Abnormal Psychology

Substance Use Disorders 423

Naltrexone (reVia) is another medication used to treat alcohol abuse; after

detox, it can help maintain abstinence. Naltrexone indirectly reduces activ-

ity in the dopamine reward system, making drinking alcohol less rewarding

(O’Malley et al., 1992); it is the most widely used medication to treat alcohol-

ism in the United States, and it has minimal side effects. Another medication,

acamprosate, is more popular in Europe; acamprosate reduces cravings and

acts by affecting a different type of receptors (NMDA receptors; Johnson &

Ait-Daoud, 2000; Tomkins & Sellers, 2001). Researchers found that a combi-

nation of naltrexone and acamprosate is more effective in preventing relapse

among those in recovery from alcohol abuse than is either drug alone (Brady,

2005; Kiefer et al., 2003).

Finally, people with alcohol dependence who are undergoing detox may de-

velop seizures; to prevent seizures and decrease symptoms of DTs, patients may be

given benzodiazepines, along with the beta-blocker atenolol. However, a patient

with DTs should be hospitalized (Arana & Rosenbaum, 2000).

Narcotic Analgesics

Medications that are used to treat abuse of or dependence on narcotic analge-

sics are generally chemically similar to the drugs but that reduce or eliminate

the “high”; treatments with these medications seek harm reduction because the

medications are a safer substitute. For instance, patients with heroin dependence

may be given methadone, a synthetic opiate that binds to the same receptors

as heroin. For about 24 hours after a current or former heroin user has taken

methadone, taking heroin will not lead to a high because methadone prevents the

heroin molecules from binding to the receptors. Methadone also prevents her-

oin withdrawal symptoms and cravings (NIDA 2007c). Although patients on

methadone are likely to abstain from using heroin, they are still using a sub-

stance, and so methadone doesn’t promote complete abstinence, but rather

heroin abstinence.

Because methadone can produce a mild high and is effective for only 24 hours,

patients on methadone maintenance treatment generally must go to a clinic to re-

ceive a daily oral dose, a procedure that minimizes the sale of methadone on the

black market. Methadone blocks only the effects of heroin, so those taking it might

still use cocaine or alcohol to experience a high (El-Bassel et al., 1993). Another

medication, LAAM (levo-alpha-acetyl-methadol), blocks the effects of narcotic

analgesics for up to 72 hours (and so requires trips to a clinic only a few times a

week) and does not produce a high. However, LAAM can cause heart problems

and so is only prescribed for patients with a dependence on a narcotic analgesic for

whom other treatments have proven inadequate.

Methodone and LAAM are generally available only in drug treatment clinics. In

contrast, those seeking medication to treat abuse of or dependence on narcotic an-

algesics can receive a prescription for buprenorphine (Subutex) in a doctor’s offi ce.

Buprenorphine is also available in combination with naloxone (Suboxone). In either

preparation, buprenorphine has less potential for being abused than methadone be-

cause it does not produce a high. Treatment of opiate dependence with substitution

medications, such as methadone, is generally more successful than promoting absti-

nence (D’Ippoliti et al., 1998; Strain et al., 1999; United Nations International Drug

Control Programme, 1997).

Naltrexone is also used to treat alcohol dependence and often in combination

with buprenorphine, to treat opiate dependence (Amass et al., 2004). Naltrexone

is generally most effective for those who are highly motivated and willing to take

medication that blocks the reinforcing effects of alcohol or opioids (Tomkins &

Sellers, 2001).

Finally, the beta-blocker clonidine (Catapres) may help with withdrawal

symptoms (Arana & Rosenbaum, 2000). A summary of medications used to treat

substance abuse and dependence is found in Table 9.10.

P S

N