As a chronic mental health disorder, addiction can be challenging to treat.
Similar to chronic physical disorders like asthma and diabetes, the risk of relapse to substance abuse both during and after treatment is fairly high, and relapse can derail the recovery process. Because of this, research is being performed all the time to find new ways of helping people overcome this risk and stay abstinent from drug abuse for the long-term.
One of the branches of research has included finding medicines that can treat symptoms of addiction and prevent relapse. Over time, a number of drugs have been both specifically developed for addiction treatment and repurposed from other uses to reduce relapse risk. In most cases, these drugs are used to help with specific addictive substances, such as alcohol, opioids, or nicotine. However, other medicines have shown promise in treating other types of addiction as well.
Using Medication to Treat Addiction
Two of the biggest challenges in addiction treatment are the withdrawal process – as the person’s body reacts to the loss of the substance use – and the continued cravings that occur both during and after treatment. These are both major contributors to the individual’s risk of relapse, as evidenced partly by an article from Alcoholism: Clinical and Experimental Research. As a result, researchers have increasingly tried to find medications that can help to ease the uncomfortable symptoms of withdrawal and curb the destructive cravings that can cause a person to return to substance use. In the case of dangerous withdrawal syndromes, such as for alcohol, this can also decrease the chance of a lethal withdrawal reaction.
Some of the medications provided during substance abuse treatment are simple, over-the-counter products that ease physical discomforts that are typical of the withdrawal period. However, certain medications are also provided to directly affect the brain systems involved in the addiction response, in the hopes that they can deter the person’s desire to start using again.
Another use of medication during addiction treatment is to manage co-occurring disorders that can contribute to substance abuse. For example, individuals who self-medicate depression by drinking alcohol may find it easier to stop alcohol abuse if they take medications to treat depression.
Some of the more frustrating symptoms of withdrawal are easily treated using over-the-counter medications to ease discomfort until the withdrawal stage is over. These include:
- Pepto-Bismol or other anti-nausea and antidiarrheal formulations
- Analgesics like acetaminophen or ibuprofen for various aches and pains
- Natural or non-narcotic sleep aids, like melatonin supplements
- Topical creams for muscle aches, like Ben-Gay
These formulations are often provided as part of the withdrawal process in treatment, because they can make the discomfort of withdrawal easier to bear while avoiding exposure to other addictive substances. By taking these supportive medications, the client is less likely to feel the degree of discomfort that can lead to a desire to start using again, thereby preventing relapse.
Not all types of addiction respond to medication to ease withdrawal and reduce cravings. However, in particular, struggles with alcohol, opioid addiction, and nicotine dependence can respond to certain medicines. The following are just some examples of these medicines:
- Naltrexone: This drug was originally developed to treat opioid addiction by reducing cravings; however, it has also been found to reduce alcohol consumption. According to the National Library of Medicine, this is most likely to be helpful when provided in concert with psychosocial therapy.
- Disulfiram: WebMD describes this as an alternate alcohol addiction treatment that helps with alcohol withdrawal and cravings by blocking the processing of alcohol in the body. In other words, an individual taking this medicine would not feel the euphoria that normally occurs with drinking, helping to reduce the desire to use alcohol.
- Methadone: In opioid addiction, methadone has become well known as a maintenance medication that helps to prevent cravings during and after treatment. Methadone itself is a type of opioid, but it is considered to have a lower addiction potential, which enables it to be used to satisfy cravings as the individual is slowly tapered down from using the more dangerous opioid. Some people with a high risk of relapse stay on methadone maintenance on a long-term basis.
- Buprenorphine: Similar to methadone, buprenorphine is meant to help control cravings by taking the place of the opioid in the body. However, it is considered to have an even lower addiction potential. As described by the Substance Abuse and Mental Health Services Administration, its effects level off at a certain dosage, meaning that higher doses will not increase the “high” felt by a person using it. Buprenorphine is often combined with naloxone, a drug that reverses the body’s response to opioids, which can make it very unpleasant to take the medication in ways other than intended.
- Gabapentin and other antiepileptic drugs: In recent years, research has noted that anti-seizure drugs like gabapentin and topiramate can also change the way the body responds to addictive substances, helping to reduce cravings. The medicines slow brain cell activity, which in turn can reduce the desire for drugs that affect this activity in other ways, such as cocaine, alcohol, and opioids. These medicines are a major focus of current addiction treatment research.
Challenges of Treating Addiction with Drugs
The development or discovery of prescription medications that can treat addiction is often heralded as a “cure” for substance use disorders. However, this is an exaggeration as there is no cure for addiction; using medicine to treat substance abuse can be a double-edged sword. In other words, using drugs to treat drug abuse may seem problematic; replacing abuse of one substance with dependence on another appears to defeat the purpose of addiction treatment.
Many researchers would argue with this sentiment, especially considering some of the medications that help to curb cravings and prevent the desire to relapse. These experts believe that medicine is a legitimate route for treating drug abuse. For some individuals, it certainly may seem to be the best course. However, there are difficulties that arise when using medicine to treat drug abuse and addiction, which include:
- Transfer of addiction from one substance to another: With treatment medications that have abuse potential, such as methadone or gabapentin, the individual may develop tolerance and addiction to the medication, simply replacing one struggle with another. For example, an article from Medscape discusses cases demonstrating that gabapentin can be a focus for substance abuse, as has been the case with methadone and even buprenorphine
- The individual feeling “better” and stopping use of the medication: It is a common misconception that, once a person has taken a medicine long enough to feel better, they can stop taking it. In the case of chronic illnesses and disorders like addiction, this misconception can lead to the individual returning to harmful behaviors and relapsing, especially in periods of stress, as described by the article from Alcoholism: Clinical and Experimental Research.
- The “magic bullet” effect, preventing the person from pursuing other helpful treatment: Often, when people take medication, they assume that’s all that’s needed to treat the disorder. This can cause them to avoid pursuing other helpful methods that don’t depend on medication to work, such as Cognitive Behavioral Therapy or peer group support programs.
These challenges of using medication to prevent relapse can cause a person to revert to former behaviors or to develop new addictions, resulting in relapse and potential overdose. A helpful way to avoid these difficulties is treatment that helps to change those behaviors rather than applying medication to the symptoms of what is often a deeper psychological issue.
Caution must also be used in the medications prescribed for co-occurring disorders because many of these prescriptions are also addictive. If these medications are necessary to support the other condition, they must be carefully supervised and supplemented with behavioral therapies and other support to avoid transferring addiction to the treatment medications.
Treatment without Medication
Because of these issues, it is important to realize that medicine is not a standalone treatment for addiction. In order for the individual to be able to recover and avoid relapse, psychosocial, behavioral therapies for addiction treatment are important, as described by the National Institute on Drug Abuse. Rather than just treating the symptoms of withdrawal or cravings, these behavioral therapies approach the underlying causes of substance abuse and addiction, with the hope that the individual will learn to manage these issues and have more control over triggers to use. This, in turn, can help the individual recognize and manage cravings when they arise without the need for medicine.
Well-rounded substance abuse and addiction treatment through research-based rehab facilities can provide these therapies both alone and with medicines and other medical treatment to provide a full spectrum of tools for recovery support. This has been shown to be the approach with a higher likelihood of helping the individual achieve and maintain recovery.