Addiction Medications Used in Treatment for Substance Use Disorders

Effective alcohol and substance use disorder (SUD) treatments have many elements that, when combined, make recovery possible, often probable. Behavioral and alternative therapies, as well as support groups, are components to teach you skills that can help prevent a relapse, but this high level of support is still not enough for some people to overcome severe withdrawal symptoms and cravings.¹ Addiction medication can complement a treatment plan to overcome these issues and help you achieve stable recovery.

In this article:

• Purpose of Medication-Assisted Treatment
• Who Should Get Addiction Medication?
• Withdrawal Medication for Detox
• Addiction Medication for Maintenance
• Maintenance Medications for Alcohol
• Maintenance Medications for Opioids
• How to Start Medication-Assisted Treatment

Purpose of Medication-Assisted Treatment

Addiction medication can be used to help you reach long-term abstinence from alcohol and other drugs such as opioids. One of the primary purposes of this medication is to make it possible for you to participate in behavioral therapies, support groups, and other treatment programs where you can learn recovery skills.²

Those with alcohol or substance use disorder who face severe withdrawal symptoms are often tempted to continue substance misuse for relief from these symptoms. Further, obsessive thoughts and urges during withdrawal interfere with daily functioning.

Medication-assisted treatment (MAT) helps you get past the withdrawal symptoms and cravings so you can progress in treatment. Other uses for MAT include the following:²

• Prevent overdose and death
• Rebalance brain chemistry
• Block euphoria caused by alcohol and opioids
• Stay in treatment until completed
• Eliminate criminal behavior
• Reduce the risk of acquiring diseases (e.g., through needle sharing)
• Improve chances for employment
• Improve outcomes for pregnant people and their babies
• Receive proper treatment for co-occurring disorders

Who Should Get Addiction Medication?

Detox Medications

Everyone should have access to medical detox if needed. A medical professional licensed or certified in addiction or mental health will assess your level of care and evaluate your need for withdrawal medications. The following will be taken into consideration when choosing the right withdrawal medication to provide the safest options:³

• Substance-induced hallucinations
• Withdrawal seizures
• Delirium tremens
• Tachycardia
• Medical conditions that cause seizures
• Head injuries
• Psychosis
• History of any of the above
• Intensity of non-life-threatening symptoms

There are times when prescribing withdrawal medication should be avoided, like if you’re taking medicines for other illnesses that may interact with medication for alcohol or drug detox. You should also avoid an withdrawal medication if you have an allergy to any of its ingredients or if the medicine will cause harmful side effects.⁴

Medication-Assisted Treatment Candidates

Not everyone is a good candidate for receiving medication-assisted treatment, or addiction medications. For example, there are not currently any FDA-approved addiction medications for stimulant addiction or sedative addiction, so if you are addicted to one of those substances, you won’t be prescribed a medication (unless you have a co-occurring mental health disorder).

People who may benefit from medication-assisted treatment include:

• People addicted to opioids
• People addicted to alcohol
• Pregnant people addicted to opioids or alcohol
• People who have previously dropped out of treatment for opioid or alcohol addiction
• People who use opioids intravenously

Generally, people under 18 are not prescribed addiction medications, such as methadone or buprenorphine.

Withdrawal Medication for Detox

Detoxification can last a few days or a few weeks, depending on the type of substance, length of time misusing substances, the severity of withdrawal symptoms, and many other factors. Some people must detox from multiple substances rather than just one, causing more acute withdrawal symptoms.

Those with moderate to severe withdrawal symptoms may need to detox in an inpatient hospital with around-the-clock medical care. Those with mild withdrawal symptoms may detox on an outpatient basis.

Detox Medications for Alcohol

If you are detoxing from alcohol, benzodiazepines are FDA-approved for withdrawal treatment. They can effectively prevent seizures and delirium tremens associated with alcohol withdrawal and can also help minimize symptoms that are not life-threatening. Medications used during alcohol detox may include:⁵

• Benzodiazepines, the first and most commonly used medication for withdrawal symptoms and to prevent seizures
• Topiramate, an anticonvulsant that also helps anxiety
• Phenobarbital, an anticonvulsant that also helps reduce cravings
• Valproate, which can help reduce seizures and withdrawal symptoms

Not everyone will need strong withdrawal medication to detox from alcohol. Those with mild symptoms can benefit from milder medicines, such as thiamine, magnesium, and nitrous oxide, to help minimize symptoms.⁵

Detox Medications for Opioids

The FDA-approved withdrawal medications used in opioid detox include methadone and buprenorphine. They are considered substitute opioid addiction medication, but they work much differently in the system than heroin, opiates, and illicit drugs. Both act on the opioid receptors in the brain to reduce cravings and withdrawal symptoms and block the effects of heroin and opiates.⁶

Another commonly used medication for opioid withdrawal is Suboxone, a combination of buprenorphine and naloxone. Suboxone is used to support detox and long-term recovery. It works by blocking all effects of opioids, preventing any feelings of euphoria no matter how much opioid medication you take. Other detox medications for opioid detoxification include:⁷

• Slow-release oral morphine to minimize withdrawal symptoms and cravings
• Lofexidine to reduce severity and duration of withdrawal symptoms
• Clonidine to treat high blood pressure

How is Opioid Addiction Medication Administered?

