Pharmacologic Medications for Addictions Treatment
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
Medications can be beneficial in addictions recovery. The goal is to restore or enhance the brain's healthy functioning. This adjustment is intended to repair damage caused by repeated stimulation from addictive substances or activities. These goals can be accomplished in several different ways. Let's look at each goal, and then discuss the medications that are commonly used for that purpose. Goals 1-3 are most applicable to substance addictions. Goals 4-5 are applicable to both substance and activity addictions. For a detailed explanation about how drugs (including medications) affect the brain, please refer to the Biology of Addiction.
1) Diminish the appealing reward of a drug by causing a person to become sick if they use it.
Disulfiram (Antabuse ®) is helpful if your drinking is impulsive, or if someone you care about wants to be confident you are not drinking. This person can watch you take the pill, or even better, drink a glass of water that has the Antabuse® crushed up in it.
The way Antabuse® works well understood. Alcohol is metabolized in the body in several steps. First, alcohol breaks down into acetaldehyde. Then it breaks down into other metabolites. Antabuse® prevents the metabolism of acetaldehyde, which builds up quickly in the body. The effect of having a large quantity of acetaldehyde in the body is very uncomfortable. This includes flushing of the skin; rapid pulse; nausea and vomiting; shortness of breath; headache; mental confusion; and other symptoms that are similar to a severe hangover. When someone knowingly takes Antabuse®, drinking is unlikely. The medication does not work for everyone. It is not recommended for people with certain medical conditions, such as liver problems.
Antabuse® has been available since the 1950s. It seemed like such a promising approach. Antabuse® prevents alcohol consumption in nearly everyone who takes it. Yet alcohol problems have not appreciably diminished since its release. Based on this disappointing outcome, we are not optimistic about the possibility of a magic cure. To be effective, someone has to take a medication. They must be motivated to recover. Even if we developed a drug that would motivate you to take Antabuse, you would still need to be motivated to take THAT drug! We discuss the central role of motivation in addiction recovery in a later section LINK.
2) Reduce or block the effect of a drug so that the experience of drug use is no longer pleasing or desirable.
Naltrexone comes in several forms. Some brand names are ReVia®, Depade®. A once-a-month injection is also available called Vivitrol®. Naltrexone apparently reduces the sense of intoxication from drinking. It makes drinking less enjoyable. It may also reduce cravings. Naltrexone is an opiate antagonist. The brain's opiate system activates the addiction process and plays a role in cravings. An opiate antagonist blocks this activation. Opiate antagonists treat alcoholism; and in some cases, opiate abuse. Naltrexone may also help people moderate alcohol consumption. People attempting moderation (versus complete abstinence) will take it daily, or only on pre-determined drinking days. For some, Naltrexone may be an insufficient deterrent. These individuals may decide that Antabuse® would be a better choice for them.