What is medication-assisted treatment for drug addiction
Substance use disorder (SUD) can be termed as a chronic relapsing medical illness with relapses and remissions and a strong genetic component. Long-term chronic drug addiction requires a holistic treatment that includes pharmacotherapy, psychotherapy, and to an extent, exercise and diet.
How does pharmacotherapy for addiction work?
In simple terms, pharmacotherapy (pharmacology) is the treatment of a disorder/disease/health condition with pharmaceutical drugs/medication. For. e.g., you have a cold, and your doctor gives you an antibiotic, that is, pharmacotherapy for your cold.
When it comes to addiction recovery, there are a few factors to consider. Years of substance abuse cause neurobiological changes in brain pathways which do not completely revert to normal even after the detoxification process, increasing the risk of relapse. Also, depending on the nature of the behavioural intervention and how strong the addiction is, the outcome of treatment for patients with SUDs can vary greatly. Medical treatment for addiction can help with a more consistent and positive outcome. Certain pharmaceutical drugs can reduce the intensity of withdrawal symptoms and cravings, and thereby prevent relapse, encouraging longer periods of abstinence. The main goal of medication-assisted treatment is for the patient struggling with substance abuse disorder to accomplish fully-sustained remission.
Is medication-assisted treatment for drug addiction necessary?
One of the main components of drug addiction recovery is detoxification. Often this is the first step towards drug addiction recovery. According to the National Institute on Drug Abuse (NIDA), detox involves getting rid of foreign substances and managing withdrawal symptoms on an as-needed basis. Withdrawal, which is the outcome of the detoxification process, is single-handedly the greatest hurdle a patient faces. Medication-assisted treatment can be extremely important in protecting the patient from the symptoms of withdrawal. Depending on the type of substance abuse, withdrawal symptoms can range from nausea, anxiety, and dizziness to violent seizures, hallucinations, and delirium and can sometimes be life-threatening. During medication-assisted treatment (MAT), patients are administered medications that ease withdrawal symptoms and cravings. This helps prevent medical complications that may arise from the detoxification process.
Medication-assisted treatment may not be necessary for someone who has been using drugs socially or only for a short while, as their bodies may not be completely dependent on drugs yet. However, it may be necessary for patients with long-term drug abuse where their bodies are dependent on the drugs they are abusing.
Types of medications for different substances
There are different medications for different substance use disorders, and they have varied effects and different outcomes. Let us look at the medications used to treat various substance abuse disorders.
Before we proceed, it’s important to understand that one needs to consult their doctor before taking any medication. The information provided here is only for you to understand how these drugs work in treating substance abuse.
Medicine for alcohol addiction.
| Medication | Effects | For whom | Side-effects |
| Naltrexone | Blocks the pleasurable effects of drinking | Patients who binge drink | Nausea, headache, and weakness |
| Acamprosate | Stabilizes and normalizes areas in the brain that are disrupted by alcohol abuse and withdrawal | Patients with liver cirrhosis | Diarrhea, upset gastrointestinal system (GI) |
| Disulfiram | Prevents relapse by causing extremely discomforting side-effects when alcohol is consumed (e.g., vomiting, headaches, sweating, etc.) | Highly motivated patients who want to quit drinking | Drowsiness, headache, and metallic taste. |
| Topiramate and Gabapentin (not approved by FDA) | Anti-seizure medication that is sometimes used to treat alcohol addiction. May facilitate moderation and help with mood, anxiety, and weight loss. | Patients who want to cut down on their drinking but not quit. | Cognitive dulling, ataxia, paresthesia, sedation, dizziness, and weight gain |
Medicine for drug addiction (opioid)
| Medication | Effects | For whom | Side-effects |
| Injectable Naltrexone | Blocks the pleasurable effects of opiates and reduces the likelihood of relapse or overdose | For patients that struggle to remember to take their medicines daily | Nausea, headache, and weakness |
| Buprenorphine | Blocks the pleasurable effects of opiates and reduces the likelihood of relapse or overdose | For patients with a low likelihood of misuse potential. | Headache, dizziness, trouble sleeping, tingling sensation |
| Buprenorphine + Naloxone | Blocks the pleasurable effects of opiates and reduces the likelihood of relapse or overdose. The added Naloxone decreases the misuse potential. | For patients with opioid use disorder with access to office-based licensed prescribers where there can be misuse potential. | Constipation, dizziness, drowsiness, and headache |
| Methadone | Prevents opiate withdrawal and cravings, but at prescribed doses, it does not create opiate-like effects | For patients with the proximity and availability to attend a clinic daily where there can be misuse potential. | Sleep problems, anxiety, restlessness, dry mouth, nausea, and decreased sex drive |
| Naloxone | Counters the effects of an opiate overdose | For opiate users during an overdose | Chest pain, shortness of breath, nausea, headache, anxiety, confusion |
Medication-assisted treatment is usually carried out under the expert guidance of a qualified doctor. The medicines are tapered off gradually till the patient no longer needs them. Medication-assisted treatment for drug addiction should ideally be a part of a larger rehabilitation plan which involves behavioural therapies like CBT, counselling, a 12-step program etc. While pharmacotherapy plays a major role during the withdrawal and relapse prevention stage, behavioural therapies may be needed to encourage patients to stay on track with their medications. Psychotherapy and counselling are also needed to resolve any underlying mental conditions or problems that may arise or may have been the cause of long-term drug use.
Pharmacotherapy for addiction rehabilitation depends on many factors the severity of the addiction, the duration of the addiction, the mental state of the person suffering from the addiction and the physical well-being of the patient. Doctors at rehabilitation centres consider all these factors before they plan the detoxification and the recovery process. Once a person has completed the detoxification, doctors may discuss with the patient or with the guardian the steps to take further and other factors like insurance coverage for medication-assisted treatment, side-effects of the medicines, long-term care and management.
In closing, medication-assisted treatment for drug addiction, along with behavioural therapies, counselling, etc., can bring about long-term successful recovery outcomes. To look for a suitable treatment for you, browse through our list of treatment centres here.
Sources
Walker.L., Fifield.J, Thomas. S. (2022, Oct) Drug and Alcohol Detoxification. www.drugabuse.com
https://drugabuse.com/treatment/levels-of-care/detox/
Douaihy. A, Kelly.T, Sullivan. C. (2013, Sept) Medications for Substance Use Disorders.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767185/
McLellan. A, Lewis. D, O’Brien.C, Kleber. H. (2000, Oct) Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.
https://pubmed.ncbi.nlm.nih.gov/11015800/
Pharmacotherapy – Medications. https://www.recoveryanswers.org/
Umhau. J., Buddy. T. (2022, July) What Is Withdrawal?
https://www.verywellmind.com/what-is-withdrawal-how-long-does-it-last-63036
Reviewed by
Rajnandini Rathod
M.Sc. Psychology,Research Associate at RehabPath
Rajnandini is a psychologist, keen on bringing awareness and uplifting the stigma attached to mental health in India. She completed her Master’s in Psychology with considerable experience with people with addiction problems. She co-initiated an online counseling platform during the pandemic to assist people with their rising mental health concerns. She is also working on various research projects and likes to spend her spare time making illustrations.
