￼by Dr. Raul Rodriguez The mechanisms of addiction have a very strong biologic and physiologic basis, in addition to the psychological and spiritual components. It is plausible then that the right kinds of medical interventions would have a strong positive impact on sobriety. New medications and new implementation of existing medications have contributed to the rising success rates in addiction treatment. Many of these have been so effective that they have become the new standards of care. Naltrexone, in the injectable form of Vivitrol, is a major medical advancement that has become one of the standards of care in the treatment of both opioid dependence and alcohol dependence. Naltrexone is an antagonist or “blocker” at the opiate receptor. This medication directly blocks the receptor, which would prevent someone from getting high on pain pills or other opiates. It also reduces the pleasure experienced from consuming alcohol, which was the original FDA indication. Vivitrol is a naltrexone injection given once a month that adds an element of added consistency and compliance to an already effective treatment. The injection usually far outperforms the pill form in clinical settings for the treatment of both alcoholism and opiate addiction. Naltrexone creates no high or dependence and can be stopped at any time without difficulty. This medication is also very well tolerated in either the pill or injectable form. A person taking naltrexone or Vivitrol appropriately, as prescribed by a qualified physician, is considered to be fully “clean and sober”. Certain cases that may not respond to naltrexone for the treatment of opiate dependence can still use Suboxone. Subutex and Suboxone, for the treatment of opiate dependence, is another medication that has emerged as a new standard of care that has revolutionized addiction treatment. These buprenorphine based medications, much more so than even naltrexone, created a major shift from the old “28 day” inpatient care model to an outpatient model. Patients no longer have to go “away to rehab” and can actually detox while still working and caring for their families. These medications neutralize much of the exaggerated biological drive to use opiates, resulting in a drastic reduction in cravings. Some receive Subutex just for detoxification. Others benefit from a daily dose or “maintenance” with Suboxone, which profoundly suppresses opiate cravings and would actually interfere with any opiates consumed in a relapse. These daily doses have a stabilizing effect and are in no way intoxicating when taken correctly. Patients that are properly treated with these medications are usually perfectly alert, energetic and feel generally good. They do not get or look “high” while taking this medication, remaining fully functional. Baclofen is a common muscle relaxant that had a rebirth as a highly useful tool in the treatment of alcoholism and cocaine dependence. Baclofen reduces cravings for both substances. The mechanism suspected to yield these benefits has to do with increasing Dopamine levels in the brain. This medication is well tolerated and has been very well received due to the safety and ease of use. With very limited treatment options for cocaine, baclofen quickly grew in popularity and is now widely used. It comes in a generic form, is inexpensive, and has a very low abuse potential. This tool is most effective when used in a motivated individual. Strong motivation and treatment compliance are essential for successful treatment of any type. Knowledge of available treatment options is equally as important. These new medical treatments have increased treatment success rates and have allowed more and more patients to receive care as outpatients. The shift towards the outpatient setting has made treatment more affordable and accessible to more people. In addition to having a lower direct cost of treatment, outpatient treatment has a much lower “opportunity cost” due to less or no loss of revenue from missing work. Individuals with major responsibilities can still tend to them while still receiving a high level of care, as opposed to having to completely detach when they enter inpatient care. With so many outpatient options available now, it is no longer reasonable to believe that anyone is hopeless or beyond help. Base your choice of treatment on the preponderance of information you find and on what clinical setting meets your needs the best. Raul J Rodriguez, MD is the founder and Medical Director of the Delray Center For Healing, as well as the leader of the Delray Center DBT program.
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