How Do Substance Abuse Treatment Medications Work?

All substances have some effect on the brain, and when an individual uses an illicit substance like heroin or cocaine, it changes how the brain processes and receives signals from the rest of the body. Heroin, for example, stimulates the brain and unnaturally activates neurons. Cocaine, on the other hand, interferes with the brain’s normal processes and makes certain neuron signals stronger. In both cases, the result is the high experienced from taking the substance.

Medications used for substance abuse treatment are intended to interfere with and ultimately counteract the damaging effects of illicit substances on the brain of the addict. These medications are prescribed to block illicit substances from being able to disrupt the brain’s normal processes or activate neurons in the usual way, which means the individual doesn’t experience the high from the substance and, thus, fall further into a cycle of abuse and addiction.

Jeremy Barnett, a Credentialed Alcoholism and Substance Abuse Counselor, explains, “Addiction medications can be essential for those individuals new to recovery but controversial for some entities, such as AA and sometimes the public in general. While certain medications, such as Suboxone and methadone can be viewed as an addictive ‘replacement’ drug, they can be very stabilizing for individuals with a history of severe opioid addiction, if monitored closely and weaned off slowly over time. Antabuse (or the generic disulfiram) is very effective in providing a strong behavioral deterrent for alcohol, prompting physical symptoms, such as nausea, stomach cramps, and headaches if combined with alcohol. Vivitrol (or the generic naltrexone) is a common medication for alcohol users, as it reduces cravings and the temptation to drink. Topamax and mirtazapine have also been shown to be helpful for those with a history of cocaine and amphetamine abuse. How long an individual is on these medications is based on many unique factors and is a decision that should always be made between the person in recovery and the prescribing doctor.”

Treatment Medications for Substance Addiction

  • Acamprosate (Campral): Helps restore the balance of chemicals in the brain and eases alcohol withdrawal symptoms
  • Baclofen (Lioresal): Regulates dopamine levels in the brain, which may reduce opioid cravings
  • Buprenorphine (Probuphine, Suboxone): Mimics the effects of opioids, making it easier to reduce the use of the substance
  • Bupropion (Wellbutrin, Zyban): Useful during the initial detoxification phase to reduce cravings and decrease depression in methamphetamine and cocaine addicts
  • Disulfiram (Antabuse): Prevents proper digestion of alcohol, causing negative symptoms if alcohol is consumed
  • Gabapentin (Neurontin): Influences neurotransmitters in the brain, reducing methadone withdrawal symptoms
  • Methadone: Binds to the brain’s receptors, easing the mental and physical aspects of heroin withdrawal
  • Mirtazapine (Remeron): Lessens alcohol withdrawal symptoms and improves depressive tendencies in addicts
  • Modafinil (Provigil): Central nervous stimulant that may reduce cocaine cravings
  • Naloxone: Prevents opioids from affecting the brain, often used in overdose cases
  • Naltrexone (Vivitrol): Decreases the pleasant effects of opioids or alcohol, lessening the desire to use
  • Topiramate (Topamax): Interacts with the brain’s neurotransmitters, reducing the ”high” alcoholics experience
  • Vigabatrin (Sabril): Inhibits the breakdown of GABA within the brain, lessening addiction cravings

Medications for Alcohol Addiction Treatment

While it may seem strange at first to learn that a pill can combat alcohol addiction, the FDA has approved several medications for precisely this purpose. These medications usually work either by reducing cravings for alcohol or by making an individual sick if he or she does decide to drink. Additionally, some medications can help with physical withdrawal symptoms, which may make it easier to remain sober, particularly in the first few weeks or months. You can find out more about these medications, as well as other aspects of substance abuse treatment for alcohol addiction, in our Guide to Alcohol Rehab and Recovery.

Acamprosate (Campral)

Acamprosate works by dampening the positive effect that alcohol has on the brain, thus limiting the high an individual experiences from imbibing. It can also help ease the cravings that occur during withdrawal. In one study, subjects who took acamprosate were more likely to have maintained their sobriety after a year than those who were given a placebo. Other studies have revealed conflicting results, however, and the research into this medication for alcohol addiction is still ongoing.

Disulfiram (Antabuse)

Disulfiram works by making it more difficult for the body to break down and digest alcohol. This means that if an individual does drink, he or she will experience negative physical symptoms, including nausea, vomiting, heart palpitations, and a feeling of being overheated. A 2011 study published in the journal Alcoholism, Clinical and Experimental Research revealed that disulfiram use had a positive correlation with higher success rates for short-term sobriety, as individuals who took the medication had longer times between relapses and fewer drinking days than study participants using other treatment methods or taking a placebo.


Vivitrol is an injectable form of naltrexone. This extended-release medication works by blocking the brain from being able to receive the positive sensations that occur when an individual ingests alcohol or another illicit substance. Vivitrol has been shown to be effective in clinical studies, decreasing cravings and increasing one-year sobriety rates.

Medication for Cocaine Addiction Treatment

Medication for cocaine addiction treatment is used to combat the withdrawal symptoms that occur during the detoxification phase. These medications can help lessen the severity of common withdrawal symptoms such as depression, anxiety, and insomnia, as well as reduce cravings. You can find out more about medication, as well as other aspects of substance abuse treatment for cocaine addiction, in our Guide to Cocaine Rehab and Recovery.

