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Detoxification can be a challenging process, as withdrawal symptoms can be very uncomfortable, and for some substances, withdrawal may even be life-threatening. Doctors in inpatient and outpatient rehab often utilize medication-assisted treatment (MAT) to ease the process of withdrawal, reduce cravings, and support early substance use recovery efforts.
- Addiction medication often either mimics the effects of a substance or works to counteract its effects. Both types of medication can reduce cravings, but drugs that mimic the effects of a substance also tend to reduce symptoms of withdrawal.
- Medication-assisted treatment (MAT) can help manage some of the more uncomfortable effects of withdrawal.
- For people addicted to alcohol or benzodiazepines, withdrawal can be dangerous or even life-threatening.
Understanding medication assited treatment (MAT)
Medication-assisted treatment (MAT) is often used during the early stages of substance use disorder treatment and during early recovery. Medication can be especially helpful to people in early recovery because it can help ease lingering symptoms of withdrawal and reduce cravings. This can substantially lower the risk of relapse for people in the first weeks and months of sobriety.
MAT medications often either mimic the effects of a substance or work to counteract its harmful side effects. Drugs that mimic the effects of a substance are mainly used to manage withdrawal by reducing the risk of adverse physical withdrawal symptoms and reducing chemical dependence and tolerance.[1]
Drugs that counteract can cause unpleasant symptoms if a person decides to use the substance, which helps to deter use. For example, Antabuse is a medication that deters alcohol use by causing nausea and vomiting if alcohol is consumed. Other medications can block the effects of a drug. For example, Naltrexone blocks opioid receptors in the brain, preventing substances like heroin and fentanyl from having the desired effect when misused.[1]
Medications will often be prescribed as part of a residential or outpatient rehab treatment program. Doctors will monitor and review medications throughout treatment, making adjustments to the dosage if necessary.
Medications used for substance withdrawal
The first stage of addiction recovery is to purge the body of any drugs or alcohol in the system. This process, called detoxification or detox, often involves withdrawal symptoms that may last a week or longer. Withdrawal symptoms can be mild, moderate, or severe, depending on various factors, including the type of substance and the potency, frequency, and duration of use.
For those with alcohol, opioid, or benzodiazepine use disorders, withdrawal symptoms can be dangerous or even life-threatening. Withdrawal from other types of drugs, such as stimulants like cocaine, may be less harmful, but can still cause unpleasant and uncomfortable effects, which may include:[2]
- Anxiety, stress, and irritability.
- Depression or mood swings.
- Nausea, vomiting, stomach cramps, diarrhea, or gastrointestinal upset.
- Muscle aches, cramps, and soreness.
- Insomnia, feeling fatigued, and trouble focusing.
- Sweating, hot and cold chills.
- Strong urges and cravings to use.
Medications used during detox
There is a wide range of medications used to treat these withdrawal symptoms. The type of medication prescribed will depend on the individual’s symptoms and what substances they are addicted to.
Certain medications may not be appropriate for all people and are often recommended to be used in combination with therapy, such as cognitive-behavioral therapy, or other forms of addiction treatment. While medications can ease withdrawals and cravings and help people in recovery, medication alone cannot cure addiction.[1]
Commonly used medications include:
| Medication class/type | Medication examples | Purpose/Benefits | Comments |
|---|---|---|---|
| Opioid medications | Methadone, Buprenorphine,Naltrexone[12] | Reduce withdrawal symptoms and cravings. | Some types can cause or worsen withdrawal symptoms if taken alongside an opioid, so they should only be used once the individual is abstinent. |
| Nicotine replacement therapy | Bupropion (Zyban) | Reduces withdrawal symptoms and cravings. | Different types available: patch, lozenge, inhaler. |
| Alcohol antagonists | Disulfiram (Antabuse) | Deters alcohol consumption by causing unpleasant effects if alcohol is consumed. | It can be dangerous if used with alcohol, so it should only be used by people who remain sober. |
