- Drugs of Abuse
What are addiction and substance abuse medications?
Addiction and substance abuse medications are used to manage withdrawal symptoms from addiction and prevent relapse. Addiction treatments may also include medications for mental health disorders people suffer along with addiction.
Different types of medications are used at different stages in the treatment of addiction. Medications can help in treatment of overdose episodes and withdrawal symptoms, detoxification, weaning off the substance and achieving abstinence.
Medications like nonopioid and opioid painkillers (analgesics) such as methadone are commonly prescribed to reduce withdrawal symptoms and cravings during detoxification.
Detoxification, or controlled withdrawal, is only the first step in treatment of addiction. Medications, along with counseling, are usually required to prevent a relapse.
Medications to prevent addiction relapse vary depending on the type of addiction, but most commonly prescribed medications are opioid antagonists like Naloxone hydrochloride (Narcan), which work by blocking the receptors and reward pathways in the brain which addictive substances stimulate.
What does substance abuse include?
Substance abuse refers to uncontrolled use of substances which have psychoactive compounds that can harm health. Long-term addiction to such substances can make lasting changes in the brain and lead to harmful behaviors.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies clinical-level substance abuse as “substance use disorder,” (SUD) a diagnosable and treatable condition.
Following is a list of psychoactive substances along with some examples, which have potential for addiction:
- Nicotine: Cigarettes, cigars, chewing tobacco and snuff
- Alcohol: Beer, wine and distilled liquors
- Cannabinoids: Marijuana, hash, hash oil and edible cannabinoids
- Opioids: Heroin, morphine, codeine and hydrocodone
- Depressants: Benzodiazepines, barbiturates and sedative hypnotics
- Stimulants: Cocaine, methamphetamines and methylphenidates
- Hallucinogens: LSD, mescaline, MDMA (Ecstasy), Amanita mushrooms and many other substances
- Inhalants: Paint, paint thinners, gasoline and other substances
What is addiction?
Addiction is a chronic disorder characterized by compulsive and uncontrolled pursuit of certain behaviors and/or substances, despite their harmful effects and consequences on health and society. The DSM-5 recognizes two types of addiction:
- Substance addiction: Addiction to psychoactive substances.
- Behavioral addiction: Addiction to gambling, identified as gambling disorder.
- Internet gaming disorder is another behavioral addiction mentioned in the DSM-5.
Examples of other common behavioral addictions not recognized by DSM-5, include:
- Food addiction
- Shopping addiction
- Sex addiction
- Exercise addiction
- Television addiction
- Social media addiction
Symptoms of addiction
Substance-related addictive disorders may vary from mild to severe depending on the symptoms. Presence of two of the following symptoms is considered to be a mild substance use disorder, ranging to severe addiction with six or more symptoms:
- Indulging in larger amounts, and for longer periods than intended
- Having the desire to cut down or stop, but unable to
- Spending a lot of time and effort to get, use and recover from use
- Craving for the substance
- Difficulty fulfilling other commitments
- Persistent use despite problems with relationships
- Giving up other important activities
- Continued use in physically dangerous situations
- Continued use despite worsening of physical or psychological problems
- Increased tolerance for larger amounts
- Withdrawal symptoms
What causes substance use disorder?
Substance use disorders and addiction are treatable medical conditions. As such, framing substance abuse as purely individual choice or moral failure on the part of the drug user is not helpful in trying to treat them. Approximately 40% to 70% of the risk for a person developing substance use disorder or addictive behavior is genetic. Genes influence:
- The degree to which a person experiences initial pleasure/reward from a substance or behavior
- The way the body processes addictive substances
- The memory and craving for continued pursuit of the pleasure
Other factors that can contribute to the risk of SUD include:
- Growing up with family or friends who use drugs or alcohol
- Easy accessibility of a substance
- Stress or trauma
- Depression and anxiety disorders
Adolescence and young adulthood appear to be periods of highest risk for developing SUD. Approximately 85% of SUDs develop in adolescence. Neurobiological research shows adolescents may be more vulnerable because the brain regions responsible for traits such as extended reasoning, judgement and inhibition are not fully developed.
What is the treatment for addiction and substance use disorder?
Treatments for addiction and SUD are typically individualized and may be long-term, depending on the severity. The first step is to bring about the right frame of mind in the individual to make them amenable to treatment. People who use more than one substance, which is common, will need treatment for all the substances.
Many of the substance addictions can be treated with medications, in combination with behavioral therapy. Some substance addictions and behavioral addiction can be treated only with behavioral therapies.
The goal of the treatment is to help a person give up addiction, prevent the relapse of addiction, and help them lead a productive and satisfying life. Treatment for addiction can be a combination of some of the following therapies:
- Behavioral counseling such as cognitive behavior therapy, and family therapy in the case of adolescents.
