Prescription drug addiction treatment

Prescription drug abuse occurs when someone uses medication in ways not intended by the prescribing doctor, often for non-medical reasons. Research from the National Survey on Drug Use and Health shows that around 14.4 million people aged 12 or older misused prescription psychotherapeutic drugs in the past year. This included 8.6 million who misused prescription pain relievers, 4.7 million who misused tranquilizers or sedatives, and 3.9 million who misused prescription stimulants. This misuse can lead to harmful and potentially life-threatening consequences.

Abusing prescription drugs can alter brain function, affecting self-control and decision-making abilities. While many initially choose to use these drugs, repeated use can lead to changes in the brain that make it harder to stop, creating strong cravings and the desire to use more.

Commonly Abused Prescription Drugs

Prescription drugs commonly misused include opioids, central nervous system (CNS) depressants, and stimulants, each of which poses risks when not used as prescribed.

Opioids

Doctors typically prescribe opioids to manage severe or chronic pain. These drugs work by binding to specific receptors in the brain to block pain signals and also increase dopamine activity, which contributes to feelings of pleasure. This mechanism can make opioids highly addictive.

Common opioids include:

• Codeine (e.g., Fiorinal)
• Fentanyl (e.g., Actiq, Duragesic)
• Hydrocodone (e.g., Vicodin, Norco)
• Hydromorphone (e.g., Dilaudid)
• Morphine (e.g., MS Contin)
• Oxycodone (e.g., OxyContin, Percocet)
• Oxymorphone (e.g., Opana)
• Tramadol (e.g., Ultram)

Side effects of opioid misuse include:

• Constipation
• Impaired focus or memory
• Nausea or vomiting
• Sleepiness or sedation
• Slowed breathing
• Slurred speech
• Tiny pupils

CNS Depressants

CNS depressants, including sedative-hypnotic drugs like benzodiazepines and barbiturates, are often prescribed for anxiety, insomnia, and muscle spasms. These drugs enhance GABA, a neurotransmitter that calms brain activity, leading to sedation and relaxation.

Common CNS depressants include:

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Eszopiclone (Lunesta)
• Zolpidem (Ambien)
• Pentobarbital (Nembutal)

Side effects of misuse include:

• Confusion or difficulty concentrating
• Dizziness or headache
• Sleep disturbances
• Slurred speech or uncoordinated movements

Stimulants

Stimulants are prescribed to treat conditions like ADHD, narcolepsy, and sometimes obesity. They work by increasing dopamine and norepinephrine activity in the brain, enhancing focus and energy but also increasing heart rate and blood pressure.

Common stimulants include:

• Amphetamine-dextroamphetamine (Adderall)
• Dextroamphetamine (Dexedrine)
• Methamphetamine (Desoxyn)
• Methylphenidate (Concerta, Ritalin)
• Modafinil (Provigil)
• Phentermine (Adipex)

Side effects of stimulant misuse may include:

• Increased heart rate, blood pressure, and body temperature
• Loss of appetite or weight loss
• Hyperactivity and insomnia
• Uncontrollable muscle movements or tics

Prescription drugs can be lifesaving when taken as prescribed, but when misused, they can lead to dangerous consequences, including addiction. Certain factors can increase a person’s susceptibility to misusing these medications, making it important to understand the risks involved. Whether due to physical health issues, mental health struggles, or environmental influences, individuals may face a higher likelihood of developing a substance use disorder (SUD) with prescription drugs. Key factors that contribute to prescription drug misuse include:

• Age: Both younger and older individuals are at higher risk. Younger adults, particularly those between 18 and 25, are often more prone to experimentation and peer pressure, which can lead to prescription drug misuse. On the other hand, older adults, especially those over 65, often take multiple medications, which increases the risk of combining drugs in ways that can be harmful.
• Gender: Research shows that women are more likely than men to misuse prescription medications, sometimes using them to self-medicate emotional pain or as a way to manage stress. Women may also take larger doses than prescribed, contributing to a higher likelihood of developing a substance use disorder.
• Mental Health Conditions: People struggling with mental health disorders like depression, anxiety, or PTSD often turn to prescription drugs as a way of coping with their symptoms. This can lead to misuse and increase the risk of developing a dependency. Misusing medication to manage mental health conditions, rather than seeking appropriate treatment, can intensify both the mental health issue and the risk of addiction.
• Chronic Pain and Health Issues: Those suffering from chronic pain or ongoing health problems are more likely to misuse prescription drugs like opioids. The need to manage pain may lead individuals to exceed prescribed dosages or use medications for longer periods than recommended, raising the risk of dependence.
• Substance Abuse History: A past history of substance misuse is one of the strongest indicators of future prescription drug misuse. Those who have struggled with addiction in the past may be more vulnerable to developing a dependency on prescription medications, especially if they are experiencing emotional or physical pain.
• Family and Social Influence: Family members, friends, and coworkers can all influence an individual’s behavior. Growing up in an environment where prescription drug misuse is common or witnessing misuse in social circles can normalize the behavior and increase the likelihood of an individual engaging in similar practices.
• High Dosage or Extended Use: Taking medications in higher doses than prescribed, or using them for longer than intended, is a significant risk factor for addiction. This is particularly true for medications like opioids, which are often prescribed for pain management but can lead to tolerance and dependence when misused.
• Seeking Euphoric Effects: Some individuals misuse prescription drugs for the euphoric or pleasurable feelings they can produce. Opioids, for instance, release large amounts of dopamine in the brain, leading to feelings of intense pleasure. This effect can be addictive, leading individuals to misuse the drugs repeatedly.

