Medications used in the treatment of addiction

Medications Used in the Treatment of Addiction
Developed by Randall Webber, MPH
Alcohol Withdrawal
MEDICATION MECHANISM
EFFECTS SIDE
OF ACTION
Sedation occurs if too high a dose is administered. Alcohol Relapse
MEDICATION PRIMARY
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OF ACTION
1 Once a month “depot” injection. Available June 2006. glutamate) thrown out of balance by chronic and excessive alcohol consumption Alcohol Relapse
MEDICATION PRIMARY
MECHANISM EFFECTS SIDE
OF ACTION
contribute to problem drinking in the male-limited population slowing, word-naming difficulties, weight loss Opiate Withdrawal

MEDICATION PRIMARY MECHANISM EFFECTS SIDE
OF ACTION
prescription or over the counter medications for gastrointestinal distress. Opiate Withdrawal and Substitution Therapy
MEDICATION PRIMARY MECHANISM EFFECTS SIDE
OF ACTION
other opiate effects occur when too high a dose is administered. Very rarely, clients will experience anaphylactic shock (hives; difficulty breathing; swelling of your face, lips, tongue, or throat). Methadone must be permanently discontinued if this reaction occurs. 2 The opiate blocking effect can be overcome, but only with a very high dose of heroin or another opiate. Opiate Withdrawal and Substitution Therapy

MEDICATION PRIMARY
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longer produce opiate agonist/morphine-like actions, but instead acts as an antagonist, precipitating opiate withdrawal. Suboxone: Produces the same effect as above, but if injected, the naloxone acts as an opiate antagonist. Produces less sedation and respiratory depression than methadone. 3 Both of these medications are administered sublingually (under the tongue). Post-Withdrawal Opiate Dependence Treatment
MEDICATION PRIMARY
MECHANISM EFFECTS SIDE
OF ACTION
MEDICATIONS USED IN THE TREATMENT OF COCAINE DEPENDENCE
No medications are normally needed in the treatment of cocaine withdrawal. The use of only one medication (disulfiram/Antabuse) has shown consistently positive results in reducing cocaine relapse. This success, more pronounced in men than women, is tied to two of disulfiram’s actions: 1. Production of the acetaldehyde effect if the client consumes alcohol (alcohol use is a major antecedent of cocaine relapse). 2. Increase in the unpleasant aspects of cocaine intoxication. Disulfiram is believed to facilitate massive increases in brain levels of dopamine. Normally, increases in brain dopamine are tied to pleasurable reactions, but the rise in dopamine produced by the combination of cocaine and disulfiram appears to override such rewarding effects by increasing the incidence of such cocaine-associated effects as paranoia and anxiety. These medications are currently being tested as possible pharmacologic adjuncts to cocaine dependence treatment:  SR141716 (Rimonabant). This is a cannabis antagonist that has been shown to reduce cocaine self-administration in mice. This medication is still undergoing clinical trials and is not available to the general medical community.  Modafinil (Provigil). This medication is currently used to treat narcolepsy. Human research has shown that using this drug in combination with cognitive behavioral therapy may decrease relapse rates in cocaine dependent clients. Modafinil works through the glutamate neurotransmitter system.  Topiramate (Topamax). This medication is currently used to treat seizure disorders. At least one short term (13 weeks) human study has shown that by affecting levels of the neurotransmitters GABA and glutamate, topiramate may reduce cocaine relapse rates among a specific population: male African-Americans who have been assessed as having a “milder” form of cocaine dependence.
MEDICATIONS USED IN THE TREATMENT OF BENZODIAZEPINE AND
SEDATIVE-HYPNOTIC DEPENDENCE
Pharmacological treatment of benzodiazepine and sedative-hypnotic dependence is confined to the management of withdrawal. Long-acting members of both drug classes are first substituted for the substance on which the client is dependent, then the dosage of the new drug is gradually reduced. Librium is usually used to treat benzodiazepine withdrawal and phenobarbital to treatment dependence on both barbiturates and non-barbiturate hypnotics. GLOSSARY
Agonist: A drug that occupies (binds to) a neurotransmitter’s receptor site and causes an
action to occur.
Antagonist: A drug that occupies (binds to) a neurotransmitter’s receptor site, but does
not produce an action. Will block neurotransmitters and drugs from occupying the
receptor site.
Full Agonist: A drug with no antagonist effect.
Opiate Substitution Therapy: The replacement of one opiate (e.g., heroin) with another
opiate (e.g., methadone, buprenorphine) that has a lower abuse potential and more
therapeutic benefits.
Partial Angonist: A drug with weak antagonist effects. In some cases, acts as an agonist
at lower doses and an antagonist at higher doses.
Consumer Guide to Medication-Assisted Recovery
There is growing recognition of the potential role of medications in helping initiate and sustain recovery from severe and persistent substance use disorders. Growing
numbers of recovery advocacy organizations are helping educate those seeking recovery
about the potential advantages and pitfalls of medications in the treatment of addiction.
One of the most notable of such efforts is PRO-ACT’s Consumer Guide to Medication-
Assisted Recovery developed by the Pennsylvania Recovery Organization—Achieving
Community Together. The Guide addresses such topics as What is medication-assisted
recovery? and discusses such medications used in the treatment of alcohol and opioid
dependence as antabuse®, naltrexone, methadone, buprenorphine (Suboxone®), and
Campral®.
Information on how to get copies of PRO-ACT’s Consumer Guide to Medication- Assisted Recovery can be obtained by contacting PRO-ACT at 444 North 3rd Street, Suite 307, Philadelphia, PA 19123, (215)279-8694 Email: [email protected].

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