Pharmacological Approaches to Treatment

Targets

Pharmacological approaches to treatment are commonly employed when the physiological dependence symptoms (i.e., tolerance, withdrawal) from a substance may decrease the likelihood of successful cessation (the process of discontinuing substance use). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines tolerance as the need for larger amounts of the substance to obtain a desired effect or lower effects with continued use of the same dosage. The DSM-IV-TR defines withdrawal as the development of symptoms due to reducing or discontinuing heavy and prolonged substance use. These symptoms cause clinically significant distress or impairment and would not be due to another medical condition or mental disorder. The presence of physiological dependence often makes it difficult or impossible for the patient to engage in counseling treatments without relapse. For these patients, pharmacological treatments may be used to aid in detoxification or to ease withdrawal symptoms.

Medical detoxification is a common precursor to substance use treatment, particularly for those patients who exhibit severe withdrawal symptoms or who have been unsuccessful at cessation attempts in the past. It may be particularly useful for those patients whose withdrawal symptoms may be medically dangerous. The National Institute on Drug Abuse (NIDA) defines medical detoxification as the systematic withdrawal from an addictive substance, typically conducted in an inpatient or outpatient treatment setting under the direct care of a physician. This precursor to substance abuse treatment is specifically designed to address the acute physiological effects of substance use cessation; however, it does not address psychological, environmental, or behavioral components of addiction. As such, medical detoxification should be followed by substance use assessment and treatment in order to produce lasting behavioral changes. NIDA reports that medications are currently available for detoxification from opioids, nicotine, benzodiazepines, alcohol, barbiturates, and other sedatives.

Pharmacological approaches to treatment are also employed for sustained periods in order to help the patient reestablish normal levels of functioning, prevent relapse, and diminish cravings. These medications may be used to inhibit or block the effects of a substance (i.e., methadone, buprenorphine), deter substance use (i.e., Antabuse [disulfrram]), alleviate withdrawal symptoms, and provide relief from drug cravings. These medications are useful in conjunction with counseling because they may serve to decrease substance seeking behaviors and increase the patient's compliance to treatment programs. These behavioral changes increase the likelihood that the patient will be able to achieve and maintain sobriety. NIDA reports that medications are currently available for sustained treatment of opioid dependence, nicotine dependence, and alcohol dependence, with treatments for stimulant dependence and cannabis dependence in various stages of development.

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