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Pharmacotherapy Treatment For Drug Abuse

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 26, 2019

Pharmacotherapies are designed to treat substance abuse in respect to detoxification, relapse prevention, and opioid maintenance. While they can be used alone, they often work best within medication-assisted treatment (MAT) programs. This approach combines pharmacotherapies with behavioral therapies and supports treatment goals, the pursuit of sobriety, and helps build a solid recovery.

What Is Addiction?

According to the American Society of Addiction Medicine “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.” To a user, an abused drug produces what appears to be positive effects. But over time, the toll on a person’s life, body, and brain become increasingly negative and damaging. This is when the role of pharmacotherapies medicines come into play, either alone or within MAT.

What Is Pharmacotherapy?

In the Substance Abuse and Mental Health Services Administration’s (SAMHSA) “A Guide to Substance Abuse Services for Primary Care Clinicians” the section on pharmacotherapy defines it as “In the context of substance abuse, pharmacotherapy is the treatment of drug or alcohol dependence with medication to achieve one of three ends: detoxification, relapse prevention, or opioid maintenance.”

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What Is Withdrawal And How Does Detox Help?

Drug use changes an individual’s brain and physiological functioning. Because of this, a person’s body reacts negatively when an individual quits drugs or alcohol “cold turkey”. The exact circumstances vary depending on the person and the substance of abuse. These withdrawal symptoms creates numerous symptoms which are uncomfortable, painful, dangerous, and in some cases, deadly.

Detoxification occurs as the body and brain begin to cleanse themselves from toxins. It lasts until the time the drug is removed from the person’s system. A supervised, medically-assisted detox is recommended to treat an individual during withdrawal. Pharmacotherapies are a critical component, as they work towards alleviating or reducing the symptoms and risks of withdrawal.

Relapse Prevention

If an individual isn’t properly treated, the risk of relapsing to drug abuse is high. Pharmacotherapies can be used after detox to maintain an individual’s sobriety, both during and after treatment. Certain medications may be used to alleviate cravings, whereas others may be used to treat co-occurring disorders. This is so these things don’t become triggers for relapse. SAMHSA elaborates: “Drugs prescribed for this purpose directly target substance abuse or treat underlying depression or other psychopathology that can be a comorbid condition for drug dependence.”

Opioid Maintenance

SAMHSA continues, reminding us that “Opioid maintenance is generally considered a treatment of last resort for opiate abusers who have not had success in abstinence-oriented treatment.” But, when a situation warrants this treatment, whether it be heroin or another form of opioid addiction, maintenance therapy does offer results. The following are the National Institute on Drug Abuse’s (NIDA) evidenced-based pharmacotherapies:

Methadone: This medication is a long-acting synthetic opioid agonist used to treat both withdrawals and cravings. Within maintenance programs, this medication is more effective when paired with behavioral therapy. It can be addictive, which is why it is highly monitored and obtained only through licensed programs.

Buprenorphine: Like methadone, buprenorphine reduces cravings and symptoms of withdrawal and may also be used for withdrawal or maintenance. Also, an opioid, this medication is a partial agonist, which means the euphoria and respiratory depression is less than methadone or many other abused opioids. There is also a lower potential for abuse and overdose. One of the most common forms of this medication, Suboxone, combines naloxone with buprenorphine to prevent misuse.

Naltrexone: This opioid antagonist blocks abused opioid drugs from attaching to the opioid receptors, thus preventing an individual from obtaining the high or euphoric state which they seek. It should be administered after detoxification is complete. Taken orally, or by injection, this medication is “highly motivated, recently detoxified patients who desire total abstinence because of external circumstances—for instance, professionals or parolees.”

Opioid Withdrawal

Clonidine: According to MedlinePlus this medication “is used to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings.”

Other: SAMHSA notes that the following may be used for additional symptoms of withdrawal:

  • Antinauseants: Nausea
  • Antispasmodics: Abdominal cramping
  • Anti-inflammatory pain relievers: Muscles aches

Pharmacotherapies For Alcohol Abuse

NIDA also outlines evidenced-based pharmacotherapies for alcohol treatment (the last two, while not included in their list are often used with positive results).

Acamprosate: Useful for symptoms of protracted withdrawal, “Acamprosate has been shown to help dependent drinkers maintain abstinence for several weeks to months, and it may be more effective in patients with severe dependence.”

