FDA approved medications effective as part of alcohol/narcotic addiction recovery plans

Substance abuse is a common health problem affecting nearly 10% of people in the United States, but just as with other health conditions, there are medications and treatments that can help with addiction.
Many times people who are drinking too much or taking pain pills do not know how to stop. They feel too sick when they try to cut back or quit, and they may have uncontrollable cravings for alcohol or drugs. These are the effects of taking more of a substance, alcohol or drugs, over time.
According to Dr. Paula Cook, MD, there are three main medications that can be prescribed for patients struggling with alcohol and opioid addiction. All three are FDA approved. Dr. Cook is Board Certified in both Family Medicine and Addiction Medicine and she works with the Southeast Utah Addiction Medicine Coalition. She’s had experience with all three of these medications and said they are all effective, depending on the patient and the circumstances involved.
The first is naltrexone, which can be prescribed as a pill taken one time each day, or as an injection (Vivitrol®) given once each month by your provider. Dr. Cook noted that naltrexone accomplishes three things: 1. It reduces cravings 2. It prolongs abstinence and 3. Reduces drinking.
“Neltrexone blocks a receptor in your brain that seems to help with cravings,” she explained. “Studies show those who use naltrexone or Vivitrol® have fewer days of drinking, and they have less heavy drinking when they do drink. In other words it prolongs sobriety and if people do drink they drink less and that’s been pretty well studied.”
Dr. Cook went on to say, “Alcohol acts on the dopamine system and the dopamine system is what makes us feel good. We know it is highly involved in the reward system of the brain. This drug blocks the reward system. You might ask, does this drug block the effects of every good thing? Does it block the effects of things like food and the other pleasurable things? It doesn’t. We don’t really understand how, but it seems to help block the effects of when we drink. Does it make you sick? It doesn’t make you sick when you drink, however what people find is that when you drink, instead of getting that good feeling, that buzz and that euphoria, they get nothing. It’s not rewarding.”
Naltrexone comes in a pill you can take once a day but it also comes in an injectable form that’s given once a month. Dr. Cook said the great thing about the injection is you don’t choose to take or not to take it every day. You just get the injection and then it’s on board and you get this nice steady level of drug in the blood system. The problem with people who are drinkers is that sometimes they premeditate a relapse, she noted.
“You know. I’m getting paid on Friday. I’ll go out with the boys on Friday and Saturday. So all week they’re good and they take their pills, and they say I won’t take the pill on Friday or Saturday, and then they drink,” she said. “If they just have the shot they don’t think about it, and it really seems to reduce that craving.”
Addiction patients can get an injection at one of the UNHS community health centers. Doctors at UNHS can order it through the pharmacy and then their provider can administer it on a monthly basis.
“We know it’s really safe. We have good studies that show the safety profile is good and they can take it for as long as it is helpful,” Dr. Cook continued. “We’ve had patients taking this medication for years. Which is really great because alcoholism is a chronic disease.”
The good thing about naltrexone is that it’s also helpful for opiates and for people who abuse heroine and pain pills, like oxycodone, OxyContin, hydrocodone, Morphine and tramadol. So it’s a really good option for those patients too, she explained.
The second medication Dr. Cook described as effective for addiction patients is Campral.
However, Campral has to be taken three times a day in pill form. So for some people, having to take medication three times a day becomes a barrier. But Campral does work.
The third medication Dr. Cook explained is Anta-buse.
Antabuse is an older drug that a lot of people know about because it is what you take so people get sick when they drink. It is given to a lot of people in the court system and it may have some short-term effectiveness. Antabuse is also only for alcohol.

