What Is Medication-Assisted Treatment (MAT)?
Since addiction and substance abuse disorders were first recognised as medical conditions requiring treatment, doctors and pharmacologists have worked to develop medications to help. Although no permanent cure has been found for addiction, many medications have proven to help people struggling with addiction relieve their symptoms and achieve recovery.
Medication-assisted treatment (MAT) is the use of medications as part of treatment for addiction. Addiction treatment usually consists of a combination of medications, therapy and other elements. Some treatment programmes omit medication, focusing solely on therapy and different nonpharmaceutical approaches. MAT is used when doctors believe medication will be useful and beneficial during the treatment process. While not without some challenges, MAT has been very successful in many cases of addiction worldwide and continues to be the centre of most modern addiction treatments.
Can Drug Addiction Be Treated?
Addiction can indeed be treated, and millions of people are alive today only because of the treatment they have received. Since there is no cure for addiction, treatment usually consists of a combination of approaches, including medication and therapy. This treatment has made the difference in countless cases worldwide, and anyone suffering from addiction should feel confident that their condition is indeed treatable.
How Do Medications for Addiction Treatment Work?
Different medications tackle different aspects of addiction and substance abuse. Some address specific withdrawal symptoms that can be extremely distressing and drive relapse and distinct psychological issues that can contribute to substance abuse and addiction. Other medications block the effects of specific abused substances, making them ineffective and often discomforting.
The exact mechanisms by which any medications take effect, of course, vary from one medication to another and not all medications are equally effective in every case. Some medications may be counterproductive or even dangerous. It is vital to take only medications prescribed to you by a doctor and to take them precisely as the doctor has instructed.
Medications Used in Addiction Treatment
Many medications are currently used worldwide to treat addiction and substance abuse disorders, and some have different brand names in different locations. Some of the medications most commonly used in addiction treatment include:
Also known as Adepend, Antaxone, Celupan, Depade, Nalorex, Narcoral, Nemexin, Revia/ReVia, Trexan and Vivitrol. Naltrexone is a medication of the substituted oxymorphone class that is used to treat alcohol and opioid dependence, as well as other behavioural disorders such as kleptomania and compulsive gambling. A prescription-only medication in the UK, naltrexone is used as a substitute for heroin and other illicit opioids. This reduces the danger to the body and the risk of criminal liability because of its legal status and improves the management of tapering. It has been shown to reduce alcohol cravings in long-term alcoholics. Naltrexone works by blocking opioid receptors in the brain, preventing or reducing their effects. While the mechanisms that make naltrexone effective in the treatment of alcohol dependence are not yet fully understood, it is believed to affect the dopaminergic mesolimbic pathway, a part of the brain specifically associated with addiction. The most common side effects of naltrexone are gastrointestinal-related, including cramping, diarrhoea and nausea (which typically occur during opioid withdrawal). It has been reported to cause liver damage at high dosages, although these reports are still being studied and no firm correlation with naltrexone consumption has been established.
Sold under brand names, including Subutex, Zubsolv, Bunavail, Sublocade, Probuphine, Temgesic, Buprenex, Norspan, Butrans, Cizdol, and Suboxone. Buprenorphine is an opioid used to treat opioid addiction, as well as chronic pain. It is usually administered orally, under the tongue, as a skin patch, as an implant or by intravenous injection. In the UK, it is a Class C controlled substance, illegal to possess unless prescribed by a doctor. It is one of most popular pharmaceutical treatments of opioid addiction because, although it causes withdrawal symptoms, they usually much less severe than withdrawal from other opioids. So substituting buprenorphine for an opioid like heroin, for example, can make it much easier for a user to stop taking drugs altogether. Buprenorphine is still an addictive substance, and dependence can develop quite quickly. Side effects include respiratory depression or insufficient breathing, which typically occurs in individuals who are also taking benzodiazepines or alcohol or who have a coexisting lung condition. Other possible side effects are nausea and vomiting, fatigue, dizziness, perspiration, itchiness, decreased libido, dry mouth, memory loss and urinary retention.
