Addiction Treatment: Medications + Therapies

Like other life-threatening diseases, drug and alcohol addiction usually requires formal treatment. There are five FDA-approved maintenance medications to treat addiction, as well as medications used off-label and in detox. 

All major health organizations, including the CDC and WHO, recommend combining medications with talk therapy to treat substance abuse addiction. There are various inpatient and outpatient options for therapy.

Medications for Addiction

Medications are used to treat drug and alcohol addiction. 

During detox, medications relieve withdrawal symptoms and help the body cope. 

Anti-craving medications are used for months or years to help satisfy areas of the brain signaling for drugs or alcohol. These medications make staying sober easier, but should be combined with therapy to increase the likelihood of success.

The Five FDA-Approved Medications to Treat Alcohol or Drug Addiction 

Vivitrol Box with vile and needle

Naltrexone (Vivitrol)

For alcohol & opioids

Real Suboxone Films

Buprenorphine (Suboxone)

Only for opioids

Methadone Dispensing into a Cup

Methadone

Only for opioids

Campral Box and Actual Pills

Acamprostate (Campral)

Only for alcohol

Disulfiram (Anatbuse) was FDA-approved to treat alcoholism in 1949, but is less common now.

Other medications are sometimes used “off-label” to help with addiction, but there’s not enough research to support widespread use.

Also, treating related mental health issues increases the likelihood of long-term success. Medications like antidepressant and antianxiety can play a big role in treating addiction.

General Breakdown of Patient Medication Choices at Symetria

Pie Chart of Patients 80% Suboxone or Methadone 15% Vivitrol 5% No Medications

Naltrexone (Vivitrol)

Vivitrol is a form of the medication naltrexone that is given as a shot once a month.

How Naltrexone Works

Naltrexone blocks receptors in the brain to decrease cravings. And, if drugs or alcohol are used, naltrexone removes the positive effects. Patients that drink alcohol or use drugs on naltrexone feel the negative effects (like hangovers) but not the reward they were seeking (the “high”). There is little motivation to continue using while on naltrexone.

Naltrexone Use by Drug of Choice

Alcohol

Naltrexone is FDA-approved and usually the best option for Alcohol Use Disorder.
Suboxone and methadone are not appropriate options for alcohol.

Opioids

There are three FDA-approved medications for opioid addiction, but naltrexone is the only non-opioid option and Vivitrol is the only option that doesn't require daily medication.

Other Drugs

Research supports the off-label use of naltrexone for cocaine and methamphetamine (meth) addictions, but not marijuana or benzodiazepine (Xanax) addictions.

Naltrexone vs. Vivitrol

Naltrexone is available in pill form, including brand names Revia and Depade. But, these medications must be taken daily. Because it is easy to accidentally miss or purposely skip a dose, Vivitrol is more effective.

Learn More About Vivitrol

Buprenorphine (Suboxone)

Suboxone is a prescription medication used only for opioid addictions that combines the ingredient Buprenorphine (a partial opioid) with Naloxone (an opioid blocker).

How Suboxone Works

Buprenorphine activates opioid receptors enough to satisfy the receptor but doesn’t activate enough to trigger a “high”. Naloxone is added to deter abuse and prevent overdose. If Suboxone is abused, the person generally goes straight to withdrawals.

Suboxone is taken daily as a film placed under the tongue. 

Other Types of Buprenorphine

Learn More About Suboxone

Methadone

Methadone has been FDA-approved to treat opioid addiction for more than 50 years. The medication has a high potential for abuse and can only be dispensed under medical supervision.

How Methadone Works

Methadone is an opioid and binds to the same brain receptors as drugs like heroin or prescription pain medications like oxycodone (Oxycontin, Percocet). But, methadone has a different chemical structure to allow patients to function normally without withdrawal symptoms. 

Opioid receptor filled by methadone

Methadone

Full Agonist

Opioid receptor partly filled by buprenorphine

Buprenorphine

Partial Agonist

Opioid receptor blocked by naltrexone

Naltrexone

Antagonist

Learn More About Methadone

Acamprostate (Campral)​

Acamprosate helps patients with chronic alcohol misuse rewire their brains to work normally again. The medication is meant for after patients have stopped drinking and does not help with withdrawals or while currently drinking. Studies show twice as many patients were able to stay sober with Acamprosate versus a placebo.

How to Take Acamprosate

Acamprosate is a pill that is taken orally three times per day. Missing a dose can increase the risk for relapse. Dosing is the main deterrent for this medication as it is well tolerated with few side effects and can be prescribed by any physician after detox. 