Nurses, doctors, and other medical personnel administer addiction medication for those being treated for opioid use disorder (OUD) in an inpatient detox. Opioid addiction medication can be given orally, in pills, films, or liquid form. Naltrexone can be administered by injection once a month, with the effects lasting for one month.⁸

The amount of doses you receive will be dependent on the severity of your symptoms. Treatment regimens may include fixed doses given at set times during the day. Loading dose regimens utilize longer-acting medicines due to their self-tapering benefits.⁸

Symptom-triggered dosing should not be given to people with a history of seizures. However, it can help medical staff monitor symptom severity and occurrence for candidates. A rapid loading dose is for used those who have trouble remaining calm. They are given opioid addiction medication doses via injection.⁸

You are not given a prescription that will go home with you once you are discharged from inpatient detox unless you transition into a lower level of care, such as inpatient rehab, partial hospitalization, or intensive outpatient programs.

Addiction Medication for Maintenance

Many people are not ready to be taken off addiction medication for fear of relapse on alcohol or other substances post-detox. Some fear a return of withdrawal symptoms and cravings, making it difficult to avoid a relapse.

Doctors can continue MAT for as long as they determine it necessary for a patient. Some people may only need a few months of continued addiction medication use, while others may need a year or several years.

Addiction medication during the maintenance phase of recovery is not a solo treatment. It supplements behavioral and family therapies, support services, and recovery activities on an outpatient basis.⁹

Maintenance Medications for Alcohol

A common characteristic of addiction medication for alcohol post-detox is that you must no longer be consuming alcohol. This is one reason to participate in a structured detox treatment program. Once all alcohol is out of your system, your doctor can begin you on maintenance medication for addiction.⁹

Acamprosate

Acamprosate, an anti-craving pill taken three times a day, typically begins on the fifth day of detox or when urine or other drug tests reveal there are no substances in your system. Acamprosate will not work if it must compete with other intoxicating substances. If you decide to continue drinking or misuse substances while taking acamprosate, you will experience withdrawal symptoms when trying to stop.⁹

Disulfiram

Disulfiram is given in pill form but taken only once a day. If you drink alcohol while taking disulfiram, you can experience severe side effects, including nausea, vomiting, headaches, and breathing problems. These side effects act as a deterrent for those tempted to drink alcohol. To avoid all side effects, doctors recommend waiting until all alcohol is out of your system before beginning disulfiram.⁹

Naltrexone

Naltrexone is an addiction medication that blocks the effects of alcohol and opioids. It is often given via injection or in pill form. While on naltrexone, if you consume alcohol or opioids, you will not feel euphoria, reward, or pleasure. This can be dangerous for some who continue to chase the high associated with substance misuse. If someone consumes too much of a substance, they may overdose.⁹

Maintenance Medications for Opioids

Naltrexone is a commonly prescribed medicine for alcohol and OUD, but other medications can be used to help people avoid relapse and return to daily life in recovery.

Opioid addiction medication may aid anyone wanting to stop misusing prescription or illicit opioids. Maintenance addiction medication can provide a  long-term solution for those who require help to keep up long-term recovery.

Methadone

Methadone is the oldest effective opioid addiction medication in helping those with OUD to maintain recovery. Methadone works by reducing cravings and withdrawal symptoms. While it is considered an opioid, it is long-acting and takes many hours for it to pass through your system. Long-acting opioids can alleviate pain but do not offer euphoria or pleasure.¹⁰

Methadone comes in many medication forms, including:¹⁰

• Powder
• Liquid
• Diskette
• Wafer
• Tablet

Methadone can be prescribed on a short-term, long-term, or lifetime basis. Research shows it reduces the number of relapses on opioids. Other benefits of long-term methadone treatment include the following:¹¹

• Reduction in the use of needles, injections, and needle sharing
• Reduction in death rate by opioids
• Reduction in criminality
• Reduction in trading or selling medicine due to receiving daily doses under clinical supervision

Methadone is not the right opioid addiction medication solution for everyone, however. Those on medications that suppress the respiratory system should not take methadone, nor should those with liver disease or allergies to any of the ingredients in it. People who continue to misuse substances or who have an underlying medical condition should also avoid using methadone.¹¹

Buprenorphine

Family physicians can prescribe buprenorphine, meaning you no longer must obtain it from a specialty clinic. Buprenorphine comes in films, tablets, implants, and extended-release injections. The benefits of buprenorphine include:¹²

• Produces less euphoric effects than methadone
• Assists with reducing physical dependency on opioids
• Reduces withdrawal symptoms and cravings
• Decreases potential for misuse
• Decreases chances for overdose

Suboxone

Another opioid addiction medication is Suboxone, the combination of naloxone and buprenorphine. It comes in tablet or film forms and is beneficial to people who cannot tolerate or access methadone or other medication-assisted therapies. Unlike methadone, Suboxone can be prescribed by a primary physician and taken at home.

Suboxone also offers:¹³

• Increased safety at high doses
• Decreased abuse and diversion
• More accessible

How to Start Medication-Assisted Treatment

Whether you need addiction medication for detox or maintenance for an alcohol or substance use disorder, you can get started by reaching out to an addiction treatment provider. There are inpatient and outpatient opportunities, and you can receive the right treatment plan for your unique circumstances.

To find out the best treatment, we recommend getting an assessment by a licensed substance abuse professional. If you need help finding a treatment professional who can provide an evaluation, give us a call at 800-908-4823 (Who Answers?) . We can connect you directly to an appropriate program. We are available 24/7.

Resources:

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