Why Are Replacement Medications Necessary during Detox?
Medications are frequently used during the course of drug and alcohol detox. Several medications have been FDA-approved to treat withdrawal from different substances, as well as to assist in relapse prevention. Medications that ease the symptoms of withdrawal can help an individual through the detox process; however, additional therapeutic treatment is still needed in order to fully recover from addiction.
Many of the medications used to treat dependence and addiction ease symptoms of withdrawal. Other medications used in detox help prevent relapse by re-establishing normal brain function, which decreases cravings. One study by SAMHSA/a> found that medication was used in nearly 80 percent of treatment facilities that offer detox services.
According to NIDA, there are medications that are approved to help with opioid, tobacco, and alcohol withdrawal. Regardless of the specific medication used, all medications are intended to lessen the intensity of withdrawal symptoms, reduce the likelihood of relapse, and encourage long-term sobriety.
Medications Used in Opioid Detox
The medications used in opioid medical detox are often term replacement medications, as they essentially replace the opiate that was being abused, such as prescription painkillers and heroin. Over time, the dosage of the replacement medication is lowered, and clients are slowly weaned off that medication, making the withdrawal process easier since it is managed.
Methadone: Methadone is an opioid agonist used both as a withdrawal medication and a maintenance medication in the treatment of opioid dependence. This drug mimics the effects of illicit opioids by activating the same receptors in the brain, which eases symptoms of withdrawal and prevents cravings. Methadone is dispensed in tablet or solution form and taken orally. Only specially licensed methadone clinics can offer methadone detox and maintenance, and the medication can only be administered on site at the treatment facility. Dosage depends on the individual and is tapered gradually over time in order to prevent severe withdrawal or complications during the detox process.
Buprenorphine: Buprenorphine is a partial opioid agonist-antagonist, meaning it mimics some of the effects of illicit opioids without causing the “high” associated with other drugs. Buprenorphine is often formulated in combination with naloxone, an opioid antagonist, which helps prevent overdose and abuse of this medication. Like methadone, buprenorphine lessens withdrawal symptoms and prevents cravings. Buprenorphine can be administered on an outpatient basis by licensed medical professionals. This medication may be used only during the detox process, or it may be continued on a long-term basis. Doctor often taper dosages of the drug gradually over time until individuals can function without it.
Naltrexone: Naltrexone is an opioid antagonist. This means that rather than mimicking the effects of opioids, like methadone or buprenorphine, naltrexone blocks the effects of these drugs. This helps restore normal brain functioning and discourages the individual from relapsing into drug use. Because this medication blocks the effects of certain substances, it is sometimes used to treat overdose. Naltrexone can be taken as an inpatient or outpatient, and it may be taken once a day or once every few days, depending on individual needs and the formulation and dosage used. This medication does not treat withdrawal symptoms, and it may actually worsen withdrawal. However, it can reduce cravings and assist in establishing sobriety.
Medications Used in Alcohol Detox
Various medications can be used during alcohol detox. Each medication works a little differently to make withdrawal more manageable and improve sobriety rates.
Naltrexone: Naltrexone, in addition to treating opioid withdrawal, can also be used in the treatment of alcohol dependence. Naltrexone blocks receptors within the central nervous system that are responsible for the effects of alcohol on the mind and body. Because of this, naltrexone can be used to discourage the use of alcohol during the detox period, as well as afterwards during addiction treatment.
Acamprosate: Acamprosate blocks the effects of alcohol on the mind and body. This medication helps to reestablish normal brain functioning after alcohol use has ceased. Long-term use of large amounts of alcohol changes brain chemistry and function; reversing these changes helps to relieve cravings and prevent relapse. This medication also helps discourage relapse by preventing alcohol from having any effect.
Disulfiram: Disulfiram discourages relapse into alcohol abuse by causing serious negative effects when combined with alcohol. This medication should never be taken while still intoxicated, and you should wait at least 12 hours after your last drink before taking the drug. When alcohol is consumed while on disulfiram, it causes multiple negative effects, including:
- Flushing
- Headache
- Nausea
- Vomiting
- Chest pain
- Weakness
- Distorted vision
- Confusion
- Perspiration
- Choking
- Breathing troubles
- Anxiety
The main function of disulfiram is to discourage drinking. It is best utilized by people who are highly motivated to stop consuming alcohol.
Medications Used in Tobacco Detox
Many replacement products are available for those who wish to quit using tobacco. From over-the-counter gums and patches to prescription medications, each product works slightly differently.
Nicotine replacement: Nicotine replacement therapy is one of the most common approaches to recovery from nicotine addiction and dependence. Over-the-counter products are available as patches, gums, sprays, and in various other forms. Nicotine replacement products provide the nicotine the body is addicted to, but in lower doses and without the smoking behaviors, which can be severely psychologically addictive. Over time, doses of nicotine replacement products are reduced, allowing individuals to slowly wean off nicotine.
Bupropion: Bupropion is an antidepressant that is sometimes used to help people stop smoking. The antidepressant effects of bupropion help to counter the symptoms of nicotine withdrawal, as well as the changes in mood and anxiety that can result from attempting to break the psychological addiction. This medication comes in tablet form and is taken 2-4 times per day in small doses. Dosage is typically built up slowly over time, and it must be tapered off gradually.
Varenicline: Varenicline is a medication used to help adults quit smoking. It is a tablet that is taken by mouth once or twice a day. Dosage of this drug must be increased slowly over time. Most people begin treatment with varenicline a week before they quit smoking and continue to take the drug for about 12 weeks. This medication helps to reduce cravings and suppress the need for nicotine, which makes it easier to quit a smoking habit.
How Successful Are Replacement Medications?
Medications, specifically replacement medications, tend to improve the outcomes of detox. The efficacy of opioid replacement medications has been well established; one such study published by >Dialogues in Clinical Neuroscience found that both methadone and buprenorphine increased rates of opioid detox completion.
Naltrexone and acamprosate, when used to treat alcohol withdrawal, have both been found to be effective in reducing rates of relapse in another study. The two approved medications for tobacco addiction treatment – bupropion and varenicline – can both reduce cravings and prevent a return to smoking, but there is some evidence that varenicline may be somewhat more effective, according to a study published by the American Journal of Health Behavior.
Medications should only be used as part of a comprehensive addiction treatment program that includes therapy. The underlying issues surrounding substance abuse must be addressed for full recovery to be reached and sustained. While medications are often part of a larger program, they do not constitute effective addiction treatment in and of themselves. Any use of medications should be supervised by medical professionals.