Dr. Paula Cook, MD, of University of Utah Health Care (R) and Dr. Patrick Bell, a Psychiatry resident at the University of Utah, who is studying to be a psychiatrist, visited the UNHS Montezuma Creek Community Health Center last week. Dr. Cook is Board Certified in Family Medicine and Addiction Medicine and works with the Southeast Utah Addiction Medicine Coalition. Staff Photo

Dr. Paula Cook, MD, of University of Utah Health Care (R) and Dr. Patrick Bell, a Psychiatry resident at the University of Utah, who is studying to be a psychiatrist, visited the UNHS Montezuma Creek Community Health Center last week. Dr. Cook is Board Certified in Family Medicine and Addiction Medicine and works with the Southeast Utah
Addiction Medicine Coalition. Staff Photo

If people are abusing pain pills Dr. Cook also noted a fourth medication that is more specialized, called Suboxone®. Dr. Cook explained that the Centers for Disease Control (CDC) and National Institute on Drug Abuse (NIDA) consider Suboxone® to be the gold standard treatment for patients with opioid dependency, if people have not been able to maintain sobriety and if they are good candidates. It is not necessarily stronger than other medications, it’s just one of the options for opioid addiction.
“If we have a patient who is using opioids we have to make the decision about which medication is most appropriate based on what’s going on with them, what their goals are, what they’re story is and what they’ve tried in the past. For a provider to prescribe Suboxone® they must have eight hours of CME training to get a special waiver to prescribe it. But no special waiver is needed for other medications.
The question remains, why a lot of providers are not familiar with these medications? If they are effective why don’t providers know about them?
“The thing is, we have viewed addiction as a moral problem. Then Alcoholics Anonymous came along and the birth of AA threw a new light on how we look at addiction and alcoholism. AA became a great resource for people,” Dr. Cook continued. “It is an abstinence model and it was kind of like AA or nothing, then we discovered through research and science that addiction is more than a moral problem. It’s really a brain disease. And from looking at studies and pictures of peoples’ brains, there are differences between those who have been on and off alcohol and drugs, and those who have not. And we also know from genetic studies that alcoholism and drug addiction are inherited diseases. People are pre-disposed to these conditions. We’ve studied these things and looked at research to find possible medication treatments to be used with AA. Because it affects so many people we think, ‘What can help besides abstinence because there are high relapse rates?’ So we have the development and introduction of these medications and even now we have these big organizations, saying, ‘Here’s these medications. They’re gold standard. They’re FDA approved. You should use them.’”
As a culture of providers, Dr. Cook noted, we’re still just barely learning how to use these medications and a lot of providers will say, man I had no idea these could be so helpful. UNHS Behavioral Health Director, Rick Hendy, likened addiction treatment without the use of medications, like naltrexone, to treating Diabetes without using insulin
“Counseling and group work may include medications to decrease cravings for alcohol and narcotics,” Hendy said. “That’s the number one message we need to let people know about. The general population doesn’t know these medications are available. Family members want to see loved ones get help, but they’re not aware these medication can help.”
Dr. Cook agreed that addiction treatment without these medications can be like a football team without an offensive line.
“AA and counseling, plus the use of these medications can really be valuable in helping patients addicted to alcohol or opioids,” Dr. Cook said. “I’ve seen in my clinical practice that it is so satisfying to see people who have that one added piece that helps with the brain chemistry that settles them down. When you talk to patients who have that help it is really amazing. They’ve been struggling up against this wall and they really want to make it work. If you can give them that assistance you can really turn their lives around.
“This is not a magic pill,” she continued. “It goes with behavioral health. It goes with AA. It can even be used with the UNHS Tele-Psychiatry program at times. Goes with changing your life style. These are not the only meds available. These are the ones that are FDA approved. It’s a team effort and the team has a whole arsenal of meds that can help. The team can include, providers, PharmD’s, Addiction Medication MD’s, Behavioral Health, AA and other organizations. PharmD’s should be part of the team. They are very knowledgeable.”
Dr. Cook also stressed that Behavioral Health counselors are key members of the team because they have a feel for what’s going on with the patients in terms of struggling with substance abuse, struggling with mental health, problems like depression and anxiety and PTSD. They can also help patients see a Tele-Psychiatrist.
In the Utah Navajo Healthcare System, the providers and clinics are committed to helping patients, families and the community, recognize and treat problems with addiction. Medication assisted therapy along with counseling and group therapy can be helpful and has been proven to work in treating patients with addiction. If you or someone you know wants help, come to the nearest UNHS Community Health Center and make an appointment to be seen and start the process of feeling better!

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