A number of drugs are used in addiction treatment. Some, like valium, mitigate the pain of withdrawal. Others reduce cravings, take away a drugs’ ability to induce a high, or make you sick if you use.
Post-detox treatment drugs usually fall into one of two categories: “partial agonists” or “antagonists.” An “agonist” is a drug that docks with neurotransmitter receptors and activate neurons. “Full agonists” dock with all available receptors. (Heroin if a “full agonist” in the opioid system, for example.) “Partial agonsists” dock with only some receptors. Treatment drugs that are “partial agonists” dock with some, but not all, receptors, which can decrease cravings while not stimulating the Limbic “reward” system enough to produce a high.
An “antagonist” is a drug that blocks neurotransmitter activity by attaching to receptors without activating them, thus preventing a high.
Following are brief descriptions of some of the most-often used drugs after detox.
Acamprosate, sold under the trade name Campral, is used to treat alcoholism. It blocks a glutamate receptor called N-methyl-D-aspartate (NMDA). Glutamate is a general neural stimulant, so the drug prevents glutamate stimulation associated with alcohol abuse. It also activates glutamate’s opposite neurotransmitter, gamma-aminobutyric acid (GABA), which depresses neural activity.
Reported side effects includediarrhea, changes in blood pressure, headaches, insomnia, and in some cases, impotence. People with kidney disease are advised not to take this drug.
Antabuse,the commercial name for the drug disulfiram, has long been used to scare alcoholics into abstinence. It causes a dramatic physical reaction — a form of alcohol poisoning that’s best dealt with in a hospital emergency room — even if only a small amount is ingested. It does this by interfering with an enzyme that breaks down a toxic byproduct of alcohol metabolism (acetylaldehyde, whose build-up is associated with some symptoms of hangover), resulting in a severe physical reaction.
I took it for quite a while. For more on my experience, click on Antabuse, The Challenges of Taking Antabuse, and emotional acceptance.
Buprorion is sold under the names Wellbutrin and Zyban. It was originally marketed as an anti-depressant and is often used as a supplement to other anti-depressants to boost their efficacy. Buproprion was also found to help in treating tobacco addiction because it’s a nicotinic receptorantagonist, preventing nicotine from activating its normal brain systems. It’s also a norepinephrine-dopamine reuptake inhibitor, which means it docks with dopamine and norepinephrine transporters. (Norepinephrine is a neurotransmitter related to dopamine.) This prevents the transporters from taking dopamine and norepinephrine out of circulation, having the effect of boosting dopmaine.
Like many anti-depressants, there is some evidence that buproprion can exacerbate suicidal thoughts and actions. Another potential risk is seizure.
Bupenorphine, marketed as Suboxone, is used to decrease cravings in opiate addicts. It’s a partial opioid agonist, which means it docks with some (but not all) opioid receptors, preventing opiates like heroin from stimulating the reward system enough to produce a high. It decreases opiate cravings in some patients.
Naltrexone is used in treating opiate addicts. It’s an opioid antagonist, meaning it blocks opioids by attaching to the opioid receptors without activating them. This prevents the high normally caused by opiates.
Naloxone is used to treat heroin and other opiate overdoses. It has the ability to displace opiates from opioid receptors: It’s a partial agonist to some types of opioid receptors and an antagonist to others.
Methadone is an opiate agonist used as replacement therapy for opiate addiction. It mitigates opiate withdrawal and can block euphoria. As a result, addicts can stop using drugs like heroin without suffering withdrawal and with lesser cravings.
Varenicline is sold under the trade name Chantix (or Champix outside the U.S.) and has helped some patients quit smoking. It’s a partial nicotine agonist targeting a nicotinic receptor, which means it interferes with nicotine’s ability to stimulate the receptors it ordinarily would.
Chantix has been associated with suicidal thoughts and actions and strange, vivid dreams.