What medications are used to treat substance use disorders?

Dr. Kelly Traver

One effective medication used in smoking cessation is Zyban, generically known as bupropion. This medication produces higher dopamine levels to avoid the precipitous drop a smoker experiences when he or she stops smoking.

A newer medication for smoking cessation is Chantix, generically known as varenicline. It activates the nicotinic receptors that cause the release of dopamine, but it does so only partially. It provides a small, steady release of dopamine while blocking the usual rush of dopamine that smoking typically provides. Therefore, there is no positive reinforcement.

Vivitrol and Revia, generically known as naltrexone, are medications for treating alcohol that block alcohol from binding to the opioid receptors that activate dopamine. These medications block the positive reinforcement of alcohol.

A new medication Acamprosate is being used to treat alcohol addiction. Its molecular structure is similar to that of glutamate. Acamprosate slows the release of glutamate. (Glutamate can be too stimulating and overwhelming for the brain.) By slowing its release, one may feel less inclined to calm the brain with alcohol.

Baclofen, a muscle relaxant, stimulates production of the inhibitor gamma-aminobutyric acid (GABA). GABA's role is the opposite to that of glutamate. Baclofen appears to reduce the cravings for several different addictive substances.

Topiramate is an antiseizure medication that appears to increase GABA levels and reduce cravings for addictive substances. In one (manufacturer-supported) research study, 370 adults with alcohol dependence were randomized to Topiramate (up to 300 milligrams daily) or a placebo for 14 weeks and Topiramate significantly reduced alcohol consumption.

Rimonabant is a medication that blocks cannabinoid receptors (the same receptors stimulated by marijuana). Our bodies naturally produce a marijuana-like chemical known as endocannabinoid. Blockage of this receptor appears to decrease cravings for food, nicotine, and alcohol. When it came up for FDA review in 2007, it was not approved for use in the United States because of psychiatric side effects.

Fredrick Wade
Addiction Medicine Specialist
There are a variety of medications used to help with the treatment of addictions. Antabuse was one of the first medications employed to treat alcoholism. It works by inhibiting or preventing the breakdown of alcohol in the body. It, therefore, causes one to become sick or flushed when alcohol is taken in combination with Antabuse, which is actually a form of aversive therapy. People who take Antabuse on a daily basis are less likely to drink, due to the desire to not become sick as the result of the interaction of the two substances

The following medications may be used to treat substance use disorders. They are most effective under a program of medical management directed by a healthcare professional.

  • Methadone is a synthetic opioid drug, generally a pill or liquid, used mainly in the treatment of heroin addiction. Studies show that treatment for heroin addiction with methadone combined with behavioral therapy reduces death rates and many health problems associated with heroin abuse.
  • Buprenorphine (Subutex, Suboxone) is related to morphine but does not produce the same high, dependence or withdrawal syndrome as morphine. It is long-lasting, less likely to cause respiratory depression and well-tolerated.
  • Disulfiram (Antabuse) is a prescription medication used to help people avoid alcohol and thus overcome addiction to or dependence on alcohol. If a person uses disulfiram and drinks alcohol, the medication causes severe symptoms that can last several hours, including flushing, rapid or irregular heartbeat, dizziness, nausea, vomiting, difficulty breathing and headache. When taken according to the prescribed schedule, the medication is used to discourage someone from resuming drinking once they've stopped.
  • Naltrexone (Revia) is used to help narcotic addicts and alcoholics. Naltrexone works by blocking the effects of narcotics, especially the "high" feeling that makes the person want to use them. When used with behavioral treatments, it can reduce the craving for alcohol and drugs and help people avoid relapse. It does not, however, block the effects of these substances.
  • Acamprosate (Campral) is approved to prevent people who have already stopped drinking from starting again. Campral is thought to work by regulating the brain chemicals that have been altered by long-term alcohol use. For Campral to work, people taking it must be alcohol-free before they take their first dose and must be prepared to follow a complete alcohol treatment plan including mental and behavioral counseling.
  • Vivitrol, a version of naltrexone, is the first Food and Drug Administration (FDA) approved injectable drug to treat alcohol dependence. It is injected by a health care professional once a month.
  • Clonidine (Catapres), a drug used to treat high blood pressure, can be used to ease opioid withdrawal symptoms but is not used to manage long-term recovery.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.