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Treating Prescription Drug Addiction
Years of research have shown us that addiction to any drug (illicit or prescribed) is a brain disease that, like other chronic diseases, can be treated effectively. No single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used and the needs of the individual. Successful treatment may need to incorporate several components, including detoxification, counseling, and in some cases, the use of pharmacological therapies. Multiple courses of treatment may be needed for the patient to make a full recovery.
The two main categories of drug addiction treatment are behavioral and pharmacological. Behavioral treatments encourage patients to stop drug use and teach them how to function without drugs, handle cravings, avoid drugs and situations that could lead to drug use, and handle a relapse should it occur. When delivered effectively, behavioral treatments-such as individual counseling, group or family counseling, contingency management, and cognitive behavioral therapies also can help patients improve their personal relationships and their ability to function at work and in the community.
Some addictions, such as opioid addiction, can be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior, and can be used to relieve withdrawal symptoms, treat an overdose, or help overcome drug cravings. Although a behavioral or pharmacological approach alone may be effective for treating drug addiction, research shows that, at least in the case of opioid addiction, a combination of both is most effective.
Treating addiction to prescription opioids
Several options are available for effectively treating prescription opioid addiction. These options are drawn from research regarding the treatment of heroin addiction, and include medications such as naltrexone, methadone, and buprenorphine, as well as behavioral counseling approaches.
Naltrexone is a medication that blocks the effects of opioids and is used to treat opioid overdose and addiction. Methadone is a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms, and relieves drug craving. It has been used successfully for more than 30 years to treat heroin addiction. The Food and Drug Administration (FDA) approved buprenorphine in October 2002, after more than a decade of research supported by NIDA. Buprenorphine, which can be prescribed by certified physicians in an office setting, is long lasting, less likely to cause respiratory depression than other drugs, and is well tolerated. However, more research is needed to determine the effectiveness of these medications for the treatment of prescription drug abuse.
A useful precursor to long-term treatment of opioid addiction is detoxification. Detoxification in itself is not a treatment. Rather, its primary objective is to relieve withdrawal symptoms while the patient adjusts to being drug free. To be effective, detoxification must precede long-term treatment that either requires complete abstinence or incorporates a medication, such as methadone or buprenorphine, into the treatment program.
Treating addiction to CNS depressants
Patients addicted to barbiturates and benzodiazepines should not attempt to stop taking them on their own. Withdrawal symptoms from these drugs can be problematic, and in the case of certain CNS depressants- potentially life-threatening. Although no research regarding the treatment of barbiturate and benzodiazepine addiction exists, addicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered. Inpatient or outpatient counseling can help the individual during this process. Cognitive behavioral therapy, which focuses on modifying the patient's thinking, expectations, and behaviors, while at the same time increasing skills for coping with various life stressors, also has been used successfully to help individuals adapt to the discontinuation of benzodiazepines.
Often barbiturate and benzodiazepine abuse occurs in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of polydrug abuse, the treatment approach must address the multiple addictions.
Treating addiction to prescription stimulants
Treatment of addiction to prescription stimulants, such as Ritalin, is often based on behavioral therapies that have proven effective in treating cocaine and methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction. However, NIDA is supporting a number of studies on potential medications for treating stimulant addiction.
Depending on the patient's situation, the first steps in treating prescription stimulant addiction may be tapering the drug dosage and attempting to ease withdrawal symptoms. The detoxification process could then be followed by one of many behavioral therapies. Contingency management, for example, uses a system that enables patients to earn vouchers for drug-free urine tests. (These vouchers can be exchanged for items that promote healthy living.) Cognitive-behavioral therapy also may be an effective treatment for addressing stimulant addiction. Finally, recovery support groups may be helpful in conjunction with behavioral therapy.
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