and cravings to drink alcohol in early recovery. Medical providers will frequently prescribe Acamprosate after the detox process, as it generally requires alcohol to be out of the system before it can be started. Sometimes it might be provided during a longer detox stay if decided to be appropriate by the medical provider.
Recovering alcoholics can start taking Acamprosate after completing detox. Acamprosate reduces the chance of relapse by managing how chemical receptors in the brain function post-alcohol use, resulting in a reduction in symptoms like cravings, anxiety, and insomnia. As a result, it has been identified as one of the most prescribed medications for AUD in the US.
Disulfiram, commonly referred to as Antabuse, is one of the first medications used to reduce alcohol consumption by discouraging alcohol ingestion. Alcohol ingestion is discouraged by Disulfiram causing uncomfortable symptoms that include nausea, vomiting, sweating, headache, and chest pains, among others.
The goal is to reduce interest in alcohol use as a learned mechanism from such uncomfortable symptoms occurring after drinking. It can be quite effective as a deterrent for alcohol use with supervision.
Unfortunately, this medication has not been proven to be an effective strategy for some due to the need to take the medication daily for it to be effective. This has resulted in people choosing not to take their medication when they experience urges to use, which means without consistent accountability from external sources (e.g., family, spouse, parole officer) ensuring medication adherence daily, it tends to not be a long-term solution for some.
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One of the most common occurrences with substance use disorders is the experience of mental health conditions such as depression or anxiety disorders, referred to as a co-occurring disorders. There is an ongoing “chicken or the egg” conversation regarding which condition occurred first. This is often an individualistic event, and each disorder can occur in various stages of one’s life. However, it can safely be stated that both conditions are frequently experienced together.
Research has shown that effective measures to treat substance use disorders must also include treating co-occurring mental health conditions simultaneously. Many different prescription medications can assist with treating various mental health conditions. Common medications include antidepressants (e.g., Zoloft) for depression disorders, mood stabilizers for bipolar disorders, anxiolytics (e.g., Buspirone) for anxiety disorders, and even some Stimulants (e.g., Vyvanse) for attention deficit disorders.
Some form of behavioral talk therapy, such as cognitive behavioral therapy (CBT), is almost always encouraged with medication approaches to simultaneously achieve the best results in treating both conditions.
Naltrexone is a medication designed to treat alcohol use disorder (AUD) and Opioid use disorder (OUD). Naltrexone is composed of tablets that are taken daily to achieve a therapeutic level in the body.
Vivitrol is the same medication; however, it is provided as an injectable medication that is given once every four weeks. It is one of the few non-addictive medications on the market that has demonstrated success in treating both conditions. The medication works by binding & blocking chemical receptors used by Opioids and alcohol, reducing cravings for both Opioids and alcohol.
To start this medication, the individual must be fully detoxed; otherwise, they can experience withdrawal symptoms as the medication takes effect. This medication has many benefits, including no potential for abuse and the option to take it monthly. As with any other medication, side effects and potential associated risks should be discussed with a medical provider before taking this medication.
Some people have attempted to detox without medical care, referred to as going “cold turkey.” Some may find success with this method. For most, however, the life-threatening effects of withdrawal symptoms are not to be minimized. Attempting to detox without medical supervision is an unsafe practice that can lead to devastating results.
A supervised detox is the first step in treating any type of addiction.
A supervised detox can alleviate health issues. Medical providers can track important vital signs such as heart rate, temperature, breathing rate, and fluid levels. Medical providers can help relieve any discomfort from withdrawal symptoms being experienced. They can also adjust any medication according to the patient’s needs and make long-term plans for medication management strategies. Those with medical conditions or health issues should also seek medical detox. Withdrawal symptoms can complicate chronic health problems like high blood pressure.
Detox is such an essential element in substance use treatment care that it is often a part of inpatient treatment centers. In most cases, inpatient treatment can be completed in 30 to 90 days. The first week may consist of closely observed detox when required. Treatment programs include other forms of treatment beyond just medication management, such as behavioral therapy, which, when combined, helps recovery become more successful.
Contact a treatment provider today if you or a loved one would like to explore potential treatment options.
Travis Pantiel, LMHC, MCAP
Travis Pantiel is a Licensed Mental Health Counselor and a National Board-Certified Counselor with specialized expertise in the co-occurring disorder treatment field.
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