Substance abuse is very common in the patients that we see every day. During training, we are taught that there are very few treatments for substance abuse with the exception of Antabuse for alcoholism and methadone for addiction to narcotics. Often, substance abuse takes its toll on our patients, having a decidedly adverse effect on many areas of their lives including relationships, finances, careers, and physical health.
There is evidence in the literature that addiction hijack a person’s limbic system. This means that the mechanisms of the brain that are responsible for survival behaviors, such as staying warm and eating, become focused on the addictive behaviors. The brain “thinks” that using the drug or drugs of choice is essential for their very survival.
Programs such as AA and rehabilitation are often helpful in a person achieving sobriety. These programs have helped millions of people. However, as we know, many of our patients continue to struggle with addiction despite treatment programs and the consequences of the addiction.
There is some research in the literature that has begun to explore the use of many medications that are currently available to help people who are struggling with addiction.
The following is a brief summary of some current treatments that are being used in the medical community to help our patients:
For cocaine and crack dependence, there is some evidence that Topmax may moderately decrease the euphoria and craving. In a study from Kampman, 2002, 59% of the subjects attained abstinence. I have treated patients with Topamax, starting at 50 mg and titrating up to 100 mg with good reults. In addition, Provigil has also been found to decrease the cravings and euphoria. In a study by Dockis et al in 2005, 60% of subjects attained abstinence. Some clinicians have found that combining Topamax in the evening and Provigil in the morning is effective. One other treatment that some clinicians have found effective is Wellbutrin. A leading expert in the field of addiction stated that Wellbutrin may help patients who also have co morbid ADHD.
For patients suffering from alcoholism, there are several medications on the market that help with treatment. For example Revia (naltrexone) can decrease cravings for alcohol and decrease binging. The research shows that this can significantly help approximately 15% of the patients. Naltrexone is also available in an IM form called Vivitrol. Campral (acrompasate) and Antabuse are two other medications that are used for alcoholism. Topamax has also been shown to be useful and is an off-label use for this medication. I have used Topamax in many of my patients with good benefit. They have often either decreased their drinking or stopped drinking altogether.
Kampman, M, Pettinati H, Lynch KG, Dackis C, Sparkman T, Weigley C, O’Brien CP: A pilot trial of topiramate for the treatment of cocaine dependence. Drug Alcohol Depend 2004; 75:233-240
Volpicelli JR, Alterman AI, Hayashida M, O’Brien CP: Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 1992; 49:876-880
Humphreys K, Huebsch PD, Finney JW, Moos RH: A comparative evaluation of substance abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups. Alcohol Clin Exp Res
COMBINE Study Research Group: Combined pharmacotherapies and behavioral interventions for alcohol dependence. JAMA 2006; 295: 2003-2017
O’Brien CP, Kampman KM: Opioids: antagonists and partial agonists, in The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 3rd ed. Edited by Galanter M, Kleber HD. Washington, DC, American Psychiatric Publishing, Inc., 2004, pp 305-319