| Benzodiazepines | Chlordiazepoxide,Diazepam (long-acting), Lorazepam[13] | Can help reduce agitation, insomnia, and other withdrawal symptoms associated with various substances. | Can cause dependence and oversedation; short-term use is recommended. |
| Antidepressants | Selective serotonin reuptake inhibitors (SSRIs) | It can help reduce mood changes caused by detox and withdrawal. Some types of antidepressants may be beneficial in reducing cravings. | May cause anxiety, suicidal ideation, and insomnia, particularly at the start of treatment. |
| Alpha-2 adrenergic agonists | Clonidine, Lofexidine | Clonidine and lofexidine can be used to help reduce withdrawal symptoms of various substances. | Shouldn’t be used by people with low blood pressure. |
| Overdose reversal medications | Naloxone (Narcan) | Medications can be used to reverse the effects of a substance overdose. | It can cause the onset of withdrawal symptoms. |
Alcohol use disorder medications
Medications for alcohol use disorder help individuals reduce cravings, manage withdrawal symptoms, and maintain abstinence. Some drugs work by deterring alcohol consumption, while others reduce the rewarding effects of drinking. [4][5]
| Medication | Brand | Benefits | Uses | Side effects |
|---|---|---|---|---|
| Acamprosate | Campral | Reduces withdrawal symptoms and cravings. | People with alcohol dependence and liver damage. | Dry mouth, dizziness, anxiety, and stomach upset. |
| Disulfiram | Antabuse | Helps maintain abstinence by causing unpleasant effects when alcohol is consumed. | People who have already stopped drinking alcohol and are committed to abstaining. | With alcohol consumption, headache, nausea, vomiting, anxiety, and shortness of breath. |
| Naltrexone | Revia, Vivitrol | Decreases the feeling of pleasure associated with consuming alcohol, reducing cravings. | People with alcohol use disorder who need help to stop drinking. | Nausea, headache, fatigue, vomiting, anxiety, and dizziness. |
| Topiramate (off-label) | Topamax, Trokendi XR, Qudexy XR | May help reduce cravings and desire to drink alcohol. | People who want to reduce alcohol consumption and people who may want help with weight loss. | Decreased appetite, trouble with speech, nausea, dizziness, issues with memory and sight, and stomach pain. |
| Gabapentin (off-label) | Neurontin, Horizant, Gralise | Reduces alcohol consumption, helps manage cravings, and improves alcohol-related sleep and mood issues. | People with heavy alcohol consumption who want to reduce or stop drinking. | Drowsiness, headache, shaking, vision problems, nausea, dry mouth, and changes in appetite and weight. |
| Varenicline (off-label) | Chantix | Nicotine addiction medication, which can help reduce alcohol consumption (though use is controversial). | People with alcohol and nicotine addiction. | Nausea, stomach issues and pain, dry mouth, appetite changes, insomnia, and headaches. |
Medication used to treat opioid withdrawal
Opioid use disorder medications aim to reduce withdrawal symptoms, curb cravings, and prevent relapse. These treatments can be short-term for detox or long-term to support ongoing recovery. [1][2]
| Medication | Brand | Benefits | Uses | Side effects |
|---|---|---|---|---|
| Naltrexone | Vivitrol | Blocks the euphoric effects of opioids and reduces cravings. | Short-term and long-term treatment for opioid use disorder should only be administered after at least 7 days of abstinence from opioids. | Drowsiness, headache, nausea, changes in appetite, aches, and pains. |
| Buprenorphine | Brixadi, Subutex | Blocks the euphoric effects of opioids and reduces cravings and withdrawal symptoms. | People who have stopped using opioids at least 8 hours prior, short-term and long-term treatment. | Stomach issues, drowsiness, dry mouth, aches and pains, insomnia, and fever. |
| Methadone | Dolophine, Methadose | Reduces cravings and withdrawal symptoms. | People who can attend a clinic daily for administration, short-term, and long-term treatment. | Insomnia, anxiety, nausea, dry mouth, sweating, and restlessness. |
| Naloxone and Nalmefene | Narcan and Revex | Reverses opioid overdose. | People who have overdosed on opioids. | Opioid withdrawal symptoms. |
Medication used to treat cocaine and other stimulant disorders
While no FDA-approved medications currently exist for stimulant addiction, off-label treatments can help reduce cravings, manage withdrawal symptoms, and improve cognitive functioning during recovery. [6]