Additional Medications Used in Addiction Treatment

Other medications can help treat addiction, used off-label, to curb withdrawal symptoms, or to treat related mental health issues.

Off-label: If FDA-approved options have not been successful, medications approved for other uses can be helpful. The most common off-label options for addiction are:

  • Topiramate (Topamax) – an anti-sezuire medication
  • Gabapentin (Neurontin, Gralise) – an anti-convulstant and nerve pain medication
  • Baclofen (Lioresal, Gablofen) – a muscle relaxant 
  • Ondansetron (Zuplenz, Zofran ODT, Zofran) – an anti-nausea medication
  • Sertraline (Zoloft) – a mental health medication


Detox Medications: 
Many different medications can be used during medical detox. For example, Lofexidine (Lucemyra) is a non-opioid medication FDA-approved for opioid withdrawals. Whereas, alcohol detox usually involves a benzodiazepine taper. If there is a history of seizures, anti-convulsants may be used. Beta-blockers like atenolol, anti-anxiety medications like Hydroxyzine (Vistaril) or anti-psychotics like Olanzapine (Zyprexa) can be helpful during detox. Over-the-counter medications can also relieve symptoms like nausea or congestion.

Dual Diagnosis Medications: Mental health medications like antidepressants or antianxieties help rebalance the brain to stop negative cycles that lead back to addiction. 

Therapies for Addiction

A variety of therapy methods are supported by the Journal of Substance Abuse Treatment, but the most common and proven approach is Cognitive Behavioral Therapy (CBT).

Cognitive Behavioral Therapy

CBT is a form of talk therapy focused on changing thinking patterns. Patients learn to recognize distortions in their thinking that are creating problems and reevaluate them in a healthy way.

Other common therapies used to treat addiction are: 

Patients can receive any combination of these therapies in an inpatient or outpatient setting, usually with a combination of both group and one-on-one therapy sessions.

Inpatient Addiction Treatment

Inpatient means staying and sleeping at the healthcare facility. It is the highest level of care and includes different options for detox-only, rehab or a hospital setting.

Inpatient Residential Rehab

Inpatient drug and alcohol rehabs usually last around 30 days. Longer-term programs can be difficult to find and may not be covered by insurance.

Appropriate for patients:

Inpatient Medial Detox

Detox usually lasts 3-7 days. It can be at a regular hospital or at a stand-alone inpatient detox center.

Appropriate for patients:

Behavioral Health Hospitals

An inpatient hospital setting usually treats a variety of mental health issues, though there may be a special unit for substance abuse. Specialized programs can sometimes accommodate stays of several months, but psychiatric hospitals are typically less than 30 days.

Appropriate for patients:

Outpatient treatment is always recommended after inpatient treatment to avoid relapse after leaving the shelter of inpatient care.

Outpatient Addiction Treamtent

The most common outpatient options for addiction treatment are Intensive Outpatient Programs (IOP) and Medication-Assisted Treatment (MAT). 

IOP usually involves at least nine hours of therapy per week for around six weeks. IOP is a good middle ground for getting enough care without the expensive and inconvenient step of “going away”. IOP helps patients cope with issues as they arise in the real world.

MAT involves the combination of any anti-craving medications paired with therapy. Many MAT clinics focus exclusively on opioid addiction and medications like Suboxone or Methadone. MAT can be continued for months or even years. The therapy for MAT typically drops down to once a month after the patient is stable. MAT allows opioid-addicted patients to detox in an outpatient setting.

Outpatient is appropriate for patients:

Treatment is most effective when therapy is combined with medications and when underlying issues like trauma, depression and anxiety are also treated. Most outpatient clinics do not combine these services (though Symetria Recovery does). Patients can find an IOP, then find a psychiatrist if not available at the same clinic.

Learn More About Addiction Thearpy

Finding the Right Addiction Treatment

Not all addiction treatment centers are equal. Call around until you feel comfortable.

Whatever brought you to this article, everyone deserves access to quality addiction treatment. Even if treatment hasn’t worked in the past, keep faith in the treatment process and keep showing up.

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Pettinati, Helen M. PhD*; Volpicelli, Joseph R. MD, PhD*; Luck, Gary*; Kranzler, Henry R. MD†; Rukstalis, Margaret R. MD*; Cnaan, Avital PhD* Double-Blind Clinical Trial of Sertraline Treatment for Alcohol Dependence, Journal of Clinical Psychopharmacology: April 2001 – Volume 21 – Issue 2 – p 143-153

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