Prescription medicine administered in rehab can be a useful aspect in treating a person with a substance use disorder. The National Institute on Drug Abuse’s Principles of Effective Treatment states that “medications are often an important part of treatment, especially when combined with behavioral therapies.”
While it may seem contradictory, there are circumstances when prescription medicine should be given while in rehab. The addictive characteristics of many substances stem from how they manipulate the brain’s reward and pleasure centers. This causes a disruption in the natural neurochemical processes of the brain caused by alcohol and drug use.
Different medicines are prescribed for different types of addiction and symptoms. Some drugs help reduce cravings and withdrawal symptoms, while others counter the intoxicating effects of substances, and some have other uses that support someone in rehab.
What Determines if Medication is Prescribed in Rehab?
The factors that determine if a person is given prescription medicine in a rehab center are many. Every person who goes into drug rehab has their own story, the root cause of addiction, the severity of addiction, co-occurring disorder, and substance they misused. All of these factors determine if the individual needs prescription medicine during detox and in addiction treatment.
Medication can be beneficial during detox because many medicines can help manage withdrawal symptoms, which can range from mild to severe. Medicine administered in detox can also readjust brain chemistry and normalize body functions, which are necessary to become medically stabilized so treatment can continue. The U.S. Food and Drug Administration (FDA) approved various medicines used for therapeutic purposes during medical detox.
Detox medications are utilized to address uncomfortable symptoms like:
- Nausea and vomiting
- Muscle pain
Medication-assisted treatment (MAT) is quite helpful to many people struggling with a severe substance use disorder. But what is it?
What is Medication-Assisted Treatment (MAT)?
SAMHSA defines medication-assisted treatment (MAT) as “the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.” It is more regularly used to treat individuals with severe opioid or alcohol dependency. It is also used to treat a person with severe benzodiazepine disorder. These specific substance use disorders can have perilous withdrawal symptoms that could be life-threatening.
MAT in addiction treatment continues to be a controversial topic, as the common belief that you should not give prescription medicine to a drug addict. MAT is often thought of as replacing one addiction for another, such as treating a person in heroin withdrawal with weaker opioids, like methadone. Nonetheless, the drugs administered in MAT therapy have different uses. Some block the euphoric effects of drugs or alcohol, some normalize body functions, and some readjust brain chemicals back to normal.
Not every rehab center will offer MAT. Some of the factors that go into the evaluation and determination of whether an individual would benefit from being prescribed medication during addiction treatment include:
- Other addiction treatment options were tried and found ineffective.
- If the person has any physical or mental health problems that MAT would be beneficial for and help them complete addiction treatment
- If the individual has an officially diagnosed opioid use disorder and would need medical maintenance therapy
- If the substance use disorder is severe enough to cause life-threatening withdrawal symptoms
- If the person has a history of relapse or multiple addictions
- If they tried MAT before and didn’t follow the prescribed instructions
What Medication is Given in Rehab?
Below is a list of drugs and a brief description of them that may be prescribed during or after detox. Some medications can be administered with others and in combination with different prescribed drugs not listed here.
Alcohol Use Disorder (Alcoholism)
Disulfiram (Antabuse) and Acamprosate (Campral)
People struggling with alcoholism may be given disulfiram and acamprosate. Disulfiram (brand name Antabuse) produces an unpleasant reaction when the individual consumes even a small amount of alcohol. It blocks the activity of a specific enzyme that is essential in metabolizing ethanol.
The buildup of a chemical intermediary (acetaldehyde) is what causes the negative physical effects. Side effects might include sweating, headache, blurred vision, nausea, vomiting, breathing difficulty, and chest pain, among others. The thought of going through these distressing symptoms or knowing they could happen might deter some people from drinking.
Opioid Use Disorders (Painkillers, Heroin)
Naltrexone (Vivitrol) and Buprenorphine (Probuphine, Suboxone)
The National Institute on Drug Abuse says that naltrexone, an opioid antagonist, works by blocking the activation of receptors in the brain that opioids would otherwise bind to and rendering opioid drugs incapable of producing the addictive high. Naltrexone is safest to use after the individual has finished detox. Naltrexone is thought to be an ideal drug for treating opioid abuse because it’s easy to administer, has minimal side effects, and minimal addictive qualities.
In the opposite effect, buprenorphine works by partially activating opioid receptors. Buprenorphine is called a partial opioid agonist, which means it activates the brain’s opioid receptors but not “full on” like heroin does. It is a good prescription medicine to wean a person off opioids.
Modafinil was approved by the U.S. Food and Drug Administration to treat narcolepsy in 1998. However, it is also used to treat those with cocaine addiction. Modafinil is a non-amphetamine central nervous system (CNS) stimulant and a drug that increases alertness and wakefulness. It is prescribed for people who struggle in their day-to-day lives due to irregular or diminished sleep patterns. Irregular sleep can be caused due to long work shifts, sleep apnea, jet lag, or some other cause. Its stimulant-like properties could help reduce cocaine cravings and extend abstinence.
Mirtazapine (Remeron) and Bupropion (Wellbutrin, Zyban)
Both of these drugs are sometimes prescribed to treat depression, a common withdrawal side effect for substance use disorder. Mirtazapine is approved to treat depression expressly, but it can also ease anxiety, another common withdrawal symptom. Bupropion is a smoking cessation drug, also given for depression and seasonal affective disorder (SAD), and there is some off-label use for managing ADD.
Other Prescription Drugs During Rehab
Baclofen is a skeletal muscle relaxant used primarily to treat muscle spasticity. It is also being looked at as a potential for opioid maintenance treatment.
Gabapentin is an anticonvulsant medication that might be able to help manage withdrawal symptoms for someone in methadone-assisted detox.
While some of these drugs are not yet approved to treat people with substance use disorder, they are prescribed to assist individuals as they undergo detox and addiction treatment.
Benefits of Medication-Assisted Treatment
The Substance Abuse and Mental Health Services Administration notes that medication-assisted treatment has been shown to:
- Improve patient survival
- Increase retention in treatment
- Increase the person’s ability to get a job and maintain employment
- Decrease illegal opiate use and criminal activity of people with addictions
- Improve birth outcomes of pregnant women with addictions and women with addictions
- Improve birth outcomes among women who have substance use disorders and are pregnant
- Lower chances of people contracting HIV, AIDS, and hepatitis C
Other substantial benefits to prescription medication given in rehab include a less mentally and physically stressful time in detox, a lesser chance of relapse, and a more significant chance of maintaining sobriety.
Effective Addiction Treatment in Drug Rehab
It can be very beneficial for an individual to be prescribed medication in a rehab center. However, addiction treatment is most effective when MAT and behavioral therapies, such as cognitive behavioral therapy, are combined. Multiple needs of the individual should be addressed, along with the substance use disorder. Medication to alleviate symptoms and stabilize brain and body functions alone is not sufficient to secure long-term sobriety.
Some of the valuable lessons to learn in rehab are how to dig deep and find the root cause of addiction and how to prevent relapse. Relapse prevention plans created are useful tools on the road to recovery. Learning how to manage stressful situations without alcohol or drugs can also be an essential lesson to learn and master. Long-term sobriety can be a tough challenge, but with support, it can be reached.
Aftercare and alumni programs, along with 12-step and other support meeting options, help the newly sober individual stay sober, find and make new friends in their same situation, and ultimately, succeed in their recovery.