8.2 Drug therapy for substance use problems

A Family Guide to Concurrent Disorders - Part III: Treatment

Medication is not used as often to treat substance use problems as it is to treat mental health problems. However, sometimes medication is added to other behavioural and psychological treatments.

Treatment strategies include:

• withdrawal management
• substitution therapy  
• antagonist therapyantagonist therapy
• aversive therapy.

Withdrawal management

The main objective in the pharmacological treatment of drug withdrawal is to prevent severe complications, particularly seizures in the case of some drugs (e.g., alcohol, barbiturates, benzodiazepines) that can happen when people stop using substances. Medication is also sometimes used to help prevent relapse.

Substitution therapy

In substitution therapy, the substance of abuse is replaced with a medication that is less likely to be abused. Substituting methadone, a synthetic opioid, for heroin is one example of substitution therapy. Methadone suppresses the withdrawal symptoms of other opioids as well as the chronic craving, without causing a person to become euphoric  or tolerant to the medication.

The side-effects of methadone include:

• drowsiness, insomnia, dysphoria (feeling uneasy), weakness, dizziness, light-headedness and nervousness
• nausea, vomiting, chronic constipation, decreased appetite and dry mouth
• sweating, flushing, impotence and ejaculatory problems.

Antagonist therapy

Antagonist therapy blocks the effects of opioids. For example, naltrexone (ReVia) is some-times used to block the effects of alcohol. It is used to help maintain abstinence following withdrawal from opioids or alcohol. It is most useful in highly motivated clients.

The side-effects of naltrexone include:

• insomnia, anxiety, nervousness, dysphoria, depression, lethargy, fatigue, confusion and headache
• abdominal cramps, nausea, vomiting and weight loss
• joint and muscle pain.

Aversive therapy

In aversive therapy, a medication is prescribed that will cause unpleasant side-effects if substances are also used. Aversive therapy discourages use of the substance. Disulfiram (formerly marketed under the trade name Antabuse) is an example of aversive therapy to discourage alcohol use. Although Antabuse is no longer made commercially in Canada, pharmacies can make capsules using disulfiram powder.

The symptoms that result when disulfiram is combined with alcohol include:

• nausea and dry mouth
• flushing, sweating, throbbing head and palpitations.

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