- Prescription medications
- Medical devices such as NSS-2 Bridge, which is an FDA-approved electronic stimulation device placed behind the ear to reduce opioid withdrawal symptoms.
- Mobile medical applications to provide cognitive behavioral therapy and skills training. The FDA has approved reSET;, an application developed for use in opioid use disorder.
- Evaluation and treatment of co-occurring mental health issues such as depression and anxiety.
- Long-term follow up to prevent relapse.
- Group therapy, for example, by joining Alcoholics Anonymous or Narcotics Anonymous.
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What are the types of addiction and substance use disorder medications?
Medications for substance use disorders vary depending on the substance. The use of medication in addiction and SUDs include:
- Antidote for acute intoxication or overdose
- Relief from withdrawal symptoms
- Long-term management and prevention of relapse
Some substances have FDA-approved medications for withdrawal and prevention of relapse, while some have antidotes for overdose and only psychotherapy for prevention.
In addition to FDA-approved medications, many other medications are in clinical trials for treating different substance addictions. Medications are more effective in combination with behavioral and other psychotherapies.
Medications used for stopping nicotine use include:
Nicotine replacement therapy (NRT), a medically approved way of using nicotine which may help in stopping tobacco use. NRT is available in the form of skin patches, spray, gum and lozenges.
Medications for nicotine addiction work by reducing the craving for nicotine and its pleasurable effects. FDA has approved the following two prescription medications:
The following three medications have been approved by FDA to treat alcohol addiction:
- Naltrexone (Vivitrol): Blocks the craving and pleasurable effects of alcohol on the brain. Effects may, however, can vary from person to person.
- Acamprosate calcium: May reduce long-lasting withdrawal symptoms such as:
- Disulfiram (Antabuse): Interferes with the breakdown of alcohol in the body causing unpleasant reactions to alcohol, such as flushing, nausea and irregular heartbeat. This medication requires compliance from the person who needs to take it.
Currently, there is no FDA-approved medication to treat cannabinoid addiction. Behavioral therapies, as well as early trials of some medications, have shown promise.
Several classes of medications are used to treat opioid addiction, overdose, withdrawal and long-term prevention of relapse. The medications approved by FDA to treat opioid use disorder include the following:
- Methadone hydrochloride (Methadose): An opioid analgesic that does not produce euphoric feelings known as a “high” but reduces cravings and prevents withdrawal symptoms.
- Buprenorphine hydrochloride (Suboxone): Reduces cravings, prevents withdrawal symptoms and also blocks the effects of other opioids.
- Naltrexone (Vivitrol): Blocks the pleasurable effects of opioids.
- Naloxone hydrochloride (Narcan): Reverses opioid effects, used for treatment of opioid intoxication or overdose.
- Buprenorphine/naloxone (Zubsolv): Used as maintenance medication to prevent relapse.
- Lofexidine hydrochloride (Lucemyra): Used to prevent withdrawal symptoms.
- Clonidine (Catapres): May help in prolonging periods of abstinence in people on buprenorphine/naloxone maintenance medication.
There is no FDA-approved medication to treat addiction to depressants. Depressant addiction can be treated with behavioral therapies and medically supervised detoxification to taper dosing of the substance. Overdose of depressants is a medical emergency and the effects are reversed with:
Currently, there is no FDA-approved medication to treat stimulant addiction and psychotherapy is the primary treatment. There is no antidote for acute overdose of oral stimulants, but activated charcoal is usually administered. Activated charcoal absorbs the toxins and reduces the systemic absorption of the drug.
Gastric lavage may be used to clear the toxins from the stomach. Specific symptoms of stimulant overdose such as, hypertension, agitation, seizures, high temperature (hyperthermia) and insomnia may be treated with appropriate medications.
Currently, there are no FDA-approved medications to treat hallucinogen addiction. Behavioral therapies may help, but require more research. Hallucinogen overdose can cause persistent hallucinations, agitation, panic and psychosis. Treatment for hallucinogen overdose is usually to sedate the person until the effects of the hallucinogen wear off.
Depending on the mental status of the individual, medications used may include the following
Benzodiazepines such as:
- Lorazepam (Ativan)
- Diazepam (Valium)
- Haloperidol decanoate (Haldol) if the individual is violent or psychotic
There are no FDA-approved medications for treating addiction to inhalants. Some people have found behavioral therapy to be helpful. Inhalant overdose can cause seizures and cardiac arrest, and is treated appropriately as a medical emergency.
- Please visit our medication section of each drug within its class for more detailed information.
- If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
- It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
- Never stop taking your medication and never change your dose or frequency without consulting with your doctor.
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.