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Medications for Addiction Treatment

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Addiction is a chronic and complex, but treatable disease. Like other chronic diseases, such as heart disease, it can be managed under the guidance of a trained clinician, with a variety of treatment approaches available that are individually tailored to a person’s needs.1 Like other mental health conditions, addiction treatment generally involves psychotherapy, where people learn new thought patterns to break the cycle of substance misuse. For individuals with certain types of substance use disorders, treatment may involve a combination of behavioral therapy and medication.1 Medications for addiction treatment are beneficial to many people in helping them abstain from alcohol or opioids.

There are numerous types of addiction treatment medications that can support an individual’s recovery goals.2 Medications that treat addiction are an integral part of treatment for many people and are typically used alongside cognitive and behavioral approaches as well.2

What Are Medications for Addiction Treatment?

It is important to understand that addiction—also referred to as a substance use disorder—is a medical illness or disease, similar to the way asthma or diabetes is a medical illness or disease.1 All of these diseases, including substance use disorders, are chronic, which means they are long-lasting, and they are not “curable,” however, people can be stabilized and achieve remission of symptoms with the help of medical interventions. They also all have the potential for relapse, where symptoms of the disease return.

For someone with a substance use disorder, relapse typically occurs after a person returns to substance use following a period of abstinence.1 Addiction is characterized by the uncontrollable and compulsive use of substances, despite the negative consequences that are caused by the substance use. Addiction affects specific parts of the brain where it affects both the brain, as well as behavior, making it difficult, and sometimes impossible, for a person to stop using a substance through willpower alone.3

Medication for treating addiction can help people’s brains return to a normal state of functioning and relieve cravings.3 The Food and Drug Administration (FDA) has currently approved medications to treat substance use disorders that involve either alcohol or opioids.2

The medications used for addiction treatment are also sometimes referred to as “medication-assisted treatment,” or MAT.2 However, the use of these medications to treat opioid use disorders and alcohol use disorders has become such a key component of modern addiction treatment, that the term “assisted” is really no longer appropriate. Studies have shown that using medications to treat opioid use disorder has superior outcomes than no treatment as well as other forms of treatment that do not involve medications.4 The use of medications for opioid use disorders is now considered to be the clinical standard of care.4

At this time, there are no FDA-approved medications to treat other types of addiction, including methamphetamine, cocaine, or marijuana; however, researchers continue to work on developing new medications for these debilitating disorders.3

Types of Medications Used for Addiction Treatment

Acamprosate

Acamprosate, also known as Campral, is an FDA-approved medication for the treatment of alcohol use disorder (AUD).5 Acamprosate comes in tablet form and is usually taken 3 times per day.6 Acamprosate does not treat alcohol withdrawal symptoms but can help reduce symptoms associated with protracted abstinence, such as insomnia, anxiety, and restlessness. By reducing these symptoms, it can help promote abstinence as part of an ongoing treatment plan.7 Acamprosate is usually given to people who have been through detox from alcohol and have been abstinent for 5 days.5

Acamprosate acts by correcting the imbalance of the glutamatergic and GABAergic systems that are affected by chronic alcohol use.6 Acamprosate does have some side effects that are typically mild, the most common being diarrhea (which may persist), but also can include headaches, insomnia, changes in sex drive, weakness, anxiety, nausea, stomach cramps, and, in very rare cases, suicidal thoughts.5 Overall, however, it is considered safe and with no potential for abuse and virtually no risk of overdose.5

Buprenorphine

Buprenorphine is an FDA-approved medication for the treatment of opioid use disorders that comes in multiple forms, such as sublingual film and tablets, injectables, and implants.8 Buprenorphine is also known by the brand names Subutex and Suboxone. It acts upon the opioid receptors in the body as a partial agonist and helps to manage withdrawal symptoms, cravings, and risk of overdose.8 Buprenorphine is available from doctors who have received special training in prescribing it.8

Buprenorphine is generally safe but has some common side effects that can include constipation, vomiting, excessive sweating, insomnia, and blurred vision.4 The drug does have some potential for misuse, but this is more likely in people who do not have an opioid dependency.8 Naloxone is combined with buprenorphine in some formulations, like Suboxone. Naloxone is a drug that blocks opioids from opioid receptors in the body, and when formulated with buprenorphine, reduces the likelihood of injected misuse.4

Disulfiram

Disulfiram has been FDA-approved since 1951 to treat alcohol use disorder.9 Disulfiram is marketed as Antabuse and comes in tablet form. Disulfiram acts as a deterrent, due to the way in which it reacts chemically if a person ingests alcohol while on it, causing a severe reaction of flushing, nausea, confusion, chest pain, and rapid breathing, among other symptoms.9 Knowledge of this reaction to alcohol while drinking is thought to increase a person’s motivation to abstain from drinking.9 There have been cases of life-threatening or even fatal reactions to using alcohol while on disulfiram, but given the screening and assessment of individuals today, these adverse events are rare.9