Acamprosate, sold under the trade name Campral, is used to treat alcohol dependence and is a prescription-only medication in the UK. Acamprosate stabilises chemical signalling in the brain that might otherwise be abnormal during alcohol withdrawal. This reduces cravings, protects neurons in the brain from damage caused by alcohol withdrawal and helps regulate behaviour. Acamprosate has shown positive benefits when taken for three to 12 months, increasing the number of abstinent days for those who continue to drink sporadically and increasing the number of individuals who do not drink alcohol at all. Acamprosate needs to be taken in conjunction with counselling or therapy. It has various potential side effects, including kidney failure; abnormal heart rhythms; low or high blood pressure; allergic reactions; headaches; insomnia; impotence; diarrhoea; pain in the stomach, back, muscles, joints and chest; infections; chills; heart palpitations; flulike symptoms; vomiting; constipation; increased appetite and weight gain; impotence; lower libido; oedema; forgetfulness; abnormal vision; tremors; abnormal thought patterns; coughing; difficulty breathing; bronchitis; rashes; and fainting.
Also known by various trade names including Provigil, Alertec, Alertex, Altasomil, Aspendos, Forcilin, Intensit, Mentix, Modafinilo, Modalert, Modanil, Modasomil, Modvigil, Modiodal, Modiwake, Movigil, Resotyl, Stavigile, Vigia, Vigicer, Vigil, Vigimax, Wakelert and Zalux, modafinil is a eugeroic or wakefulness-promoting drug, usually taken in tablet form, used to treat addiction to cocaine and other stimulants. It is a prescription-only medication in the UK; it is also on the World Anti-Doping Agency’s prohibited list. Modafinil is a dopamine reuptake inhibitor, which means that dopamine (a chemical in the brain connected with feelings of pleasure and happiness) stays active longer than it would normally. In the treatment of addiction, modafinil is used as a legal and less harmful substitute for stimulants such as cocaine, methamphetamine and amphetamine, enabling users to substitute modafinil whilst tapering off these more damaging and illegal substances. Some side effects associated with the use of modafinil include headaches, nausea, nervousness, insomnia, dizziness, anxiety, diarrhoea and other gastrointestinal problems, skin rashes, high blood pressure, dry mouth and loss of appetite.
A tetracyclic antidepressant (TeCA) usually taken orally, mirtazapine is known by a very large number of trade names including Adco-Mirteron, Afloyan, Amirel, Arintapin Smelt, Avanza, Azapin, Beron, Bilanz, Calixta, Ciblex, Combar, Comenter, Depreram, Divaril, Esprital, Maz, Menelat, Mepirzapine, Merdaten, Meronin, Mi Er Ning, Milivin, Minelza, Minivane, Mirastad, Mirazep, Miro, Miron, Mirrador, Mirt, Mirta, Mirtabene, Mirtadepi, Mirtagamma, Mirtagen, Mirtalan, Mirtamor, Mirtamylan, Mirtan, Mirtaneo, Mirtapax, Mirtapil, Mirtapine, Mirtaron, Mirtastad, Mirtax, Mirtaz, Mirtazap, Mirtazapin, Mirtazapina, Mirtazapinum, Mirtazelon, Mirtazon, Mirtazonal, Mirtel, Mirtimash, Mirtin, Mirtine, Mirzapine, Mirzaten, Mirzest, Mitaprex, Mitaxind, Mitocent, Mitrazin, Mizapin, Motofen, Mytra, Norset, Noxibel, Pharmataz, Promyrtil, Rapizapine, Ramure, Redepra, Reflex, Remergil, Remergon, Remeron, Remirta, Rexer, Saxib, Sinmaron, Smilon, Tazepin, Tazimed, Tetrazic, Tifona, U-Mirtaron, U-zepine, Valdren, Vastat, Velorin, Yarocen, Zania, Zapex, Zestat, Zismirt, Zispin, Zuleptan and Zuli. A prescription-only medication in the United Kingdom, mirtazapine is used to treat depression (and a number of other psychiatric disorders), which as previously noted can help prevent substance abuse including relapse. Mirtazapine works by normalising levels of chemicals such as serotonin and dopamine that can be significantly lowered in individuals suffering from depression. It can also have powerful sedative effects, reducing the likelihood of insomnia in clients going through withdrawal.
