Detox and Withdrawal Management
Inpatient drug treatment is designed to help anyone with a drug or alcohol addiction stop compulsively seeking out drugs or alcohol. Medically supervised programs are more effective in helping a person stay sober than quitting alone. They also have a much better chance of staying clean and avoiding a relapse.
Detox is often the first step in drug rehabilitation, allowing the substance to exit the body safely. During detox, it may be necessary for the supervising physician to administer medications that control unpleasant or even dangerous withdrawal symptoms. This is called Withdrawal Management.
Aside from and usually following detox, many people benefit from medication in conjunction with therapy to help them control cravings and prevent relapse into substance use. This is called Medication-assisted treatment (MAT).
How Does Medication Assisted-Treatment Work?
Medication-assisted treatment is defined by SAMHSA as “the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a holistic approach to addiction treatment and alcohol use disorder.”
In medication-assisted treatment for opioid use disorder, doctors have two options:
- Substitute the drug with another opiate. First, they can substitute the medicine for a different opiate that would activate the same receptors but would be absorbed over a more extended period. Since this drug is less likely to give the patient a “high,” it is less likely to be abused, and will reduce withdrawal symptoms and cravings.
- Use an opioid antagonist. The second option is to prescribe recovering addicts an opioid antagonist that blocks receptors that the addictive drug would typically activate. This can reduce cravings and also prevent relapse by blocking the intoxicating effects of their drug of choice.
Although there is a contention that medication-assisted treatment is often substituting one drug for another, medication-assisted treatment has proven to be effective in combating addiction throughout the recovery process.
In the next section, we’ll look at the medications used in medication-assisted treatment and how each helps combat addiction.
The medication prescribed is dependent on the type of addiction a person struggles with. There are different medications used for opioids, alcohol, and nicotine. There are no known FDA-approved medications to help with methamphetamine, cocaine, or cannabis addiction. These are a few of the medicines used in a medication-assisted treatment plan.
Rehabilitation centers like Zinnia Health that offer medically supervised detoxification may prescribe buprenorphine to participants with opioid addiction. This medication eliminates opioid withdrawal symptoms. It partially activates opioid receptors. Patients are given this medication sublingually as a standalone dose like Subutex or in combination with a drug called naltrexone (Suboxone). Although this medication is prescribed for use in a detox setting, physicians with special certifications can prescribe it in an office-based treatment or as post-detox maintenance therapy.
Perhaps one of the most well-known detox medications – methadone – curbs opioid cravings and withdrawal symptoms in those with opioid use disorder. Methadone reduces opioid cravings and withdrawal symptoms. It is given as a liquid, powder, or diskette. The National Institute on Drug Abuse states that methadone treatment should be provided for a minimum of 12 months (although some patients may require a longer prescription).
Naltrexone is used in opioid and alcohol addiction. This medication is FDA-approved for medication-assisted treatment in detox and after graduation. As a pill, naltrexone is given daily in a 50 mg dose. As an injection, naltrexone is given as a 380 mg injection once per month. The pill forms of naltrexone are called ReVia and Depade, and the injectable form is called Vivitrol. According to the Psychiatric Research Institute, those with substance use disorder are warned to abstain from illegal opioid use for 7 to 10 days before starting naltrexone. This ensures that they are entirely withdrawn from opioids.
According to the American Academy of Family Physicians, Acamprosate – also called Campral – is used to treat alcoholism. Unlike methadone, acamprosate is prescribed to a person who is no longer drinking and wants to avoid it. This medication takes away the craving for alcohol but has no effect on active drinkers. Therefore, it is ineffective for people who choose to continue drinking. This medication is prescribed for an individual to use three times daily starting on day five of their alcohol abstinence.
Disulfiram treats chronic alcoholism in those who have graduated detox or are in the beginning stages of detox. This medication is given in pill form once per day. Disulfiram is FDA-approved as a second-line option after naltrexone for alcohol abuse. Disulfiram inhibits the metabolism of alcohol. If someone tries to drink while on this medication, they will experience unpleasant effects that serve as a deterrent to continued drinking.
Bupropion is a prescription antidepressant used to treat Major Depressive Disorder (MDD) and seasonal affective disorder (SAD) and help people with nicotine addiction. This pill reduces the craving for tobacco, but the way it works isn’t entirely known. Bupropion is given daily, 1 to 2 weeks before a person stops smoking. It Is also given 7 to 12 weeks after they quit. After that, the prescription is given for six months to one year.
Nicotine Replacement Therapies (NRP)
The addictive substance in a cigarette is called nicotine. Nicotine replacement therapy (NRT) gives you nicotine without the additional harmful chemicals found in cigarettes and cigars. NRT is provided as lozenges, inhalers, gum, patches, and sprays. Some people might think that NRT will cause addiction. However, while NRT contains nicotine, this medication isn’t a cigarette substitute. Instead, the prescribing physician will reduce the amount of nicotine in NRT over time. Unlike some medications, you don’t have to stop using tobacco for any specific time before using NRT.
What is the Success Rate of Medication Assisted Treatment?
Medication-assisted treatment decreases the risk of relapse — significantly. MAT has also been effective in preventing infectious diseases like HIV. Lastly, medication-assisted therapy is effective in preventing overdoses. Research shows that more than 90% of MAT patients maintain sobriety passed the 2-year mark.
One 2018 study conducted by the National Institutes of Health and published in the Annals of Internal Medicine found a statistically significant correlation between the decrease in the number of deaths from opioid overdoses and the use of treatment with buprenorphine, one of three drugs often used for MAT.
The medications used in MAT programs have additional on-label uses. For example, individuals with mental and physical withdrawal symptoms may experience immediate relief when taking these medications. In addition, individuals with anxiety, muscle pain, digestive issues, depression, and joint pain may also experience relief.
What is the Uncertainty Surrounding Medication-Assisted Treatment?
It is important to note that there is not one precise success rate due to some gaps in the literature on medication-assisted treatment. For example, there is not one clear rule to follow that describes how to pick the correct dose and the right drug for each patient.
Although the American Society of Medicine National Practice Guideline for medication-assisted treatment outlines evidence supporting the efficacy of one medication over another, they note that there isn’t a good-quality study comparing the relative benefits of one medication over another. The drug of choice and dosage are in the doctor’s hands after a conversation with the patient.
Medication-assisted treatment to overcome opioid addiction can be a life-saving option. Medication-assisted treatment helps a patient feel healthy and ready to begin the journey to sobriety by alleviating the physical and psychological withdrawal symptoms.
Zinnia Health offers medicine-assisted treatment for those addicted to drugs or alcohol. Our medically supervised detox programs give you the best start on a life of sobriety. Withdrawal is a painful experience for those who go it alone. In some cases, it can cause life-threatening side effects. Instead, you can detox comfortably in a supportive environment with Zinnia Health experts. Call us at (855) 430-9439 to learn more about our substance use treatments.