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Medications for Alcohol and Substance Abuse Symptom and Relapse Reduction

Mark Dombeck, Ph.D.

Medication (Symptom Reduction)

Recovering drug or alcohol dependent persons often complain of mood and anxiety problems. The origin of these problems is not clear in many cases. People's mood and anxiety problems may have preceded their drug or alcohol dependence (and may have been a partial cause of the drug or alcohol dependence). Mood and anxiety problems may also have been caused by drugs or alcohol. In either case, the continuing presence of mood and anxiety problems is a considerable stressor to the recovering person. Left untreated, such symptoms can provoke the recovering person to return to substance abuse. For these reasons, a physician may prescribe medication to reduce symptoms of depression, anxiety, and other concerns. Anti-depressant, anti-anxiety and even anti-psychotic medications may be used for these purposes.

Some drug and alcohol dependent persons are known to have a mental health diagnosis that preceded their substance dependence (and cannot be accounted for by the effects of the drug), or that remains a significant problem for them despite sustained recovery from substances. Such persons are known as "dual diagnosis" patients. Dually diagnosed patients may require psychiatric medication to treat their mental illnesses.

A general warning about medication treatment for anxiety is appropriate. Some of the most effective anti-anxiety drugs are also themselves highly addicting. Drug and alcohol dependent people aren't stupid - they tend to abuse those drugs that help them to feel better (at least in the short run). For example, anxious addicts often gravitate towards alcohol abuse, as alcohol has anti-anxiety properties. Some physicians will treat their recovering patients' underlying anxiety with benzodaizapines (a class of medicines that includes Valium, Ativan, Klonopin and Xanax) which are themselves addicting! This sort of 'treatment' can result in the trading in of one sort of addiction for another, if both the patient and the physican are not careful. Not all physicians are thoughtful about this problem! There are several anti-anxiety medications that are non-addicting. Consult with your doctor to find out if one of these medications is most appropriate for you.

Medication (Relapse Reduction)

Detoxified drug and alcohol dependent people are at significant risk for relapsing back to using their drugs of choice, particularly in the early hours, days, weeks and months of their recovery. There are several medications that physicians can prescribe for their recovering patients which can help to minimize their chances of relapsing.

Administration of Antabuse (generic: Disulfiram) blocks alcohol from being metabolized (detoxified) by the liver, resulting in an extremely unpleasant reaction when alcohol is consumed. Patients who drink while taking disulfiram will turn purple, become severely ill for 30 to 60 minutes (or longer) and often vomit. Patients on disulfiram may also have this same response to alcohol ingested in mouthwash, wine sauces or vinegars, or even to inhaled alcohol vapors from aftershave lotions. Giving alcoholic patients Antabuse can provide them with a strong motivation to not relapse.

Naltrexone is a drug that blocks the action of heroin, codine, morphine and other opioid compounds. Naltrexone binds with but does not activate opioid endorphin receptors, thus reducing or blocking entirely the effects of opioid consumption. In essence, an opioid addict can take opioids (heroin, codine, etc.) while on Naltrexone, but it won't get them all that high. Being on Naltrexone then, can help discourage an opioid dependent person from relapsing. Naltrexone is also administered to alcoholics as a way to help them remain sober. The exact way in which Naltrexone compounds are able to help prevent relapse to alcohol is not well known. Unlike Disulfiram, consumption of alcohol while on Naltrexone does not produce sickness; rather it seems to make the alcoholic less interested in the effects of alcohol.

A new alternative to Naltrexone has become available in the last few years. Like Naltrexone, Suboxone is a partial agonist for opioid receptors, meaning that it fills up many of the the receptor spaces on nerons where opioid drugs would normally bind to produce their effect.