Also known by trade names including Paxil, Seroxat, Aropax, Brisdelle, Deroxat, Paxil, Pexeva, Paxtine, Paxetin, Paroxat, Paraxyl, and Sereupin, paroxetine is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Taken orally, in the UK paroxetine is a prescription-only medicine. It is used to treat depression, a major driver of substance abuse and addiction, as well as one of the most common and challenging symptoms of withdrawal. Paroxetine is also used to treat other disorders, including obsessive-compulsive disorder (OCD), social anxiety disorder, panic disorder, post-traumatic stress disorder, generalised anxiety disorder and premenstrual dysphoric disorder. Although the precise mechanisms by which SSRI antidepressants affect the brain are not yet completely understood, they are believed to increase levels of serotonin (linked with sensations of pleasure and happiness) in the brain by reducing the rate at which it is reabsorbed. Like many other SSRI antidepressants, taking paroxetine can result in side effects that include nausea, diarrhoea, dry mouth, drowsiness, constipation, headache, insomnia, blurred vision, nervousness, dizziness, nightmares, weakness, loss of appetite, sweating, sexual dysfunction, tremors, mania and paraesthesia. It is especially important to note that links have been made between SSRI antidepressants such as paroxetine and suicidal ideation, possibly resulting in suicide, in children and young people. Studies into this connection are ongoing.
Some side effects associated with mirtazapine include constipation, dry mouth, increased appetite, weakness, confusion, sleepiness, dizziness and elevated cholesterol levels.
Sold under numerous brand names including Norpramin, Pertofrane, Irene, Nebril, Pertofran, Pertrofran, and Petylyl and also known as desipramine hydrochloride, desipramine is a tricyclic antidepressant (TCA) typically taken orally. A prescription-only medication in the UK, desipramine is primarily used to treat depression including major depressive disorder and is sometimes prescribed in the treatment of attention-deficit hyperactivity disorder (ADHD) and some eating disorders. Depression is both a major driver of addiction and substance abuse and a very common withdrawal symptom; treating depression can prevent substance abuse in the first place and help reduce cravings and the likelihood of relapse in recovering users. Desipramine is typically associated with fewer and less severe side effects than other TCAs, although it has been known to produce symptoms that include nausea and vomiting, dry mouth, gastrointestinal complaints, problems with vision and hearing, insomnia, constipation, lowered libido, impaired memory, cognitive faculties and breast swelling in both sexes.
Also known by a variety of trade names including Wellbutrin and Zyban, bupropion is a substituted cathinone used as an antidepressant and a smoking cessation aid. It is typically administered in tablet form and is a prescription-only medicine in the UK. Bupropion selectively inhibits the reuptake of dopamine, noradrenaline and serotonin in the brain, creating higher levels of these chemicals and thus elevating mood and reducing cravings. The most important potential side effect of bupropion is the risk of epileptic seizures, which prompted the drug’s withdrawal from the market from 1986 to 1989. The use of antidepressants, including bupropion, may increase the risk of suicide, especially in individuals aged 25 or younger. It has also been associated with unusual behaviour changes, and bupropion-induced psychosis may develop or a pre-existing psychotic condition may worsen. Bupropion is also associated with a large number of other side effects, some of which include headaches, insomnia, anxiety, constipation, nausea, tremors, sweating, itchiness, fever, dry mouth, dizziness and agitation.
Established as a generic medication in 2019, vigabatrin is an anticonvulsant medication usually provided in tablet form, primarily used to treat epilepsy and other seizure-causing disorders. In the UK, vigabatrin is a prescription-only medicine. It works by inhibiting the production of enzymes that catabolise gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter that acts as a calming agent on the central nervous system. In the treatment of addiction, vigabatrin can have a beneficial effect on clients going through withdrawal, especially from alcohol and benzodiazepines, who may be subject to seizures. It is also increasingly used to reduce cravings in users — especially of cocaine and other stimulants — going through detoxification and withdrawal. Numerous side effects have been associated with vigabatrin consumption, including sleepiness, nervousness, headache, dizziness, depression, diplopia, memory disturbances, ataxia, hyperactivity, loss of vision, vertigo, insomnia, confusion, personality disorders, impaired concentration, anxiety, psychosis, irritability, speech disorders, abnormal gait, abdominal pain, constipation, dyspepsia, vomiting, nausea, fatigue, asthenia and weight gain. Some studies have associated vigabatrin with pregnancy abnormalities in animals, though no firm links have yet been established in humans; research in this area is ongoing.