| Medication | Brand | Benefits | Uses | Side effects |
|---|---|---|---|---|
| Modafinil (off-label) | Provigil | Reduces cravings and withdrawal symptoms, improves cognitive functioning. | Helps to stop stimulant use and remain abstinent. | Headache, insomnia, nausea, stomach issues, dizziness, loss of appetite. |
| Bupropion (off-label) | Aplenzin, Wellbutrin | Reduces the reinforcing effects of stimulants, helps reduce use, and maintain abstinence. | People with low to moderate addiction to methamphetamine. | Anxiety, insomnia, drowsiness, dry mouth, headache, nausea, stomach pain, change in appetite and weight |
| Topiramate (off-label) | Topamax | Decreases stimulant use, reduces withdrawal symptoms. | People stopping stimulant use. | Nausea, headache, fatigue, vomiting, anxiety, and dizziness. |
| Disulfiram (off-label) | Antabuse | Alcohol use disorder medication found to help decrease cocaine use. | People with cocaine use disorder, wishing to reduce use. | Headache, drowsiness, impotence, rash. |
| Dextroamphetamine (off-label) | Dexedrine, Adzenys ER, others | Increases abstinence. | Treating cocaine use disorder and reducing use. | Anxiety, fast heart rate, loss of appetite. |
Medication used to treat benzodiazepine addiction
Medications for benzodiazepine use disorder focus on safely managing withdrawal symptoms and reducing dependency. Long-acting benzodiazepines or other supportive treatments can be used to taper use gradually. [7][8]
| Medication | Brand | Benefits | Uses | Side effects |
|---|---|---|---|---|
| Diazepam | Valium | Long-acting benzodiazepines can be used as a replacement to reduce use. | People addicted to benzodiazepines and using short-acting drugs. | Sedation, dizziness, weakness, and headaches. |
| Carbamazepine (off-label) | Carbatrol, Equetro, Epitol | Help reduce benzodiazepine use | Benzodiazepine tappering. | Shaking, dizziness, abnormal thinking and speech, and dry mouth. |
| Flumazenil | Romazicon | Prevents withdrawal symptoms and reverses benzodiazepine overdose. | For rapid reduction in benzodiazepine use. | Sedation, impaired cognition, and seizure. |
Nicotine replacement medication
Medications for nicotine dependence help reduce cravings and withdrawal symptoms, supporting individuals who wish to quit smoking. These include nicotine replacement therapies, antidepressants, and other FDA-approved treatments.[9][10]
| Medication | Brand | Benefits | Uses | Side effects |
|---|---|---|---|---|
| Nicotine replacement therapy (NRT) | Reduce nicotine withdrawal symptoms. | To help reduce smoking cravings. | Irritation on the skin where the patch is worn. | |
| Bupropion | Wellbutrin | Reduces cravings and withdrawal symptoms. | People wanting to stop smoking. | Anxiety, insomnia, drowsiness, dry mouth, headache, nausea, stomach pain, and changes in appetite and weight. |
| Varenicline | Chantix | Reduces withdrawal symptoms and cravings and blocks the rewarding effects of smoking. | People requiring help to reduce and stop smoking. | Nausea, stomach issues and pain, dry mouth, appetite changes, insomnia, and headaches. |
Medical detox and rehab treatment
Some people benefit from an inpatient stay, where they can safely detox from a substance. Medication-assisted treatment (MAT) in a rehab facility is provided as a structured, drug-free program to help detox from drugs or alcohol while managing some of the more uncomfortable effects of withdrawal. For those addicted to alcohol or benzodiazepines, a medically supervised detox is important as withdrawal symptoms can be life-threatening.[2]
During medical detox, trained physicians will monitor the individual’s heart rate, temperature, fluid level, and respiration. People with co-occurring disorders or underlying physical or mental health issues will receive the appropriate medication to manage these conditions alongside addiction medications, often in conjunction with behavioral therapy.[11]
A medical detox or inpatient rehab stay should be followed up with a long-term outpatient treatment program for addiction. Most inpatient rehab programs last 30 to 90 days, although research shows that a longer treatment duration can provide more benefits.[11]Â
If you or someone you know is suffering from alcohol or drug addiction, contact a treatment center today to find the best options for medical detox.
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