How Medications Are Used in Drug TreatmentPeople in the beginning phases of addiction treatment often develop a range of mild, moderate or severe symptoms. Some of these symptoms appear during the initial process of detox (detoxification) and withdrawal, while others can appear later, during active recovery. When addiction is related to the use of opioids or alcohol, treatment programs can use any one of several medications to decrease the severity of withdrawal symptoms. They can also use medication to help people recovering from opioid or alcohol problems avoid relapses.

Drug and Alcohol Detox and Withdrawal Basics

The detoxification process begins when a person in drug treatment stops taking a given substance while under a doctor’s care. Since the brains of addicted users are accustomed to receiving frequent and/or large doses of drugs or alcohol, the sudden halt in substance use triggers the onset of withdrawal symptoms. The types and severity of withdrawal symptoms depend on the type of substance a person was using. For example, people withdrawing from opioid street drugs or medications can experience symptoms such as[i]:

  • Sleeplessness
  • Pupil dilation
  • Increased mucus and tear production
  • Mental agitation
  • Sore muscles
  • Stomach or abdominal cramping
  • Increased sweat output

People withdrawing from alcohol can experience symptoms such as[ii]:

  • Headaches
  • Irritable or anxious mental states
  • Nervous or “jumpy” mental states
  • Mood fluctuations
  • Nausea
  • Vomiting
  • Trembling hands
  • Rapid heartbeat
  • Sleeplessness
  • Unclear thinking

People with severe alcoholism may also experience seizures or a potentially fatal complication called delirium tremens (i.e., the DTs) while going through withdrawal. For safety reasons, detoxification should take place at a detox facility that offers 24/7 monitoring by medical professionals.

Medications Used During Detox and Withdrawal

There are FDA-approved medications available for people withdrawing from both opioids and alcohol[iii]. The medications used for opioid-related withdrawal are:

  • Buprenorphine
  • Methadone

Buprenorphine is an opioid substance that lacks the potency of opioid painkillers and street drugs. When given to a person detoxing from these powerful substances, it can make withdrawal symptoms less severe. In addition, buprenorphine provides enough of an opioid effect to ease the intense cravings that can lead to a relapse during withdrawal. However, the medication does not make recipients “high.”

Methadone is a more powerful opioid than buprenorphine. When it enters the bloodstream, it reduces the intensity of withdrawal symptoms by making the brain and spinal cord less susceptible to feelings of pain.  When used properly, methadone also does not make recipients high.

Some people going through alcohol-related detox and withdrawal develop a condition known as protracted withdrawal or post-acute-withdrawal syndrome. This condition is marked by lingering detox/withdrawal after effects that can include:

  • Unusual anxiousness
  • Sleeplessness
  • A general sense of unease
  • Restlessness

An FDA-approved medication called acamprosate (Campral) can help limit the impact of protracted alcohol withdrawal. It appears to produce its benefits by readjusting some of the brain chemistry alterations triggered by alcoholism.

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Medications Used for Opioid Relapse Prevention

Relapses are often driven by ongoing cravings for substance use after completion of the withdrawal process. Relapse prevention plays a major role in substance use treatment, and medication can support prevention efforts in people recovering from opioid problems or alcohol problems.

In addition to reducing the intensity of opioid withdrawal, buprenorphine and methadone can reduce the risks for relapse. Buprenorphine produces its benefits by making it less likely that a person who completes detox will experience strong opioid cravings. Methadone produces its benefits in two ways. First, it stays in the bloodstream for a relatively long time, and thereby helps people in recovery avoid the chemical lows that can lead to a relapse. While in the bloodstream, methadone also prevents opioid painkillers and street drugs from reaching the brain.

There is a third option for relapse prevention in people recovering from opioid addiction: the anti-opioid medication naltrexone. When it enters the circulatory system, this medication creates a chemical barrier that halts the effects of opioid substances. People with naltrexone in their systems won’t be able to get high if they take these substances.

Medications Used for Alcohol Relapse Prevention

Naltrexone can also help prevent relapses in people recovering from alcohol addiction. This is possible because some of the intoxicating effects of drinking are produced through the same chemical pathways as opioid intoxication. People with naltrexone in their systems experience a decline in the intensity of their alcohol cravings.

Apart from its role in easing protracted withdrawal, acamprosate can also play a role in alcohol relapse prevention. As with withdrawal, the medication’s benefits in this second role seem to come from the corrections it makes in the brain’s chemical balance. The National Institute on Drug Abuse reports that people who receive acamprosate improve their chances of remaining alcohol-free. The biggest boosts to abstinence may occur in people recovering from severe alcoholism.

People in alcohol treatment may also benefit from use of the medication disulfiram (Antabuse). Disulfiram produces a number of mild toxic effects by preventing the breakdown of a key alcohol byproduct. Examples of these effects include such things as[iv]:

  • Facial flushing
  • Altered breathing
  • A confused mental state
  • Nausea
  • Vomiting
  • Chest pain
  • A pounding heartbeat

A desire to avoid such unpleasant sensations can be a motivator to avoid drinking, especially in people who have committed themselves to the process of alcohol recovery.

Medication Use in Co-Occurring Alcohol and Other Drug Disorder

Medication can also make it easier for doctors to manage cases of co-occurring alcohol and other drug use disorder. This condition is marked by problems related to the combined use of alcohol and other addictive substances. In many cases, those other substances are opioids. When used together, alcohol and opioids can severely depress the normal level of function in the central nervous system. In turn, this severe drop-off in normal function can lead to the onset of an overdose, and research data has revealed that some people who die from opioid use have also consumed alcohol[v]. The same medications used separately to treat alcoholism and opioid addiction can work in combination to address overlapping alcohol/opioid problems and reduce overdose risks.

  1. U.S. National Library of Medicine – MedlinePlus: Opiate and Opioid Withdrawal https://medlineplus.gov/ency/article/000949.htm
  2. U.S. National Library of Medicine – MedlinePlus: Alcohol Withdrawal https://medlineplus.gov/ency/article/000764.htm
  3. Substance Abuse and Mental Health Services Administration: Medication and Counseling Treatment
    https://www.samhsa.gov/medication-assisted-treatment/treatment
  4. U.S. National Library of Medicine – MedlinePlus: Disulfiram https://medlineplus.gov/druginfo/meds/a682602.html
  5. Centers for Disease Control and Prevention: Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse-Related Emergency Department Visits and Drug-Related Deaths
    https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a1.htm