The rate of addiction in the United States has reached epidemic levels, and health professionals are increasingly turning to medications like naltrexone to help treat the disease. The addiction crisis has become one of the largest public health emergencies the country has ever faced. Data collected by the CDC between 1999 and 2016 found that over 632,000 people died from a drug overdose, with more than 350,000 of those deaths being attributable to opioid overdose. Meanwhile, excessive alcohol use was responsible for 88,000 death between 2006 and 2010. Many people misunderstand the factors that lead people to substance abuse in the first place. It is not a matter of willpower or a lack of moral principles – rather, addiction is a complex chronic disease that affects the mind and body in significant ways. The disease is characterized by compulsive drug seeking behaviors that are difficult to control despite known harmful consequences.
Recognizing Addiction: Signs and Symptoms
Spotting addiction can be tough, but the according to the DSM-V addictive behaviors tend to fall into one of four categories. These categories are: Impaired control. Impaired control can be exhibited by using the substance for a longer period of time than intended, using a larger amount than intended, expressing a desire in reducing use but being unable to or spending a lot of time getting, using or recovering from use of the substance. Social impairment. Social impairment can mean the addict has an inability to keep up with family, work or social obligations due to their substance use, or giving up an activity they previously enjoyed in favor of substance use. A person who is socially impaired due to substance use also will continue to use despite negative consequences on interpersonal relationships. Risky use. Risky use is characterized by continued substance use despite known dangers. It can also mean someone continually uses substances in physically dangerous situations, such as while driving a car or operating machinery. Pharmacological indicators like tolerance or withdrawal. When someone uses a substance habitually, it is possible for him or her to develop a tolerance. This often means the addict seeks higher quantities of the substance to achieve the same high or other effects. Trying to stop substance use after increasing levels can result in painful or uncomfortable withdrawal symptoms, but often reduces the likelihood that stopping use will be successful. Treatment options for addiction are varied, but they generally involve some combination of the following modalities:
- Behavioral counseling
- Medical devices and applications used to manage withdrawal symptoms or deliver skills training
- Evaluation and treatment for co-occurring mental health issues such as depression and anxiety
- After-care to prevent relapse
People struggling with addiction may feel alone, but they certainly are not. Data collected by the Substance Abuse and Mental Health Services Administration (SAMSHA) reveal that in 2009, more than 23 million people in the US older than 12 years old were in need of treatment program for their substance abuse issues. SAMSHA also reports that in 2008 there were almost 2 million total admissions to rehab. About 41% of those admissions were associated with alcohol abuse, followed by heroin and other opiates (20%) and marijuana (17%).
Naltrexone: How it Works
Just like other chronic diseases, addiction may require medication for recovery. Naltrexone, which is sold under brand names ReVia and Vivitrol, is a medication that is FDA-approved to treat both alcohol dependence and opioid dependence. Naltrexone is a member of the opiate antagonist drug family, and it blocks serotonin and dopamine, which are the hormones responsible for euphoric effects. With naltrexone, both serotonin and dopamine are unable to attach to cells or nerve receptors in the brain, spine or gastrointestinal tract. This reduces the reward effect associated with drug or alcohol use, which helps users ween off the substance. The drug is available in either pill form or as an extended-release injectable. Unlike other medications used to treat addiction, naltrexone is not addictive and does not have negative interactions with drugs or alcohol. Widely-touted as a highly effective method in preventing relapse, many addiction rehabilitation facilities incorporate naltrexone in their treatment methods. Side effects from use of naltrexone are minimal and typically affect less than 10% of people. They include:
Use of Naltrexone to Treat Opioid Addiction
Opioid addiction in America has become a major public health crisis. Data published in the 2014 National Survey on Drug Use and Health reveal other somber statistics relating to prescription drug abuse:
- 4.3 million Americans self-reported non-medical use of prescription opioids within the month prior
- About 2 million people in the US qualified as having a prescription medication abuse disorder based on their use habits in the year prior.
- Of the people who used prescription opioids non-medically in 2014, nearly 1.5 million were first-time users. The average age of these users was just over 21 years old.
The role of naltrexone is to block the euphoric effect that accompanies opioid use, which in turn helps to reduce the motivation for abusing these substances. If an addict tries to use prescription opioids or heroin while taking naltrexone, they will perceive the experience differently. Unlike other opioid replacement therapies, naltrexone has no potential for abuse because it is not addictive and does not reinforce addictive behavior. Naltrexone is typically only used once a patient has completed detox.