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Sold under various brand names including Lioresal, Liofen, Gablofen, Beklo, Baclodol, Flexibac, Gablofen, Kemstro, Lyflex, Clofen, Muslofen, Bacloren, Baklofen, Sclerofen and others, baclofen is a central nervous system (CNS) depressant and skeletal muscle relaxant usually taken orally; it is a prescription-only medicine in the UK. It is primarily used to treat muscle contractions and spasticity and is also increasingly used in the treatment of alcohol withdrawal syndrome. Baclofen prevents the release of certain chemicals in the brain that can cause abnormal brain function, helping to reduce cravings and decrease the severity of withdrawal symptoms. Potential side effects of baclofen consumption include fatigue, drowsiness, headaches, dizziness, weakness, insomnia, nausea, vomiting, constipation and urinary retention.
Also sold under brand names including Neurontin, gabapentin is an anticonvulsant used to treat seizures and restless leg syndrome. Taken orally, it is a prescription-only medicine in the UK. In the treatment of alcoholism, gabapentin can reduce symptoms of alcohol withdrawal and cravings and may reduce the severity of seizures that are often associated with alcohol withdrawal syndrome. It is also being studied as a treatment for cannabis dependence and as a smoking cessation aid. Common side effects associated with gabapentin include fatigue, drowsiness, oedema, tremors, dizziness, ataxia, sexual dysfunction, suicidal ideation and dependence.
Also known by trade names including Topamax, Trokendi XR and Qudexy XR, topiramate is a broad-spectrum anticonvulsant drug taken orally as a tablet. A prescription-only medicine in the UK, topiramate is usually used to treat epilepsy and other seizure-causing conditions and is also commonly used in the treatment of alcohol use disorder. Whilst the mechanisms of topiramate’s action are not fully understood, it is believed to stimulate the production of chemicals in the brain that has a calming effect upon the central nervous system. Topiramate has been proven to reduce alcohol cravings and decrease the length and severity of the anxiety and depression that may accompany alcohol withdrawal and detoxification. Several side effects have been associated with the consumption of topiramate, including dizziness, weight loss, nausea, diarrhoea, fatigue, paraesthesia, sleepiness, depression, nasopharyngitis, asthenia, oral paraesthesia, sedation, weight gain, anaemia, gastritis, abdominal discomfort, irritability, blurred vision, lowered attention levels, impaired memory, visual disturbance, abnormal feelings, vertigo, cognitive disorders, hypersensitivity, tinnitus, dysuria, alopecia, impaired motor skills, rashes, convulsions, pruritus, expressive language disorder, anxiety, tremors, muscle spasms, arthralgia, confused state, vomiting, myalgia, aggression, constipation, muscle twitches, muscular weakness, altered mood, agitation, balance disorder, musculoskeletal chest pain, anorexia, pyrexia, mood swings, dry mouth and abnormal behaviours. Topiramate has also been associated with congenital malformations and other negative impacts on pregnancy, and a very small number of people taking topiramate have also reported suicidal thoughts. Topiramate consumption can also result in overdose, resulting in symptoms that include agitation, fainting, loss of coordination, loss of consciousness, seizures and potentially coma and death.
Other Medications Used for Addiction Treatment
As well as the medications listed above, a broad variety of other drugs have been observed to be beneficial in the treatment of addiction. Some of the most popular include clonidine, klonopin, Librium, methadone, Prozac and Zoloft, some of which may be available worldwide under other brand names. As the understanding of addiction and its treatment continues to improve, new medications are discovered to mitigate the condition, especially specific withdrawal symptoms. Ask your GP and/or an addiction specialist about medications that might be appropriate for you when taken according to the instructions of a prescribing physician.
How Are Medications and Devices Used in Drug Addiction Treatment?
