Psychiatrist and Substance Abuse Specialist
Integrating the science of addiction medicine with the art of addiction psychotherapy
RELAPSE PREVENTION MEDICATION FOR TREATING ADDICTION
The medical doctors of Compass Medical Services PLLC use a variety of safe and effective medications to help ease withdrawal symptoms, reduce cravings, and prevent relapse to alcohol, painkillers, and other opioids.
Alcohol and Opioid Withdrawal
Withdrawal from alcohol and other depressant drugs (e.g. benzodiazepines) is usually managed with benzodiazepines (e.g., Valium, Ativan, Klonopin) whereas opioid withdrawal is usually managed with longer-acting opioids such as Suboxone. The first step of a detox regimen is to stabilize the patient on a sufficient dose of the substitute medication to prevent dangerous or intolerable withdrawal symptoms. The substitute medication is then tapered over the course of several days or weeks and ultimately discontinued completely.
Medications for Relapse Prevention
Naltrexone. Naltrexone (Texan, ReVia, Vivitrol) blocks the euphoria (“high”) and all other physical effects of opioid drugs for at least 24 hours after each oral dose. It was developed in the 1970s mainly to prevent relapse to heroin and methadone, the most widely used opioids at that time. Naltrexone itself produces no euphoria and is completely non-addictive. More recently, naltrexone has been shown to significantly reduce binge drinking episodes in people trying to remain abstinent from alcohol. It partially blocks alcohol’s pleasurable effects so that drinking is less rewarding and less likely to get out of control. Naltrexone is usually taken in pill form on a daily basis. A longer-acting injectable form of naltrexone, known as Vivitrol, works for up to 30 days after each implant of a time-release pellet.
Antabuse is one of the oldest and most widely known medications for preventing relapse to alcohol. Similar to naltrexone, disulfiram is neither psychoactive or addictive. However, unlike naltrexone, it does not block the effects of alcohol but causes a highly unpleasant reaction when combined with alcohol. It works by blocking enzymes involved in alcohol metabolism so that drinking while on Antabuse causes an extremely noxious physical reaction that may include nausea, vomiting, sweating, etc. The ability of disulfiram to cause this reaction lasts for approximately 24-36 hours after taking each dose of the medication. Antabuse is most effective in preventing an unplanned or impulsive return to drinking. Because Antabuse can be discontinued at any time with no ill effects, drinking can be resumed within a day or two after stopping the medication. The beneficial effects of taking Antabuse include a marked reduction in obsession and cravings as a result of knowing that alcohol will produce no positive effects. As with other medications used to prevent relapse, disulfiram is most effective when used in combination with counseling or therapy.
Recent studies indicate that the anticonvulsant medication, topiramate, can reduce the frequency of heavy drinking episodes in people trying to abstain completely from alcohol and in those trying to moderate but not abstain completely from alcohol. Results from several studies indicate that patients are given Topamax:
Report fewer days of heavy drinking
More days when no alcohol was consumed at all
Consumed fewer drinks per drinking day
Similar to topiramate, researchers have found that patients given the anticonvulsant medication, gabapentin, refrained from heavy drinking twice as often as those getting the placebo. They abstained completely from drinking four times as often. Those taking Neurontin also cut back on the number of drinks they consumed in a given drinking episode by a significant amount. They reported experiencing less depression, fewer cravings, and better sleep.
Buprenorphine (Suboxone, Subutex, Zubsolv)
Buprenorphine is a prescription medication that blocks other opioids (narcotics) from attaching to receptors in the brain. Buprenorphine is a “weaker” narcotic than standard opioids (heroin, oxycodone, hydrocodone, etc) and also can block the effects of these other drugs. It can produce mild euphoria (usually limited to the first few doses, if at all), but fortunately is less likely to suppress breathing to the point of causing an overdose. Buprenorphine produces enough of an opioid effect to eliminate cravings and prevent the emergence of an opioid withdrawal syndrome. It is often used to help people withdraw (detoxify) from other opioids and it can also be used as a substitute medication that is taken over a longer period of time to prevent relapse to other opioids. Many patients report that in addition to preventing withdrawal symptoms and drug cravings, buprenorphine also helps to reduce anxiety and depression.