Medications for Substance Use Disorders

The below have been approved by the FDA for the treatment of substance use disorders.  Medications are prescribed under medical supervision, as part of comprehensive plan of care. Several other medications are prescribed off label (or are under investigation) for the treatment of substance use disorder, however these are not summarized here. Patients should always consult with their physicians before taking any medication.

ALCOHOL

  • Disulfiram
    Used as part of a treatment plan for problem drinking. Creates an unpleasant reaction when drinking alcohol, which reduces the desire to drink. This medicine is part of a recovery program that includes medical supervision and counseling.

  • Acamprosate
    Acamprosate has been used in Europe for the treatment of alcohol dependency since 1989. In 2004 it became the third drug to receive approval from the U.S. Food and Drug Administration for this indication, following disulfiram (Antabuse) and naltrexone (ReVia). Acamprosate is a structural analogue of γ-aminobutyric acid (GABA). It is thought to decrease alcohol intake by affecting calcium channels and modifying transmission along GABA and glutamine pathways in the brain, which may result in decreased positive reinforcement of alcohol intake and decreased withdrawal cravings. However, the exact mechanism of action of acamprosate is unknown.
    American Academy of Family Physicians Article

  • Naltrexone oral/depot
    In people with alcohol dependence, it is believed that naltrexone blockade (opioid antagonism) diminishes craving for alcohol and leads to a greater ability to resist urges to drink excessively. Naltrexone is available in two forms: oral daily form and injectable monthly extended-release form. 
    SAMHSA Naltrexone Page

OPIOIDS

NICOTINE

  • NRT
    Nicotine replacement therapy uses products that supply low doses of nicotine. These products do not contain the toxins found in smoke. The goal of therapy is to cut down on cravings for nicotine and ease the symptoms of nicotine withdrawal.  Nicotine replacement therapy is of the most help for people who smoke more than 15 cigarettes a day. 
  • Buproprion
    Reduce craving for tobacco although the mechanism is not entirely known. Bupropion does not contain nicotine and does not help you quit smoking in the same way that nicotine replacement therapy does.  Bupropion is also prescribed to treat depression. 
  • Varenicline
    A prescription medication used to treat nicotine addiction. The FDA has approved the use of varenicline for up to twelve weeks. If smoking cessation has been achieved it may be continued for another twelve weeks.
    Varenicline has not been tested in those under 18 years old or pregnant women and therefore is not recommended for use by these groups. Varenicline is a nicotinic receptor partial agonist—it stimulates nicotine receptors more weakly than nicotine itself does.