Pharmacotherapy: Treating Addiction with Medicine | The Drug …

Pharmacotherapy may be the future of substance addiction

You may know that addiction is a chronic brain disease, but are you aware of the latest medications available to treat its symptoms? While some worry about treating alcohol and drug dependence with medicine, the reality is that pharmacotherapy products help many people achieve and maintain recovery. So is medication the future of substance addiction treatment?

Topiramate, a popular FDA-approved medication used to treat epilepsy and migraines, has been on the market for nearly thirty years. But it’s currently making headlines now that researchers have found it not only fights headaches and seizures – it battles alcoholism as well.

Lessening the amount of dopamine – the brain’s “feel-good” chemical – released following alcohol consumption, topiramate curbs binging by preventing drinkers from feeling an alcohol-induced high. Alcohol-addicted individuals taking the prescription pill can’t get physical pleasure from drinking, so most don’t feel the urge to consume enough alcohol to get drunk. Instead, they are able to lead sober and productive lives – often for the first time in years.

Topiramate users aren’t the only people in recovery who are receiving help in the form of a prescription medication. Today, many struggling with alcohol or opiate (such as heroin or prescription painkiller) addictions are benefitting from legal pharmaceutical aids, also known as pharmacotherapy products, including naltrexone, methadone, buprenorphine, and more. These medications, which can be taken orally or injected by a doctor, work in various ways to keep users away from their drugs of choice by subduing withdrawal symptoms, reducing cravings, blocking the pleasurable effects of substances, and, in the case of a product called disulfiram, making users sick when they drink alcohol.

Life-Changing Benefits

For countless people, medication-assisted treatment is a blessing. Take Paula Pennell, a mother from Michigan who abused either opiates or alcohol from the time she was 12 until she became pregnant at age 40. She chose to get treated with methadone and then buprenorphine for her unborn son’s sake, and has now been sober for over four years. “[Buprenorphine] is non-abusable, makes other opiates non-effective, and helps me with pain issues as well,” says Pennell, who currently holds a steady job as an educator for those struggling with mental disorders. “I work and take care of my son, who is now almost four. I have a good life, and I wake up each day with a clean conscience and the ability to feel good about myself.”

Michele Watkins, a 34-year-old woman from Pennsylvania, tells a similar story. “I started taking prescription pills after a car accident. It started like many other [people’s addictions] – a couple [pills] here and there, and then every day until I couldn’t wake up without knowing I had them.” Watkins’ son was taken from her and was two weeks away from formal adoption when Watkins decided to try methadone. “With the help of my methadone clinic, my counselor, my groups and meetings, I received custody of my son and I had a beautiful little girl. I got the trust and respect back from my family members that I never thought I would get back. My life is good now, and I have a great family.”

Like Pennell and Watkins, numerous people have regained their health, happiness, and self-control thanks to pharmaceutical aids, but pharmacotherapy (and treatment in general) doesn’t just help individuals – it helps society. According to a recent study by the National Center on Addiction and Drug Abuse, the government spends about 500 billion taxpayer dollars a year on drug abuse costs and consequences, which include “illness, crime, and social ills.” But research shows that opiate-addicted individuals receiving medication-assisted treatment, such as the popular methadone maintenance treatment, are much less likely to contract and spread HIV and commit crimes than those not receiving any form of treatment.

An Aid – Not a Cure

Despite the many proven advantages of pharmacotherapy products, critics – including some physicians and many people in the recovery community – are quick to argue that medication-assisted sobriety isn’t “real” sobriety. Although most FDA-approved pharmaceutical aids are not addictive, some refer to medication-assisted treatment as “treating addiction with addiction,” or substituting one form of chemical dependence with another. Others believe that the “quick fix” of a pharmacotherapy product encourages users to seek instant gratification, no matter what the source.

Furthermore, some professionals in the substance abuse field, such as Sally Satel, M.D., are wary of pharmaceutical aids; although they may like the idea, they don’t think that these products tackle the emotional reasons why addicts use drugs or alcohol – only the physical ones. “Why do people use drugs?” challenges Dr. Satel, a psychiatrist at Oasis Drug Treatment Clinic in Washington, DC and Resident Scholar at the American Enterprise Institute for Public Policy Research. “People use drugs for a reason. If these deeper matters of self-medication and bad decision-making styles remain, patients are likely to replace [opiates or alcohol] with other substances that alter mood and feelings related to demoralization of self-worth.”

But pharmacotherapy products alone aren’t expected to “cure” addiction.