Modafinil (Provigil)

Modafinil was originally developed to treat narcolepsy, but it was then discovered to show promise in aiding cocaine addiction treatment. However, studies to determine effectiveness as a treatment medication have had mixed results, and outside variables were found to be a large factor in its success. Modafinil has had the best results when combined with other treatments, such as behavioral therapy.

Medications for Opioid (Including Heroin) Addiction Treatment

Medications used to manage opioid addiction differ from those used in cocaine and alcohol addiction treatment because some of them, such as methadone, can be addictive in and of themselves if not properly managed. These treatment medications block the high an individual receives from opioid use, which reduces positive reinforcement and eventually the desire to use the substance. You can find out more about these medications, as well as other aspects of substance abuse treatment for opioid addiction, in our Guide to Heroin Rehab and Recovery.

Medications for opioid addiction treatment fall into three categories:

  • Full agonists: These substances have a similar effect on the brain as opioids but, when managed by a physician, can be helpful in weaning an individual from opioid use.
  • Partial agonists: These substances affect the brain as opioids do but to a lesser extent, which can help manage withdrawal symptoms as an individual works toward sobriety.
  • Antagonists: These medications block opioids from affecting the brain, which eliminates the rewarding high that results from taking the substance.

Buprenorphine (Probuphine, Suboxone)

  • Category: Partial agonist
  • How it works: Stimulates the brain in a similar way as opioids but to a lesser degree, which makes it effective in helping to wean patients off stronger treatment medications, such as naltrexone

According to studies, buprenorphine has shown promise in its role in helping patients achieve long-term recovery. It’s available in both pill and implant form.


  • Category: Full agonist
  • How it works: Reduces cravings and blocks the high experienced from opioid use

Studies reveal that methadone has been used successfully for years to help treat opioid addiction. It is generally considered effective, but there is some controversy surrounding this treatment because it can be addictive in and of itself if not appropriately managed.


  • Category: Antagonist
  • How it works: Blocks the brain’s neurons from being able to experience positive effects (i.e., the high) from using opioids

Naltrexone has been shown to be effective in treating alcohol addiction, and, as mentioned earlier, its extended-release form, Vivitrol, can help patients better comply with opioid addiction treatment protocols.


  • Category: Antagonist
  • How it works: Prevents opioids from interfering with the brain’s processes, which blocks the positive feelings associated with taking the substance. It is most often used to treat overdoses

According to studies, naloxone is extremely useful in treating opioid overdoses, and it has become an essential medication for hospitals and first responders, most commonly known as the brand names Narcan and Evzio. For long-term opioid addiction treatment, it is often combined with buprenorphine.

Additional Medications Used or Investigated for Use for Substance Abuse Treatment

When a medication is first developed and utilized in clinical trials, it’s not uncommon for other possible applications to be discovered. This usually occurs when trial participants report side effects not initially known to be associated with the medication. Once enough participants experience the side effects to demonstrate a direct correlation to a medication, researchers can conduct specific studies to see if it may be helpful in other circumstances, such as substance abuse treatment. Following are several medications currently being used or investigated for use in substance abuse treatment.

Baclofen (Lioresal)

Originally developed as a muscle relaxant for patients suffering from epilepsy, baclofen helps regulate dopamine levels, which can help stabilize moods and lessen drug cravings. A 2003 study found that baclofen was effective as part of opioid addiction maintenance treatment, but research is ongoing.

Bupropion (Wellbutrin, Zyban)

Bupropion is well-known for its use in treating depression and other mood disorders, as well as a medication for smoking cessation; however, it’s also being used off-label to help manage both cocaine and methamphetamine addiction.

Gabapentin (Neurontin)

Gabapentin was first developed as an anti-convulsant but has been used to manage withdrawal symptoms during methadone-assisted detoxification. A 2013 study found that patients who took gabapentin along with methadone required lower doses of methadone and had fewer withdrawal symptoms.

Mirtazapine (Remeron)

Mirtazapine was originally approved by the FDA in 1996 to treat depression but has been used off-label since then for a variety of conditions, from insomnia and sleep apnea to post-traumatic stress and obsessive-compulsive disorders. Initial studies have shown that mirtazapine has promise when used to treat alcohol addiction, especially in individuals whose addiction involves self-medication for depression and anxiety.

Topiramate (Topamax)

Topiramate had an original use as a prescription migraine treatment and as an anti-convulsant. However, a 2011 study published in BMC Psychiatry found that the medication had a marked positive effect on reducing alcohol cravings. It also alleviated early withdrawal symptoms and correlated to a better likelihood of the patient abstaining from drinking for at least the first 16 weeks of treatment.

Vigabatrin (Sabril)

Vigabatrin’s official use is as an anti-convulsant for individuals suffering from epilepsy, but it’s also been found to significantly reduce the addiction cravings associated with alcohol withdrawal, which can both increase the chances of a successful detoxification period and support ongoing sobriety. Consequently, it’s being investigated for use in treatment for alcohol addiction.

Substance abuse is a multifocal problem and, as such, it often requires a combination of treatment regimens to achieve success. The use of medications to lessen withdrawal symptoms, reduce drug cravings, and help patients handle some of the coping issues associated with the addiction is a welcome addition to the rehabilitation process. Combined with both individual and group behavioral therapies, these treatment medications may help addiction sufferers on their road to recovery.

Note: The purpose of this guide is to inform readers about the currently available and potential medications for substance abuse treatment and not to provide medical advice. Always consult with a physician or addiction treatment specialist before beginning a substance abuse treatment program.