Are there medications for alcohol or drug problems, and how do they fit with counseling?

Why medication is part of treatment at all

Addiction changes how the brain responds to a substance, and those changes can last well beyond the last drink or dose. Medication can work on some of those effects directly. NIDA's page on treatment and recovery describes medicines being used at different stages: to help someone stop, to stay in treatment and to avoid a return to use.

Using medication does not mean the problem is being handed over to a pill. It is one tool among several, in the same way that someone with diabetes might take medicine and also change what they eat.

Medications for alcohol problems

NIAAA's treatment booklet says three medications are approved for alcohol use disorder in the United States. Naltrexone, taken as a daily pill or a monthly injection, helps reduce the urge to drink. Acamprosate is a pill that eases some of the uncomfortable feelings people can have after stopping. Disulfiram discourages drinking by causing unpleasant symptoms if alcohol is taken.

NIAAA says all approved medications for alcohol use disorder are nonaddictive and can be prescribed by a primary care provider or another health care provider. They can be used alone or together with counseling or mutual-support groups.

ASAM's handout on medications for alcohol use disorder adds that some doctors also prescribe topiramate or gabapentin “off-label”, meaning they are not approved specifically for alcohol but are used for it. Those two should not be stopped suddenly and are not for use in pregnancy, according to the handout.

Medications for opioid problems

NIDA's page on medications for opioid use disorder names three FDA-approved medications: methadone, buprenorphine and naltrexone. NIDA says people who receive them are less likely to die or overdose than people who do not.

The three work differently and are obtained in different ways. Methadone for opioid use disorder is only available from certified opioid treatment programs, which usually means visiting a clinic, at least at first. Buprenorphine can be prescribed by many doctors, nurse practitioners and physician assistants, including through telehealth, and comes as a tablet placed under the tongue, an injection or an implant. Any health care provider can prescribe naltrexone, NIDA says, but a person usually needs to have stopped opioids for 7 to 10 days before starting it.

NIDA also lists lofexidine, which is approved to ease withdrawal symptoms but is not a long-term treatment.

Medications for tobacco, and where there are none

NIDA lists nicotine replacement products, bupropion and varenicline as medications used to help people quit tobacco.

For stimulants such as cocaine or methamphetamine, and for cannabis, NIDA says no medications are currently available. Treatment for those relies on behavioral approaches. NIDA's treatment overview describes one called contingency management as especially effective for stimulants.

How medication and counseling fit together

NIDA's Principles of Drug Addiction Treatment says that, overall, combining behavioral therapies with medication generally appears more effective than either alone. For opioids, NIDA recommends medication as the first line of treatment, usually with some form of counseling. ASAM's patient guide on opioid treatment says counseling is recommended with each of the three medications.

For alcohol, the picture is more flexible. NIAAA says medication can be used on its own or with other treatment, and ASAM's handout says the medications work best alongside counseling, group treatment or peer support.

Counseling can help with things medication does not touch: situations that lead to drinking or using, relationships, stress and building a life that makes a return to use less likely. Medication can make that work possible by easing cravings or withdrawal enough to take part.

Questions to ask a prescriber or program

If medication has not been mentioned, you can raise it: “Is there a medication that could help with this, and would you prescribe it or refer me?”

If it has been offered, ask what it is meant to do, how you take it and how often you would need appointments. Ask about side effects to watch for, how it interacts with other medicines or with alcohol, and what happens if it does not suit you. Ask about cost and insurance coverage.

Also ask the program whether it provides these medications, allows people to continue ones already prescribed or coordinates with an outside prescriber. Programs differ, and it is better to know before you start.

Keep the decision with qualified care

Do not start, stop or change a medication based on this guide or on someone else's experience. Combining some of these medicines with alcohol or sedatives can be dangerous. Tell the prescriber about everything you take, and about pregnancy or plans for pregnancy.

A medication that works for one person may not suit another. If the first choice does not help, ASAM's guide says that can be discussed with the clinician and another option considered.