Use of Naltrexone to Treat Alcohol Addiction
According to SAMSHA, around 14 million American adults meet the diagnostic criteria for alcoholism, and every year more than 1.5 million people seek treatment for alcohol abuse. Alcoholism is one of the leading preventable illnesses in the US Many people underestimate the dangers of alcohol abuse because drinking is a huge part of social life for many Americans. As such, spotting alcoholism can be difficult. Things to watch out for include:
- Drinking four or more times in one week
- An inability to consumer alcoholic beverages in moderation
- Using alcohol a motivator to start the day
- Feelings of guilt or remorse after a night of drinking
- Gaining a reputation among friends and family as someone who drinks too much and needs to slow down
Alcohol rehab is a proven method for overcoming alcoholism, and naltrexone can be used to extinguish cravings among people with alcohol use disorder. If taken about an hour before drinking, the user does not experience the buzz they normally would. This leads to reduced cravings because the “reward” is not present, and reduced cravings leads to increased compliance with sobriety. During their time in alcohol rehab, people in recovery are encouraged to seek additional support. Examples of additional support available include:
- Alcoholics Anonymous (AA). AA is the largest alcoholism support group in the world, and the program champions the highly effective 12-step program for recovery. AA promotes a spirituality-based recovery method that includes prayer and appeal to a higher power. It serves as an effective accompaniment to traditional rehabilitation programs, and it can be easily incorporated into outpatient treatment regimens.
- SMART Recovery. The SMART modality is similar to AA, but there are several distinct differences that may appeal to certain people in recovery. The program focuses on self-empowerment and reliance, which is a good alternative for people who are not interested in the spirituality of AA.
- Family support. Addiction affects more than just the individual – it can affect entire families and communities. Family counseling can help to drive awareness in household about alcoholism as a disease and potential triggers.
Overall, naltrexone is said to make the alcoholism recovery process a more manageable experience.
Drug and Alcohol Recovery: Factors to Consider When Choosing a Treatment Facility
Naltrexone is just one element of treatment for addiction. Other important treatment components include:
- Detoxification. In the most severe cases, detox is done in the intensive care unit of a hospital. People who undergo an accelerated detox are placed under general anesthesia and given naltrexone or other opiate-blocking drugs intravenously. Medication is also used to manage withdrawal symptoms, which can be painful and are the leading cause for early relapse.
- Rehabilitation. Rehabilitation facilities and services can come in many different forms, and the most appropriate option depends on the individual and the extent of the addiction. Inpatient services, outpatient services, and sober living facilities are all viable options for people in recovery who need support to continue their sobriety.
- Compliance monitoring. Monitoring a person’s success in their efforts to become sober is an important component of sustained recovery. A urine samples are the most common form of compliance monitoring due to its low-cost, efficiency and low level of invasiveness.
- Accountability meetings. Testing for drug recovery compliance should ideally be coupled with psychosocial counseling to help support the person and help address issues that could cause them to relapse and revert to addictive behaviors.
- Complete lifestyle change. People in recovery need to ensure that the life they lead outside of rehab is healthy and does not involve any triggers. Aftercare services, continued counseling, support groups and transitional living offerings can bring an extra level of accountability in your recovery that can work to prevent relapse into old habits of substance abuse.
No two experiences in any rehabilitation facility are exactly alike, and choosing the right facility based on an addict’s individual needs is an important first step to sustained recovery and renewed life. Here are some of the common characteristics of rehabilitation facilities that should be considered when choosing the right treatment program:
- Residential treatment options. Residential treatment for recovering addicts can last anywhere from a few weeks to a few months. Many facilities also offer transitional housing and sober living facilities for addicts who have successfully completed an inpatient program.
- Hospitalization. Patients with more extreme addiction needs may need to enter a facility that offers partial-hospitalization so detoxification can be medically supervised. Addicts can usually transfer into an inpatient program after their hospital stay or go home, depending on their wishes and ability to afford further treatment.
- Counseling. Recovering addicts typically need different types of counseling based on the extent of their addiction and any co-occurring mental health conditions. Cognitive-behavioral therapy, for example, can provide instruction on how to manage thoughts and feelings to control the physical response to cravings. Meanwhile, multi-dimensional family therapy can help loved ones recognize and address factors that may have prompted addictive behaviors in this first. The overall goal of counseling is to improve both individual and family functioning.