Today's question is on which medications are the best available addiction blockers money can buy.
What are the best drug and alcohol addiction blockers on the market?
Larissa Mooney: It depends on what your goals are and what substance you are struggling with. Naltrexone is a true “blocker” – it acts on receptors in the brain to block the activity of opioids, including heroin and prescription opioid painkillers. It is available as a daily oral pill or as a monthly injection (as Vivitrol®). Several studies presented to the FDA indicated that monthly injections of Naltrexone were more effective in maintaining abstinence than the pill form as it reduces the problem of medication compliance.
Nalrexone is approved for the treatment of alcohol and opioid addiction and has been shown to reduce cravings for both substances. If an individual uses opioids while on naltrexone, he or she will not experience the effects, and feelings from drinking alcohol may be less pleasurable (due to blockade of “natural” opioids including endorphins).
Buprenorphine, a medication with partial opioid activity approved for maintenance treatment of opioid dependence, also blocks the effects of other opioids because it binds strongly to opioid receptors in the brain. Buprenorphine is absorbed under the tongue and may be taken once a day, relieving the highs and lows associated with intoxication and withdrawal from short-acting opioids, respectively.
Other FDA approved medications for addictive disorders do not act as “blockers” in the traditional sense, though they may be useful in reducing substance use or cravings. Disulfiram (known as Antabuse) inhibits the metabolism of alcohol, causing an aversive reaction when alcohol is consumed. Acamprosate may facilitate abstinence from alcohol by stabilizing chemicals that are dysregulated after chronic alcohol use, including GABA and glutamate. Methadone, a long-acting opioid, is approved for maintenance treatment of opioid dependence.
There are a number of medications approved for nicotine addiction treatment. Nicotine replacement therapies,including the patch, gum, and lozenge, are available over the counter and may be used to reduce nicotine cravings and withdrawal after a quit attempt (others, such as the nicotine inhaler, are only available with a prescription). Extended-release bupropion, an antidepressant that is also approved for smoking cessation, may reduce cravings, improve quit rates, and facilitate abstinence from cigarettes. Varenicline, a medication with partial activity at nicotine receptors in the brain, may also reduce cravings and pleasurable effects of cigarette smoking.
Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA.www.LarissaMooneyMD.com Full Bio.