17 SUBSTANCEABUSE 419
expensive, the client can continue to work, and the
family can provide support. If the client cannot re-
main sober during outpatient treatment, then in-
patient treatment may be required. Clients with re-
peated treatment experiences may need the structure
of a halfway house with a gradual transition into the
community.Pharmacologic Treatment
Pharmacologic treatment in substance abuse has two
main purposes: to permit safe withdrawal from alco-
hol, sedative/hypnotics, and benzodiazepines and to
prevent relapse. Table 17-1 summarizes drugs used in
substance abuse treatment. For clients whose primary
substance is alcohol, vitamin B 1 (thiamine) often is
prescribed to prevent or to treat Wernicke’s syndrome
and Korsakoff’s syndrome, which are neurologic con-
ditions that can result from heavy alcohol use. Cyano-
cobalamin (vitamin B 12 ) and folic acid often are pre-
scribed for clients with nutritional deficiencies.
Alcohol withdrawal usually is managed with a
benzodiazepine anxiolytic agent, which is used to
suppress the symptoms of abstinence. The most com-
monly used benzodiazepines are lorazepam, chlor-
diazepoxide, and diazepam. These medications can
be administered on a fixed schedule around the clock
during withdrawal. Giving these medications on an
as-needed basis according to symptom parameters,
however, is just as effective and results in a speedier
withdrawal (Lehne, 2001).
Disulfiram (Antabuse) may be prescribed to help
to deter clients from drinking. If a client taking disul-
firam drinks alcohol, a severe adverse reaction occurs
with flushing, a throbbing headache, sweating, nau-
sea, and vomiting. In severe cases, severe hypoten-
sion, confusion, coma, and even death may result (see
Chap. 2). The client also must avoid a wide variety of
products that contain alcohol such as cough syrup, lo-
tions, mouthwash, perfume, aftershave, vinegar, and
vanilla and other extracts. The client must read prod-
uct labels carefully because any product containing
alcohol can produce symptoms.
Methadone, a potent synthetic opiate, is used as
a substitute for heroin in some maintenance pro-
grams. The client takes one daily dose of methadone,
which meets the physical need for opiates but does not
produce cravings for more. Methadone does not pro-
duce the high associated with heroin. The client has
essentially substituted his or her addiction to heroin
for an addiction to methadone; however, methadone is
safer because it is legal, controlled by a physician, and
available in tablet form. The client avoids the risks of
intravenous drug use, the high cost of heroin (which
often leads to criminal acts), and the questionable con-
tent of street drugs.
Levomethadyl is a narcotic analgesic whose only
purpose is the treatment of opiate dependence. It is
used in the same manner as methadone.
Naltrexone (ReVia) is an opioid antagonist often
used to treat overdose. It blocks the effects of any opi-
oids that might be ingested, thereby negating the ef-
fects of using more opioids. It also has been found to
reduce the cravings for alcohol in abstinent clients,
although research is in the early stages (Zepf, 2002).
Acamprosate (Campral), which modulates neuro-
transmission of GABA and NMDA, has been used
with some success in the United Kingdom to decrease
alcohol cravings and to maintain abstinence; acam-
prosate is only in clinical trials in the United States
(Harvard Mental Health Letter, 2002).
Clonidine (Catapres) is an alpha-2-adrenergic ag-
onist used to treat hypertension. It is given to clients
with opiate dependence to suppress some effects of
withdrawal or abstinence. It is most effective against
nausea, vomiting, and diarrhea but produces modest
relief from muscle aches, anxiety, and restlessness
(Lehne, 2001).
Odansetron (Zofran), a 5-HT 3 antagonist that
blocks the vagal stimulation effects of serotonin in the
small intestine, is used as an antiemetic. It has been
used in young males at high risk for alcohol depen-Box 17-4
➤ NATIONALADDRESSES FORSELF-HELPGROUPS ANDTREATMENTPROGRAMS
Alcoholics Anonymous Women for Sobriety
PO Box 459, Grand Central Station PO Box 618
New York, NY 10163 Quakertown, PA 18951
1-212-870-3400 1-800-333-1606
Al-Anon Family Group Headquarters, Inc. Rational Recovery Systems
1600 Corporate Landing Parkway 1460 Pleasant Valley Road
Virginia Beach, VA 23454 Placerville, CA 95667
1-757-563-1600 1-530-621-4374