What are the different types of drug addiction treatments?
There are numerous options for treating drug addiction that have proven to be effective, including:
Long-term follow-up to prevent relapse includes behavioural counselling, medication, medical devices, and applications used to treat withdrawal symptoms or deliver skills training, as well as evaluation and treatment for co-occurring mental health issues such as depression and anxiety.
A wide range of care, including a customised treatment plan and follow-up options, can be critical to success. As needed, treatment should include both medical and mental health services. Community- or family-based recovery support systems may be used as part of the follow-up care.
How are medications and devices used in the treatment of drug addiction?
Medications and devices can be used to treat withdrawal symptoms, avoid relapse, and treat co-occurring conditions.
Withdrawal. Medications and devices can aid in the suppression of withdrawal symptoms during the detoxification process. Detoxification is not "treatment" in and of itself, but rather the first step in the process. Patients who do not receive further treatment after detoxification typically resume drug use. According to one study of treatment facilities, medications were used in nearly 80% of detoxifications (SAMHSA, 2014). The Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, in November 2017 for use in helping to reduce opioid withdrawal symptoms. This device, which is worn behind the ear, sends electrical pulses to stimulate specific brain nerves. In addition, the FDA approved lofexidine, a non-opioid medicine designed to alleviate opioid withdrawal symptoms, in May 2018.
Prevention of relapse. Medication can help patients re-establish normal brain function and reduce cravings. There are medications available to treat opioid (heroin, prescription pain reliever) addiction, as well as tobacco (nicotine) and alcohol addiction. Other medications are being developed by scientists to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use multiple drugs, which is very common, require treatment for all of the substances they use.
To treat opioid addiction, methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine®, SublocadeTM), and naltrexone (Vivitrol®) are used. Methadone and buprenorphine suppress withdrawal symptoms and relieve cravings by acting on the same brain targets as heroin and morphine. Naltrexone works by blocking the effects of opioids at their receptor sites in the brain and should only be used in patients who have already been detoxed.
All medications aid patients in reducing drug seeking and related criminal behaviour, as well as in becoming more receptive to behavioural treatments. According to an NIDA study, once treatment is started, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are equally effective in treating opioid addiction. Because full detoxification is required for naloxone treatment, initiating treatment among active users was difficult, but once detoxification was complete, both medications had comparable efficacy.
Tobacco: Nicotine replacement therapies come in a variety of forms, including patches, sprays, gum, and lozenges. These items are available without a prescription. The Food and Drug Administration (FDA) of the United States has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They function differently in the brain, but both aid in the prevention of relapse in people attempting to quit smoking. When combined with behavioural treatments such as group and individual therapy, as well as telephone quitlines, the medications are more effective.
Alcohol: Three medications have been approved by the FDA to treat alcoholism, and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three medications that have been approved are as follows:
Naltrexone inhibits opioid receptors, which are involved in the rewarding effects of alcohol as well as the craving for alcohol. In some patients, it significantly reduces relapse to heavy drinking. Genetic differences may have an impact on how well the drug works in specific patients.
Acamprosate (Campral®) may alleviate long-term withdrawal symptoms such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It could be more effective in patients suffering from severe addiction.
Disulfiram (Antabuse®) prevents alcohol from being broken down. Acetaldehyde accumulates in the body, causing unpleasant side effects such as flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient consumes alcohol. Compliance (taking the medication as prescribed) can be a challenge, but it may benefit patients who are highly motivated to quit drinking.
Co-occurring disorders: Other medications are available to treat potential mental health conditions, such as depression or anxiety, that may be contributing to the individual's addiction.