“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas. Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”
~ Dr. Michael Miller, past President of the American Society of Addiction Medicine
In the not-too-distant past, alcohol and drug addiction were viewed – even by many doctors – as a moral weakness. Addicts and alcoholics were told to “be strong” and to “use their willpower” to stop drinking and using.
However, decades of research has shown definitively that addiction is a disease that changes the brain, specifically those areas of the brain involved in memory, motivation, reward, and inhibition control.
These alterations in the structure and function of the brain disrupt a person’s ability to make the choice to not use drugs, even in the face of severely negative consequences. Put another way, while a “normal” person can make the initial choice to use drugs or drink alcohol when a person has become addicted, the ability to choose is taken away.
There is good news. When addiction is viewed chiefly as a medical condition – a disease – there can be effective medical solutions that can give an addict/alcoholic some measure of relief. As with almost any other chronic manageable health condition – diabetes, hypertension, epilepsy, asthma – there are lifestyle changes and medications that can arrest the insidious progress of the disease and make life more manageable.
Let’s take a look at some of the medications that are most commonly-prescribed for addicts and alcoholics in recovery:
During Alcohol Detox—
Benzodiazepines, such as Diazepam (Valium), Chlordiazepoxide (Librium), Lorazepam (Ativan), and Oxazepam (Serax)
These anti-anxiety drugs can be useful in the treatment of such withdrawal symptoms as delirium tremens – “the DT’s”.
The biggest caution when using benzodiazepines is the fact that they should only be used for a short period of time, because they in themselves can become addictive.
In cases of severe withdrawal, with anti-seizure medication may be necessary, such as Carbamazepine (Tegretol), Valproate (Depakote), or Phenytoin (Dilantin).
According to the US Food and Drug Administration, seizure medications can increase the risk of suicidal thoughts and suicide. Therefore, anyone taking these medications should be closely monitored for warning signs and be in regular contact with their physician.
During Alcohol Recovery –
Disulfiram (Antabuse) changes the way that a person’s body metabolizes alcohol. If a person taking the medication drinks alcohol, they will get physically sick – a headache, severe nausea, and vomiting. It is considered effective because it helps a person completely stop drinking by increasing the number of days without a drink.
Acamprosate (Campral) reduces a person’s cravings for alcohol by balancing the brain’s neurotransmitters. According to the US FDA, it can also help with anxiety, sleep problems, and mood swings, which are all common problems caused by alcohol withdrawal.
Naltrexone (Vivitrol, ReVia) can interfere with the pleasurable effects a person gets from drinking.
Heroin/Prescription Opiate Addiction
During Opiate Detox –
Buprenorphine (Subutex, Suboxone) is regarded to be the most effective medications for opioid withdrawal because it blocks other opiate narcotics. Unlike other medications that treat opioid dependence, this has a lower probability of abuse. Because of this, individuals in recovery from opioid addiction can be given a home supply of their medication.
Side effects are generally mild – flu-like symptoms, dizziness, and upset stomach
Methadone reduces withdrawal symptoms from other opioids because it is a long-acting opiate that binds to the opiate receptor sites in the brain. It keeps those receptor sites “occupied” and unavailable to other opiates. This “opiate satisfaction” reduces cravings.
Because methadone itself can be habit-forming and has a possibility for abuse, it is usually only dispensed under a strict protocol – daily visits to a methadone clinic. This may be difficult for many patients.
In general, the substitution of a long-lasting benzodiazepine and a gradual “tapering-off” period is considered the best, safest treatment for dependence.
Because Clonidine works in a person’s central nervous system, it is often prescribed to help with withdrawal symptoms during the tapering period.
Gabapentin (Neurontin) and Vigabatrin (Sabril) are anti-convulsants that reduce cocaine cravings by affecting the brain’s neurotransmitters. Baclofen (Gablofen, Lioresal), a muscle relaxant, has the same effect.
There is no medication currently approved to treat methamphetamine addiction. However, that may be changing soon. Researchers at UCLA have reported that “very preliminary results would indicate that Ibudilast may dampen craving”, by preventing activation of central nervous system cells linked to drug dependence.
According to the National Institute on Drug Abuse, there is currently no medication available to treat marijuana addiction.
Because many forms of addiction are similar, some medications can be used across the board, to treat different kinds of substance abuse disorders.
The most important thing to remember about medications used in recovery and detox is this – there is no medication that is a “magic wand” that will completely cure a person of his or her addiction, once and for all.
Any medication used will be to assist the person in recovery as they use other, primary means – psychological therapy, counseling, support groups, and professional rehabilitation. Used properly, medications can be a tool that can give a suffering addict/alcoholic the “leg up” they need to receive the other positive messages of recovery.