Table 5.
Pharmacotherapy and behavioral therapy comprising a comprehensive substance abuse treatment plan.
| Pharmacotherapy |
| • Opioid Dependence Methadone—Federally regulated through OTP; opioid receptor agonist for pharmacological therapy Buprenorphine—office-based opioid treatment or OTPs; Federally regulated, partial opioid receptor agonist for pharmacological therapy Naltrexone—office-based and substance abuse treatment programs; used when opioid abstinence is possible without significant relapse risk; opioid receptor antagonist for relapse prevention |
| • Alcohol Dependence Naltrexone—an “anti-craving” agent, opioid receptor antagonist; reduced reward effect with daily use; new forms are long acting Acamprosate—an “anti-craving” agent that normalizes glutamatergic neurotransmission; slow acting, attenuates relapse Disulfiram—a “vicarious” aversive medication supporting complete abstinence to alcohol that blocks complete oxidation of alcohol with accumulation of acetaldehyde and resultant unpleasant “allergic” physical symptoms when alcohol is absorbed (e.g. flushing, headache, and vomiting) |
| • Nicotine Dependence Nicotine replacement therapy—many over-the-counter regimens, such as patches, gum, and inhalers, are used to replace the daily physical requirement for nicotine and may be used for nicotine withdrawal or maintenance Buproprion—an antidepressant also found to be an “anti-craving” agent that reduces the psychological craving for tobacco |
| Behavioral therapy |
| • Brief interventions for 1 to 3 visits (low intensity); for early drug use and substance abuse; available in many different outpatient settings |
| • Motivational enhancement interviewing and therapy |
| • 12-step facilitation |
| • Stage-of-change model interventions |
| • Long-term, multimodal, and multidimensional comprehensive therapies and interventions to restructure belief and cognitive systems; enhance coping strategies; and change friendships, environment, and behavior |
| • Individual interpersonal one-on-one therapy, such as cognitive behavioral therapy and insight-oriented psychotherapy |
| • Group therapy—such as family or faith-based, Therapeutic Communities |
| • “12-step” programs and “clean and sober” recovery living environments in which peer groups interested in sobriety mutually help one another stay sober |