Disulfiram can be prescribed by doctors in many settings, with strong evidence supporting supervised administration (by a doctor, pharmacist, or even a family member) to ensure compliance with taking it as one key component of an alcohol use disorder treatment plan.9

Methadone

Methadone is another FDA-approved medication that can treat opioid use disorder.10 Methadone is a full opioid agonist that can eliminate or reduce withdrawal symptoms as well as cravings for opioids.10 Methadone is dispensed as a liquid, powder, or disk.10

Unlike buprenorphine, methadone is only available at certain licensed treatment programs and the acute inpatient hospital setting, and its use is closely regulated.10 At first, people must visit the treatment site daily to be given their dose of methadone. As an individual shows progress in the treatment program, they may be allowed to take home doses of methadone to use in-between visits.10 Part of the reason for the close monitoring is that methadone can be diverted and used, and supervised administration ensures patient compliance and safety.10

Common side effects of methadone can include constipation, sweating, dizziness, sedation, nausea, and vomiting.4

Naloxone

Naloxone is an FDA-approved medication to treat opioid overdoses and is marketed under the brand names Narcan and Kloxxado.4, 11 Naloxone is an opioid antagonist, which means it binds to the opioid receptors resulting in the displacement and blocking of other opioids from attaching to the receptors. This both reverses and blocks the effects of other opioids in the person’s system.11 Naloxone can be administered as a nasal spray or by injection and is available by prescription or without a prescription at the pharmacy counter in most states.11

Allergic reactions to naloxone can occur but are rare, but the majority of side effects result from it blocking opioid receptors, immediately putting someone physiologically dependent on opioids into withdrawal.11 This means a person will experience typical symptoms of opioid withdrawal such as nausea, vomiting, diarrhea, sweating, body aches, fever, chills, irritability, or anxiousness.11

Naltrexone

Naltrexone is another FDA-approved medication that can treat both opioid use disorders and alcohol use disorders.12 The pill form is prescribed only for alcohol use disorders, whereas the injection can be used to treat either type of substance use disorder.12

Naltrexone blocks the effects of opioids so that if a person uses opioids while taking it, they will not feel any of the usual sensations of euphoria from opioids, thus it has no abuse potential and can be prescribed by any physician.12 It can result in decreased opioid cravings, and also dull the cravings and effects of alcohol.4, 12 The side effects of naltrexone can include nausea, injection site reactions/pain, dizziness, abdominal pain, insomnia, hepatic enzyme abnormalities, nasopharyngitis, and drowsiness.4

Medications for Addiction Treatment: What are the Benefits?

There are numerous benefits of medications for addiction treatment that include:3

  • Making people more open and receptive to behavioral treatment.
  • Reducing withdrawal symptoms.
  • Reducing criminal behavior.
  • Helping to manage cravings and avoid relapse.
  • Reducing overdoses.

Treatment Doesn’t Stop at Medication

Treatment isn’t just about medication. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that medications for addiction be used as part of a whole-person approach to recovery.7 SAMHSA further states that medications work more effectively when combined with behavioral therapies.7

When a person is dealing with addiction, behavioral therapies can address why they started using substances in the first place and help a person develop healthier ways of coping that can help them overcome these underlying issues and avoid relapse.13

Behavioral therapy can take many forms, including:1, 14

  • Cognitive-behavioral therapy (CBT): CBT is widely used in treatment programs and can help change thoughts and behavioral patterns that lead to substance use, as well as learn new ways of coping with stress that doesn’t involve drugs.
  • Contingency management: This approach uses various forms of incentives or rewards to keep people in treatment. For example, a program may offer vouchers for movie tickets for attending counseling sessions.
  • Motivational interviewing: This is most often used to get people into treatment, or retain them in treatment, as well as overcome their resistance to going to treatment.
  • Support groups, such as 12-Step programs and other mutual help groups, are an important part of ongoing recovery. Oftentimes, treatment programs incorporate the concepts of 12-Step groups and encourage people to keep going to groups like Alcoholics Anonymous (AA) after discharge from treatment.
  • Family therapy: Another popular intervention, family therapy can help address patterns in family functioning and the impact on substance use, as well as help make overall family functioning better.
  • Group counseling: Counseling in a group setting reinforces drug-free lifestyles through social reinforcement.14

Finding a Rehab Program that Incorporates Medications

If you are seeking addiction treatment, a program that uses behavioral therapy and incorporates medication, such as buprenorphine or methadone, can help you manage withdrawal and avoid relapse with an opioid use disorder. For an alcohol use disorder, naltrexone or disulfiram offers additional components to your treatment program to help you avoid relapse and stay in recovery. Get started today by locating a treatment program near you or checking your health care coverage to find out what services may be covered. Call .

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NREMT
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series of in-depth articles on Community Paramedicine programs across the country that go beyond transporting patients to emergency rooms and connects specific patients, such as repeat system users, the homeless and others with behavioral health issues and substance use disorders, to definitive long-term care and treatment. In his current capacity as Medical Editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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