Non-addictive medications, when used in conjunction with psychosocial treatment, can increase the likelihood of a successful recovery. Medications play an important but ancillary role in the Kolmac treatment program. Our goal is to reduce physical discomfort that distracts from doing the psychological work of recovery. At Kolmac, we use medications that have substantial evidence of effectiveness.
Medications Can Help Prevent Alcohol Relapses
For alcohol, we use the following three medications:
Antabuse (disulfiram) has been used to treat alcohol problems since the 1950’s. This medication gives you an additional incentive not to drink because after it is in your system, drinking alcohol would cause an unpleasant reaction. An important part of successful treatment is separation from alcohol, which residential programs accomplish geographically. Antabuse accomplishes this same goal chemically.
When used as the sole treatment element, there is little evidence of effectiveness. When it is used, however, as a component in a comprehensive recovery plan, many patients who use it briefly or for an extended period of time find it highly useful and regard it as a sobriety saver.
Campral (acamprosate) has been used since 1989 in Europe where it has been found to reduce alcohol relapses and to have no significant side effects. It appears to work by reducing preoccupation with alcohol and reducing the power of triggers that would ordinarily set off thoughts of drinking. It is believed to reduce the activity of glutamate – an excitatory neurotransmitter that becomes overactive when alcoholic drinking stops.
Naltrexone (Revia, Vivitrol) has been used for many years to block the action of opioid drugs. More recently it has been found to be useful in reducing alcoholic relapses. Naltrexone works by reducing both your cravings for alcohol as well as the pleasurable effect of alcohol if you do drink.
Medications That Facilitate Recovery From Opioid Addiction
For opioids we use the following medications:
Buprenorphine, also known as Suboxone, is a medication that has significantly improved treatment outcomes for opioid addiction. It greatly reduces or entirely eliminates withdrawal symptoms and can also eliminate drug cravings. You begin taking buprenorphine at either our Silver Spring and Towson offices and then may continue taking it in any of our six offices. We do not charge an extra fee for buprenorphine prescriptions.
Resistance to the use of buprenorphine persists despite substantial evidence of its effectiveness. We urge people with concerns about buprenorphine to read a comprehensive February 2015 Huffington Post article on this issue. [http://huff.to/1CzLlz5]
Common questions about buprenorphine are:
- What is buprenorphine and how does it work?
Buprenorphine is an “opioid” medication that has been used in Europe since the 1990’s for the treatment of addiction and became available in the U.S. in 2003. It attaches to the same places in the brain that heroin and pain medications do. Because it only partially activates these sites, it does not make people high when used properly. It also prevents people from getting high on other opioids by blocking the effect of these substances.
- Can buprenorphine cause physical dependence?
Yes. If you suddenly stop taking it, you will probably experience withdrawal symptoms. Because it is long acting, this may take 2 days to appear. Therefore when you decide to get off of buprenorphine, you should reduce the dose gradually over a period of time and not discontinue it abruptly.
- What is the difference between buprenorphine, Suboxone, Subutex, and Zubsolv?
Suboxone, Subutex, and Zubsolv are “brand” names for buprenorphine, which is the “generic” name. Suboxone has the opioid blocker, naloxone, compounded with the buprenorphine. When using Suboxone, the naloxone is not absorbed when the medication is dissolved under your tongue. It is only there to discourage people from dissolving the pill and injecting it, in which case the naloxone works as a blocking agent. Subutex is a preparation containing only buprenorphine and no naloxone, which now only exists in a generic form. Zubsolv is a newer brand that dissolves faster and has a better taste.
- How is buprenorphine taken?
To be most effective, it should be allowed to dissolve under the tongue. Try not to swallow until after it is dissolved.
- How is buprenorphine different from methadone?
- It is safer. Overdose is almost impossible.
- Sedation is less.
- It blocks the effect of pain pills and heroin at lower doses than methadone does.
- You can get prescriptions for it from waivered physicians in a traditional office setting.
- How long should I stay on buprenorphine?
You can decide to get off buprenorphine at any time. We recommend that you remain on it for at least the first month of treatment before you make longer term decisions.
Nalrexone is available as a pill and also as an extended release injection (Vivitrol) which lasts for one month. It is an “opioid antagonist” and works by blocking opioid drugs from attaching to the opioid receptor sites. If you take an opioid after naltrexone is in your system, you do not feel any rewarding effect. You will only get sick if you take naltrexone while an opioid drug is still in your system. This is called precipitated withdrawal. If the idea of being on an opioid such as buprenorphine is not acceptable to you, naltrexone is another option.