Identifying prescription drug misuse can be challenging, as the signs are not always obvious. Simply experiencing side effects from prescribed medication doesn’t necessarily indicate misuse. However, when someone takes prescription drugs in a way other than intended, it may lead to a substance use disorder (SUD), which is a clinical condition characterized by addiction.

Doctors diagnose SUD based on specific behavioral patterns, and at least two of the following must be present:

• Taking higher doses or using the drug for longer than prescribed.
• Wanting to stop or cut back but being unable to.
• Spending a significant amount of time obtaining, using, or recovering from the drug’s effects.
• Strong cravings for the substance.
• Inability to fulfill responsibilities at work, school, or in personal relationships due to drug use.
• Continuing use even when it negatively impacts relationships or causes conflict.
• Reducing participation in social, work, or leisure activities because of the substance.
• Using the drug in dangerous situations or environments.
• Persisting in use even after experiencing physical or mental health issues linked to the drug.
• Developing a tolerance, requiring more of the drug to achieve the same effects.
• Experiencing withdrawal symptoms when not using the drug, relieved only by resuming use.

Treatment for prescription drug addiction is highly effective when it incorporates both therapy and medication.

Detox

Prescription drug dependence can develop even when medications are used as prescribed. Over time, the body becomes accustomed to certain medications, such as opioids, benzodiazepines, and stimulants, leading to physical dependence. Stopping or reducing these drugs can trigger withdrawal symptoms, which can vary in intensity based on the drug type, usage duration, and dosage.

Although withdrawal from prescription medications is not typically life-threatening, the discomfort and cravings it causes can lead to relapse. Medically supervised detoxification helps manage withdrawal safely and comfortably, allowing individuals to stabilize both physically and mentally before beginning the next stage of treatment. During detox, healthcare professionals may use medications to reduce symptoms and prevent complications.

Rehabilitation Programs

Once detox is complete, the focus transitions to rehabilitation, where the emphasis is on healing the mind and addressing the root causes of prescription drug misuse. Effective treatment typically involves a personalized approach, combining various therapeutic modalities to meet the individual’s unique needs and challenges.

Inpatient Treatment

Inpatient rehab provides around-the-clock care in a secure, structured environment. This intensive form of treatment is ideal for individuals who require constant supervision and support during the early stages of recovery. Inpatient treatment typically involves a mix of individual therapy, group therapy, psychoeducation, and, in some cases, medication to address the emotional and psychological challenges of prescription drug misuse.

Outpatient Treatment

Outpatient programs allow individuals to continue with their daily lives while receiving treatment. Services are provided in scheduled sessions, often including individual counseling, group therapy, and support programs. These options offer more flexibility than inpatient care and can be used as a step-down from residential treatment or as an initial treatment approach. For some individuals, telehealth services are an effective way to access ongoing support from home.

Aftercare and Continuing Care

Aftercare is a crucial component of long-term recovery. It involves continued support to help individuals maintain their progress after completing formal treatment. Aftercare services can include sober living programs, continued counseling, participation in support groups (such as 12-Step programs), and peer support networks. These services play a significant role in reducing the risk of relapse by providing individuals with the tools and community they need to stay on track.

Medications for Prescription Drug Addiction

Medication-assisted treatment (MAT) is often used to help individuals manage cravings and withdrawal symptoms, particularly with prescription drugs that lead to physical dependence. For those dealing with prescription opioid misuse, medications like buprenorphine and naltrexone may be used.

• Buprenorphine helps alleviate withdrawal symptoms and cravings by stabilizing opioid receptors without inducing the high associated with opioids.
• Naltrexone (available as a monthly injection or pill form) works by blocking the effects of prescription opioids, preventing the euphoria they induce and reducing cravings, which can help prevent relapse.

For individuals using benzodiazepines or stimulants, specific medications may be prescribed to manage anxiety, insomnia, or other symptoms while they continue with therapy. MAT, in combination with behavioral therapy, offers a holistic approach to treatment, increasing the chances of long-term recovery.