Medication for the treatment of substance use problems is not an alternative to treatment, but may be a needed component of comprehensive treatment. Being placed on the right medication regimen can help stabilize patients while they receive counseling, therapy, 12-Step support, psychosocial support, and education in relapse-prevention skills.
By selecting the correct medication plan, the addiction professional helps patients successfully navigate the most difficult period of recovery. The goal is to help the patient regain a more normal state of mind by decreasing cravings and smoothing out the highs and lows that come with early recovery from drugs and alcohol. Once the craving for drugs is alleviated and the mood more normal, the focus can shift to learning lifestyle changes and other aspects of recovery.
One benefit of a carefully structured medication plan is improving impulse control, calming the urge to use drugs inappropriately. Ideally, drugs that help treat addiction might not be necessary later in the treatment process as the patient becomes better able to resist the urge to use and the brain has been given time to heal.
One challenge is how to combat the stigma of using medications to treat chemical dependency, especially if that dependency is on prescription drugs. Using drugs to control drug addiction might seem counter-intuitive, but it actually is not. In fact, appropriate medication-assisted treatment is proven to save lives. Other therapeutic options take time to integrate into the patient’s lifestyle and medication may help the patient, most notably in the early treatment period when the patient has poor impulse control and mood instability.
Why the strong stigma?
A widespread misconception is that the patient is just switching from abusing one drug to another. For example, the patient might be accused of replacing his or her OxyContin dependency with one on Suboxone, prescribed to help break the cycle of abuse.
Complicating the issue is that both methadone and Suboxone are abused on the street and might, in some cases, be one of the drugs involved in a patient’s initial dependency problem.
The drug should never be the only treatment for dependency. Simply put, medication must be integrated into the patient’s overall care plan. Responsible physicians never prescribe a drug such as methadone or Suboxone as a standalone treatment for chemical dependency.
Instead, medical professionals must weight a variety of factors in choosing the correct treatment and medication regimen. For opioid-use disorders, the most commonly used medications are methadone (brand names Methadose and Diskets), buprenorphine (brand name Suboxone), and naltrexone (brand names ReVia and Vivitrol). While methadone and buprenorphine decrease craving by activating the opiate receptor in the brain, naltrexone works differently by blocking the effect of opiates so that the patient does not get high. It also decreases cravings. Without the pleasurable effect and with less craving, the user is less likely to relapse.
Buprenorphine is most effective for patients who are opiate-dependent but without other significant drug use. It also can be effective for patients who have a drug addiction related to chronic pain. Because it relieves discomfort while also dampening cravings, pain patients on buprenorphine often have an easier time progressing in recovery.
Finding the right option
Still, medication-assisted treatment is not the right option for everyone who is chemically dependent. Some patients require the structure of inpatient detox and treatment to keep from relapsing. With access to treatment professionals and other resources – and no availability of drugs – some of them might be able to curtail use altogether and at once without any long term medications.
On the other hand, a good candidate for medication-assisted treatment is the patient who has been to multiple abstinence-based programs but still is not stable. Perhaps they lack the family or community support to remain sober. Some patients have more damage to their brains from the drug abuse than others. These patients may require medication assistance. The brain may heal more slowly in some than others and medications may help.
However, addiction treatment professionals shouldn’t be surprised if they find themselves facing stigma and misunderstanding regarding medication assistance. They may experience some resistance from patients, family and therapists who may disagree with the idea of using another prescription drug to help combat dependency on illegal drugs, alcohol or, especially, medications. The chronically relapsing patient might not understand that brain chemistry can differ amongst individuals and blame themselves – which makes recovery even more difficult.
Prescribed appropriately, with psychosocial support, medication can help break that cycle.