The way a medication is used to treat addiction depends on its purpose, effects, side effects and other factors. Some medication may be used short-term to ease withdrawal and detoxification; others are taken over a longer-term to deal with more serious withdrawal symptoms and other disorders that can contribute to substance abuse. In addition, some medications are given as alternatives to more dangerous or illegal drugs to manage to taper off and eventually ceasing use altogether.
Most addiction specialists agree that medication by itself is not an effective form of treating addiction, though it can improve the effectiveness of the treatment. The core of addiction treatment remains therapy, and medication is overwhelmingly used in combination with therapy as part of a broader addiction treatment programme. The use of devices in addiction treatment including electro-stimulus aids is currently being researched, with some devices already approved in various parts of the world to treat withdrawal. As with medication, these devices should only be used in accordance with the instructions of a doctor and as part of a holistic treatment plan.
The Link Between Pleasure, Pain and Addiction
Addiction does not develop overnight; repeated instances of substance abuse are necessary for it to form. This substance abuse might be driven by the pleasurable sensations it produces; on the other hand, many people become addicted because of using habit-forming painkillers to stave off chronic pain. Recent studies suggest that certain chemicals — especially dopamine — may be active in the brain at times of both extreme pleasure and extreme pain. The neurochemical connections between pleasure and pain, and subsequently addiction, are currently an area of a great deal of research that may pave the way for the development of more effective medications.
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Myths About Pharmaceutical Treatments for Addiction
The use of medication in addiction treatment is somewhat poorly understood by the general public, and a number of profound misunderstandings are relatively common. Probably the most prevalent of these is the belief that any medication can “cure” an addiction. Whilst playing a very useful role in various aspects of the treatment and recovery process, no medication has yet been developed that can by itself remove an addiction and an individual’s desire to consume substances of abuse.
Similarly, some people mistakenly believe that medication alone is sufficient treatment for addiction. Medication should be provided as part of a broader treatment programme with psychotherapy at its heart; only this will tackle both the short-term challenges of physical dependence and the longer-term issues of psychological addiction.
One potentially dangerous myth is that medication can be safely consumed without having to consult a doctor first (perhaps by procuring it from the dark web). Many medications used in the treatment of addiction have potentially dangerous side effects and/or interact dangerously with other substances. No medication should be consumed at any point unless in accordance with the instructions of a prescribing physician.
Why Aren’t These Drugs More Well-Known?
Put simply, there is no need for most of the population to be familiar with many of the substances used as a medication for addiction. Only people struggling with addiction and those close to them need to know the names of many of the medicines available in this field, and the stigma associated with substance abuse and addiction means there is comparatively little open discussion about the efficacy of any given medication. Of course, some medications used in addiction treatment are also used in the treatment of other conditions and may have become more widely known, as a result, especially commonly encountered antidepressants. It is important to note that this does not mean such medications are more effective or more valuable in the treatment of addiction than lesser-known drugs.
Another compounding element is that compared with many medications that need to be taken over a long period, there is less profit to be made from short-term addiction treatment. Therefore, pharmaceutical companies are less likely to spend significant quantities of money on marketing to improve public awareness of any given anti-addiction medication.
Principles of Effective Treatment
Why Addiction Medications Are Best Combined with Therapy
As noted above, while medication can tackle specific aspects of addiction and withdrawal, no medicine is a cure for the condition. Medication can be especially useful during the initial stages of detoxification and withdrawal but is of limited efficacy over the longer term, especially when considering the deep-seated psychological nature of addiction. To tackle this profound challenge, psychotherapy is considered an indispensable element of addiction treatment, as only therapy can both reveal and address the psychological causes of substance abuse and addiction and provide recovering users with the defence mechanisms they need to resist the temptation to relapse.
Counselling and behavioural therapies
There are a great number of different approaches to therapy that can be employed during the treatment of addiction. Most commonly, clients will receive counselling and/or behavioural therapy (especially cognitive behavioural therapy, or CBT) that encourages them to consider the root causes of their addiction and address the behaviours that have led to its development. Such therapy can be provided in a range of settings and formats, and each patient may react differently to different therapy models.
Numerous different rehabilitation (“rehab”) options are available across the UK, both NHS-provided and private, offering inpatient and outpatient care. Speak to your GP and/or an addiction specialist about whether rehab is an appropriate solution for you.
