Medications = hope
That being said, I also know how powerful some of the new medications to treat a wide range of mental health and addiction related problems are. I previously worked in a clinic that offered methadone maintenance. With all of the ups and downs, medications save lives if used appropriately and are closely monitored. Medications + psychotherapy produce the best outcomes. Medications alone are generally less effective. The mind, body, and spirit are all connected and need healing.
We are on a great path on the medical path to treat both alcohol and opioid dependence. Medications to reduce cravings and produce a non-euphoric experience following use are evidence-based and a tool.
Some medications are "agonists" - meaning they actually provide the addicted substance in measured and longer half-life doses to avoid the pain of withdrawal. Some medications are "partial agonists" - they provide some of the medication to occupy the receptors while also having a blocking effect to avoid euphoria if a person slips with use and some that completely block and occupy the receptor eliminating any euphoria that comes from use. Antagonists completely block a brain receptor and "fills" it so that getting high is not rewarding because it is bypassing the pleasure centers of the brain that likes addiction so much.
Some of the medications I've seen people significantly helped by:
- Campral (acamprosate) is one of the medications specifically for alcohol and reduces cravings for use. There is less risk for people with liver disease than taking naltrexone.
- Suboxone/buprenorphine (partial agonist) to reduces euphoria for opiates and is what is called a partial-agonist. There's a blocking effect within the medication that reduces the risk for abuse while still occupying receptors that crave opiates.
- Naltrexone (antagonist) - Blocks receptors and seems to work both for opiates and alcohol.
- Methadone - (agonist) - Used for opioid dependency (must meet criteria for). Has a long half-life so that a person can avoid withdrawal. It should be noted that methadone is carefully monitored and if you seek this medication you'll need to present to a clinic daily to receive your dose. Opioid clinics do not generally accept those with co-occurring pain management problems and doctors sometimes use methadone long-term for chronic pain which doesn't require daily dosing in primary or palliative care settings. After a period of successful dosing along with treatment involvement, take-home doses of the methadone can be granted with team and doctor approval. Because methadone is a full agonist, there is a risk of abuse. Medicaid often covers methadone fully. In rural areas, traveling to clinics in larger cities may be an obstacle. You may want to discuss options with your primary care doctor and see if there's a primary care doctor certified to provide suboxone instead.
I have seen many people who also have a significant mental health concern that needed medications to help tackle their addiction. Some clients have had an untreated bipolar disorder which cycled into mania making them more at risk for use during these cycles. Because of the delicate balance for both addiction and mental health, treating both at the same time along with psychotherapy results in the best outcomes.
Interested in learning more? Come see me and we can talk about your options and I can refer you to a physician or psychiatrist specializing in both areas. Let's tackle this together.