Disulfiram: This medication actually reacts with alcohol, causing acetaldehyde (a byproduct of alcohol) to build up. This accumulation creates a variety of uncomfortable effects which turn people off from drinking. Disulfiram requires commitment, but in patients who are committed to sobriety it does produce results.

Topiramate: NIDA cautions that this medication is not FDA approved for treating an alcohol use disorder, though they do note that it its used off-label in this way. Topiramate has been shown to be beneficial for treating withdrawal, reducing cravings, and as a maintenance medication. Better outcomes are reported when it is used adjacent to behavioral therapy.

Naltrexone: Naltrexone is commonly used to reduce both cravings and the pleasurable feelings associated with alcohol. A National Institute on Alcohol Abuse and Alcoholism publication lists this as a medication for alcohol dependence; however, they do note that “it is especially helpful for curbing consumption in patients who have drinking “slips.” It is less effective in maintaining abstinence.”

Benzodiazepines: These have a high potential for abuse; however, when used only to treat withdrawal they are generally considered safe. SAMHSA explains: “They decrease the likelihood of withdrawal seizures and episodes of delirium tremens and suppress severe anxiety, insomnia, tremulousness, tachycardia, rising blood pressure, and grand mal seizures.” Three that are commonly used include chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan).

Marijuana (Cannabis): NIDA reports that there is currently not an approved medication to treat marijuana use disorders or withdrawal; however, research is ongoing. But they do not that buspirone (BuSpar) may help for anxiety, while zolpidem (Ambien), and gabapentin (Neurontin) have shown some benefit in treating sleep issues, with the latter medication also being shown to improve executive function.

Stimulants (Amphetamine, Cocaine, Methamphetamine, etc.): There is currently not an FDA-approved pharmacotherapy for stimulant-related disorders, including detoxification. But according to a 2013 Current Psychiatry Reports publication, there are numerous medications which show promise.

While research continues, treatment facilities may utilize different medications depending on the drug, the client’s unique needs, and their specific treatment protocol. For any agitation or insomnia, SAMHSA does tell us that chlordiazepoxide (Librium) may provide client’s with relief.

Co-Occurring Disorders

It is very common in situations of addiction to see a co-occurring disorder, such as anxiety, depression, stress, and trauma. Sometimes during withdrawal, treatment, or within recovery an individual may experience depression or anxiety as they adjust to chemical, biological, and behavioral changes, or this could be a co-occurring disorder. Various medications, especially those that are non-addictive, may be used to address symptoms of these and other conditions.

Antidepressants: Many experts agree that selective serotonin reuptake inhibitors (SSRIs) are good choices to treat depression, especially for those recovering from an alcohol addiction. This is due to the way they are often tolerated better than the tricyclic versions.

Anti-Anxiety Medications (Anxiolytics): While benzodiazepines may be used, these medications are must be used with caution. This is due to the addictive potential and risk of polydrug abuse, especially in those with alcohol addictions. Many addiction specialists prefer to abstain from benzodiazepines for these reasons, instead choosing a nonaddictive alternative, such as buspirone (BuSpar).

Sleeping Difficulties: In avoiding the abuse potential of various sedative-hypnotics used for this purpose, certain other medications may be used. One example includes trazodone (Oleptro). This is actually an antidepressant, though it also has a sleep-inducing (hypnotic) effect.

In circumstances of abuse stemming from self-medication, the root concern may yet need to be addressed during and after detox. These concerns include anxiety, depression, pain management, and sleep disturbances; various non-addictive medications may be used to alleviate symptoms linked to these.

Depending on the exact concern, comprehensive support may be received in an outpatient or inpatient setting or by certain addiction specialists within ongoing recovery care. Specific pharmacotherapies are determined by the client’s specific needs, lifestyle, and most importantly by the type of drug abuse and the intensity of the addiction.

We Can Help You Build A Treatment Plan

If you’re facing an addition or trying to support a loved one while they are, let us support you. RehabCenter.net can help you to better understand your options in regard to pharmacotherapies, medication-assisted treatment, and rehab. Contact us today.

National Institute on Drug Abuse - Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

U.S. National Library of Medicine - Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond

U.S. National Library of Medicine - Maintenance Medication for Opiate Addiction: The Foundation of Recovery

U.S. National Library of Medicine - Pharmacotherapy for Stimulant-Related Disorders

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