Dr. Kloda is highly experienced in using various medications that are usually taken on a daily basis to help maintain abstinence. He will see you in consultation to discuss medications for addiction that might be helpful to you. Dr. Kloda uses medications as a part of medication assisted treatment (MAT).
The definition of “recovery” is when a person changes a dysfunctional life, that is a result of drug and alcohol use, to a life that is functional and healthy. This occurs with either medication alone, or with medication plus addiction psychotherapy. There are now a number of different medications that can be used as a part of medication assisted recovery.
Benzodiazepines (“benzos”) are the class of medications that includes Xanax, Klonopin, Valium, and Ativan. These medications are usually prescribed to treat anxiety. The patients that I see in my medical practice have become physically dependent on these medications from legitimate prescriptions that were being taken as directed. Unfortunately, tolerance withdrawal can develop. Previously effective doses of their medication become ineffective, with withdrawal symptoms either on or in between doses. Detoxification from benzodiazepines can absolutely be the most difficult detox for patients to accomplish. The anxiety and withdrawal symptoms that develop can protracted and severe. I follow the Ashton Method (www.benzo.org.uk/manual/) for benzo detoxification. In addition, I prescribe medications to not only treat the primary anxiety disorder, but to treat the withdrawal symptoms as well. Antidepressants such as Prozac and Cymbalta are used for the treatment of anxiety disorders. Remeron is antidepressant that works particularly well in treating insomnia, primary anxiety disorders, and benzodiazepine withdrawal symptoms. Some of the medications that I use for treating withdrawal symptoms include Neurontin and Topamax for sleep and anxiety, beta blockers for physical symptoms such as palpitations, and Atarax, an antihistamine, for insomnia and anxiety.
SUBOXONE FOR OPIATE AND OPIOID ADDICTIONS
For opioid (oxycodone, Oxycontin, Percocet) and opiate (Heroin, Morphine) addictions, Suboxone can be a life saving medication. Treatment with Suboxone is known as Opioid Agonist Therapy (OAT). It is an opioid that is taken as a daily dose in place of the opioid or opiate being abused. Suboxone is also used for outpatient detoxification, or medically supervised withdrawal, to wean patients off from opioids and opiates. Suboxone can be thought of as a much safer and more convenient alternative to methadone. It can be prescribed in a doctor’s office, and filled at a pharmacy just like any other prescription. Due to its unique properties, Suboxone has all of the positive psychological effects of opioids, and none of the negative psychological effects.
Stimulation of the GABA-A receptor by alcohol is responsible for alcohol’s anti-anxiety and calming effect. This is the same receptor that is stimulated by sedatives such as Valium and Xanax. In fact, alcohol can be thought of as liquid valium, and Valium can be thought of as freeze dried alcohol. In treating alcoholism, there is a large group of highly functioning professionals, business owners, and working people, who have very stressful jobs, with long hours, who do not drink during the day. Instead, they start drinking immediately after work. Their drinking is heavily driven for the relief of anxiety, tension, and to decompress from the stressors of the day. In treating other alcoholics, there are many with anxiety disorders who use alcohol as their medication to deal with their crippling symptoms. Two medications that I prescribe which work on the GABA system are baclofen (most effective in my experience) and Neurontin (second most effective in my experience). Both medications basically work by treating anxiety. They also provide after work relief of tension and stress that alcohol would usually provide. These effects are accomplished minus the intoxicating effects of alcohol.
NALTREXONE AND THE SINCLAIR METHOD
One of the receptors that alcohol stimulates is the mu-opioid receptor. This is the same receptor that is stimulated by narcotic pain medications such as Percocet and Vicodin. Activating this receptor causes a release of dopamine in the brain. Dopamine is a neurotransmitter that is responsible for feelings of pleasure, reward, and euphoria. Naltrexone is a medication that is a mu-opioid receptor antagonist, meaning that it blocks the receptor. If a person drinks while taking this medication, the alcohol will have a much less pleasurable effect. With the Sinclair Method, naltrexone is prescribed in a very specific way. Patients are told to continue drinking as they normally would, but they must take the medication one hour before they start drinking. By taking the medication this way, the intense pleasure associated with drinking is diminished. The main goal with the Sinclair Method is to achieve the process of extinction for cravings for alcohol. With extinction, when a behavior which was pleasurable and positively reinforcing, becomes less pleasurable and less positively reinforcing, the behavior gradually stops occurring. This gradual process eventually leads to less cravings and less desire for alcohol. The goal with the Sinclair Method is to eventually enable people to either stop drinking or to moderate their drinking.
If you would like more information about alcoholism treatment, call me directly for a phone consultation at (646) 713-6578. Thank-you.