Along with treatment provided by doctors and specialist facilities, various self-help groups operate across the UK that have been instrumental in transforming countless lives over the years. The best-known of these are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), providing support, companionship and advice to recovering alcoholics and drug users respectively. Self-help groups are typically most beneficial for clients in recovery who have gone through an addiction treatment programme, but they can also be useful for anyone wanting to stop their substance abuse before undergoing formal treatment. Speak with your GP and/or an addiction specialist about self-help groups active in your area.
Side Effects of Anti-Addiction Medication
As can be seen in the details of the medications discussed above, some medicines used in the treatment of addiction can have unpleasant and even dangerous side effects. Always consult your doctor about any side effects of the medication you have been prescribed. Some of the most common side effects of the anti-addiction medication include nausea, vomiting, diarrhoea, weight loss or gain, sleepiness, depression, paraesthesia, muscle pain, abdominal discomfort, irritability, mood swings, cognitive impairment,
impaired memory, vertigo, alopecia, impaired motor skills, rashes, anxiety, tremors, convulsions, psychosis, chest pain, anorexia, dry mouth, abnormal behaviour, insomnia, muscle spasms and suicidal ideation.
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Alcohol Addiction Medications
Several medicines are used to treat alcohol addiction, including some of those listed above. Typically, these medications address some of the more dangerous and/or distressing side effects of alcohol addiction or cause a negative reaction to consuming alcohol, such as creating hangover symptoms immediately after drinking it. Because alcohol withdrawal is one of the most dangerous of all withdrawal syndromes and can be fatal, medication is very frequently prescribed during treatment. If you are concerned about your drinking, speak with your GP and/or an addiction specialist about which approach to treatment might be most appropriate for you.
Heroin and Opiate Addiction Medications
Addiction to opioids, including heroin, is one of the most catastrophic issues in worldwide public health, and various medications have been developed to aid its treatment, including some of those mentioned above. Typically, such medications either act as more manageable substitutes for dangerous and/or illegal opioids such as heroin or impede the effect of opioids on the brain to prevent further consumption. Again, if you are concerned that your consumption of opioids has resulted in addiction and/or is causing you harm, consult your GP and/or an addiction specialist about your situation and whether you require professional help.
What Are My Choices in Addiction Medication?
A great number of different medications are used to treat addiction at various times and for various reasons. However, not every medication is right for every client; some treat only specific withdrawal symptoms or are relevant for specific substances, while others may be dangerous for certain individuals. Independently acquiring and/or taking anti-addiction medication without consulting a doctor could be fatal. It is always recommended to take the advice of a prescribing physician rather than making your own uninformed choice about which medication to take.
Is Medication for Addiction Right for Me?
Every case addiction is unique; not every medicine is appropriate in every case for every individual. Some individuals may not require medication at all and are able to overcome their addiction through therapy and other elements of a coordinated treatment plan. However, only a medical professional is qualified to determine whether medication is appropriate for you and if so, which specific medication you should take. Making that determination is the role of your doctor or medical professionals in rehab.
Speak openly and honestly with your GP and/or an addiction specialist about your situation, your medical history, your substance abuse and any other relevant information and allow them to make the decision about possible medication in your case. Acting independently could be fatal.
Ready to Get Help for Your Addiction?
No treatment for addiction can be effective unless the person in question truly desires to overcome their addiction. Only when you are willing and able to acknowledge your condition and reach out for help can help be provided effectively. If you are able to admit your addiction and that you require help, there are many treatment options available to you, either on the NHS or privately. Your GP and/or an addiction specialist will be able to discuss these options and recommend next steps.
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Get help today
Addiction is a devastating condition with huge ramifications for the user and anyone around them. If you are struggling with addiction, the longer you go without seeking help, the greater the damage you may do to your health, your life prospects and the well-being of your loved ones. If you are able to acknowledge your addiction, don’t waste any more time. Reach out to your GP and/or an addiction specialist today to discuss your situation and to enquire about treatment options that might be appropriate for you. By doing so, you will take the first steps on the road back to a healthy, happy and successful life.
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