Medications Used in Treatment

Medications are one part of treatment for some substance use disorders, not all of them. NIDA states that FDA-approved medications exist for opioid, alcohol and tobacco use disorders, and that none are yet available for stimulants or cannabis, where treatment relies on behavioral therapies. This page covers opioids and alcohol and gives no doses, because a prescriber sets those for each person.

Medications for opioid use disorder

NIDA calls medication the standard of care for opioid use disorder, with three approved options: methadone, buprenorphine and naltrexone. It also describes a first-line role for medication in its overview of treatment principles, usually combined with some form of behavioral therapy or counseling.

Methadone activates the same receptors as heroin and fentanyl, but more slowly and for longer, which reduces withdrawal and cravings with less intense pleasure. In the United States it is available for this use only through approved opioid treatment programs.
Buprenorphine binds the same receptors more weakly than methadone and can block other opioids from attaching. It reduces cravings and withdrawal without a strong high. It comes in several forms, including tablets dissolved under the tongue, long-acting injections and implants.
Naltrexone blocks opioid receptors so opioids no longer produce pleasure. It is given as a monthly long-acting injection, and treatment usually starts only after the person has stopped other opioids.

NIDA reports that methadone and buprenorphine are associated with a lower risk of death and overdose compared with no treatment, that they are about equally effective at reducing opioid use, and that both help people stay in treatment. It says naltrexone can be as effective as buprenorphine for long-term prevention of return to use. NIDA also notes that fewer than 1 in 5 people with opioid use disorder receive these medications.

A fourth medicine, lofexidine, is approved for opioid withdrawal symptoms rather than for ongoing treatment. Withdrawal itself is covered in withdrawal and detox in outline.

Medications for alcohol use disorder

Naltrexone works by blocking receptors in the brain involved in craving alcohol and in the rewarding effects of drinking. It comes as a daily pill or a monthly injection, according to NIAAA. NIAAA says people with a liver condition or who use opioid pain medications should not take it, which is a reason a prescriber reviews each person's health first.
Acamprosate helps people stay abstinent by easing some of the negative symptoms of prolonged abstinence.
Disulfiram produces unpleasant reactions such as nausea and skin flushing when a person drinks, and the expectation of those effects can discourage drinking.

The NHS describes the same three. It says acamprosate or naltrexone reduce cravings and are usually started after a person has stopped drinking, and that disulfiram causes symptoms such as nausea, headache and palpitations if alcohol is drunk.

The medicines at a glance

Approved medications named by NIDA and NIAAA, and what each source says they do
Medication	Condition	What it does, as described by the source
Methadone	Opioid use disorder	Reduces withdrawal and cravings; dispensed through approved opioid treatment programs (NIDA)
Buprenorphine	Opioid use disorder	Reduces cravings and withdrawal without a strong high (NIDA)
Naltrexone	Opioid use disorder; alcohol use disorder	Blocks opioid receptors; for alcohol, blocks receptors involved in craving and reward (NIDA, NIAAA)
Acamprosate	Alcohol use disorder	Eases negative symptoms of prolonged abstinence (NIAAA)
Disulfiram	Alcohol use disorder	Causes unpleasant reactions when alcohol is consumed (NIAAA)

Medicines work alongside counseling

Both institutes describe medicines as one part of a plan. NIDA says behavioral therapies can enhance the effectiveness of medications and help people stay in treatment longer. NIAAA says medications work best within a comprehensive treatment plan and can make behavioral counseling more effective. Options such as cognitive behavioral therapy, motivational interviewing and contingency management are often paired with them.

Who prescribes, and who decides

NIDA says many doctors, nurse practitioners and physician assistants can prescribe buprenorphine, and that any health care provider can prescribe naltrexone. NIAAA says any physician can prescribe the alcohol medications, as can doctors who specialize in addiction, and that a doctor can determine which suits a patient. NIAAA also states that not everyone responds to medications, and that people may need to try more than one to find the best fit. The decision belongs to the person and the prescriber together. See what happens when you ask for help for ways to reach one.

Common misunderstandings

"It is just substituting one drug for another"

NIDA acknowledges this is a common view and answers it directly. When taken as prescribed, methadone and buprenorphine prevent cravings and withdrawal without the high other opioids cause, and NIDA describes them as less addictive than other opioids. It says they do cause dependence, but withdrawal from them is milder and can be managed by lowering the dose slowly with a prescriber. NIDA also notes that misuse is possible, mainly through injection.

"These medicines are addictive"

NIAAA states that the three alcohol medications are non-addictive. For opioid medicines, NIDA says that, when taken as prescribed by a person with a substance use disorder, they control withdrawal symptoms and cravings and are not addictive themselves. It describes naltrexone as not addictive because it blocks receptors instead of activating them.

"A medicine on its own is enough"

The sources describe medicines as part of a broader plan, as above, and NIDA adds that treatment should address the whole person: medical, mental, social, occupational, family and legal needs.

Questions to ask a clinician

Which medications fit my situation, and which would not be safe for me?
How would this be combined with counseling, and who would provide each part?
What are the common side effects, and what should prompt me to call?
Where would I get the medicine, and how often would I be seen?
How would we decide together whether it is working, or whether to change the plan?