“Stopping drug use is not the same as recovery,” explains Herb Kleber, M.D., an addiction expert and a professor of psychiatry at Columbia University. Prescription aids are usually used – or should be used – in conjunction with emotional therapy or support, says Dr. Kleber, “to keep patients taking the medication, to help repair the problems that anteceded or followed the addiction, or both.”

Dr. Satel agrees:

“Anything that removes distractions [such as pharmacotherapy products] can help people focus on the real reasons they’re using drugs.” She goes on to explain that pharmaceutical aids really can be successful when taken by individuals truly motivated to stop their drug abuse. “It’s no surprise that naltrexone works best with doctors and pilots – these people have something to lose,” she says. “When people have a reason to get clean, they do!”

What’s in Store

Like most forms of medical care gaining national attention, medication-assisted treatment has its shortcomings. For one, there are still no available medications to treat addictions to cocaine or methamphetamine. With these drugs, “there is a lack of a single receptor [in the brain], as with opiates,” Dr. Kleber says. Developing aids for alcoholism is almost as hard. However, there is hope – the narcolepsy drug modafinil is currently being tested to treat amphetamine addiction, and the drug D-cycloserine may work in the future to help users combat cocaine.

Another obstacle medication-assisted treatment faces is, unsurprisingly, stigma. Since many still view addiction as a moral failing, some major pharmaceutical companies are not inclined to put their names on products specifically for people who abuse drugs. Most likely, however, this view will change as people realize that addiction is not a choice but a disease – a disease that is more prevalent in society than most believe, affecting an estimated 23 million Americans. Nicotine-replacement therapies – such as the nicotine patch – were once met with the same resistance pharmacotherapy products face, but today are very well-received due to the passing of time and the large number of people addicted to nicotine. “Forty-five to fifty million [people] in America [smoke],” explains Dr. Kleber, so “nicotine is less stigmatized” than other drugs.

What does Dr. Kleber see in store for the future of medication-assisted treatment? “Pharmacotherapy will grow as stigma lessens,” he says. He even believes that vaccines to treat all different kinds of drug addictions will be on the market within ten years. Dr. Satel isn’t quite as optimistic. She believes that the real-world effectiveness of vaccines remains to be proven and that the extent to which they are used, assuming they are of value, will depend upon their cost. Still, she isn’t ruling anything out. “I am in favor of anything that is shown to work,” she says, “and I’m willing to be pleasantly surprised.”

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Here’s a look at some of the most popular pharmacotherapy products available.

To treat alcoholism:

Name: Acamprosate (Campral®)

Form: tablet

Use: helps reduce feelings of withdrawal and reduces cravings

Name: Disulfiram (Antabuse®)

Form: tablet

Use: makes user violently ill when it reacts with alcohol and keeps him/her from drinking out of fear of being sick

Name: Naltrexone (ReVia®, Vivitrol™, Trexan®, Depade®)

Form: tablet, liquid, or injection

Use: reduces cravings and blocks pleasurable feelings of intoxication

Name: Baclofen (Kemstro™, Lioresal®)

Form: tablet

Use: reduces cravings and blocks pleasurable feelings of intoxication

Note: not yet approved for addiction treatment by FDA

Name: Topiramate (Topamax®)

Form: tablet

Use: blocks pleasurable feelings of intoxication

Note: not yet approved for addiction treatment by FDA

To treat opioid addiction:

Name: Methadone

Form: liquid or tablet

Use: reduces cravings and blocks the “high” feeling user normally gets from opiates

Name: Buprenorphine (Suboxone®, Subutex®)

Form: tablet

Use: helps reduce feelings of withdrawal, reduces cravings, and lessens the “high” feeling user normally gets from opiates

Name: Naltrexone (ReVia®, Vivitrol™, Trexan®, Depade®)

Form: tablet, liquid, or injection

Use: blocks the “high” feeling user normally gets from opiates

Name: Levo-Alpha-Acetyl Methadol (LAAM)

Form: liquid

Use: reduces cravings and blocks the “high” feeling user normally gets from opiates

To treat nicotine addiction:

Name: Nicotine patch

Form: adhesive

Use: helps reduce withdrawal symptoms

Name: Nicotine lozenge

Form: hard candy

Use: helps reduce withdrawal symptoms

Name: Nicotine gum

Form: gum

Use: helps reduce withdrawal symptoms

Name: Bupropion (Zyban™)

Form: tablet

Use: reduces cravings and withdrawal symptoms

Name: Varenicline (Chantix™)

Form: tablet

Use: blocks user from feeling the pleasurable effects of smoking and reduces withdrawal symptoms