The video for this presentation is available on our Youtube channel: https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c= Unlimited Counseling CEUs for $59 https://www.allceus.com/ Specialty Certificate tracks starting at $89 https://www.allceus.com/certificate-tracks/ Live Webinars $5/hour https://www.allceus.com/live-interactive-webinars/ Patreon: https://www.patreon.com/CounselorToolbox Pinterest: drsnipes Youtube.com: https://www.youtube.com/user/allceuseducation Explore the current pharmacologic interventions for alcohol and opiate dependence.

2. Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC
Executive Director, AllCEUs

3.  Review some myths about Medication
Assisted Treatment
 Identify medications used to treat opiate
dependence
 Identify medications used to treat alcohol
dependence
 Discuss the mechanisms of action
 Evaluate pros and cons of each

4.  Medications are a crutch
◦ We do what is more rewarding than the alternative
 Medications can make sobriety “feel better” by addressing
underlying neurochemical imbalances
 Medications can remove the rewards from use by
 Making it unpleasant (Antabuse)
 Removing the “high” (Buprenorphine, Naltrexone)
 Both (Suboxone)
 Remember recovery is more than just NOT using.
 Medications can help ease the transition until the brain has
rebalanced and the new lifestyle is in full swing

5.  Using medication goes against 12-Step Philosophy
◦ Alcoholics Anonymous does not encourage AA participants
to not use prescribed medications or to discontinue taking
prescribed medications
 The Big Book states, “God has abundantly supplied this world
with fine doctors, psychologists, and practitioners of various
kinds. Do not hesitate to take your health problems to such
person …Try to remember that though God has wrought
miracles among us, we should never belittle a good doctor or
psychiatrist. Their services are often indispensable in treating a
newcomer and in following his case afterward.”

6.  Medications Can…
◦ Increase energy and motivation (dopamine and
norepinephrine) while the person’s brain and body
are recovering
◦ Remove some of the reinforcing effects of the drugs
◦ Prevent relapse by making relapse very unpleasant
◦ Reduce the intensity of co-occurring disorders
◦ Reduce conflict/improve social support
◦ Reduce absenteeism from work

7.  Physicians who are educated about addiction
treatment and endorse a biopsychosocial model
of treatment are difficult to find
 Medications can give a false sense of security
 Medications may provide false hope
 Medications have side effects
 There is a stigma associated with the use of
medications
 Costs money

8.  Neurotransmitters
◦ Mainly dopamine
 Patients report feeling
◦ Less pain
◦ Less anxiety

9.  Buprenorphine
 Methadone
 Naltrexone
 Naloxone (for opioid overdose)
 Buprenorphine & Naloxone (Suboxone)

10.  Is as partial opioid agonist (ceiling effect)
 Reduces the symptoms of withdrawal from
misused opiates
 Can be abused

11.  Full Mu opiate agonist (suppresses cravings)
 Lessens the painful symptoms of opiate withdrawal
and blocks the euphoric effects of opiate drugs
 Considered relatively safe during pregnancy and
breastfeeding
◦ Opiate w/d during pregnancy can trigger contractions and
miscarriage
 SAMHSA TIP 43 MAT for Opioid Addiction

12.  Decreases the pleasurable effects of alcohol or
opiates by blocking opiate receptors
 Alcohol abstinence is not required, but opiate
abstinence is
 Naltrexone will cause opiate withdrawal in
dependent users
 Third-Party Payer Acceptance:
◦ Oral is covered by most major insurance carriers,
Medicare, Medicaid, and the VA
◦ Vivitrol is not covered in many cases

13.  Blocks opioid receptors
 Antagonizes morphine and other opiates.
 Prevents or reverses the effects of opioids
including respiratory depression, sedation
and hypotension.

14.  Alcohol consumption impacts the following
neurotransmitters
◦ Dopamine (motivation, pleasure)
◦ Endogenous opioids (pain and euphoria)
◦ Glutamate (Get up and go)
◦ GABA (Relaxation--- Produced from Glutamate)

15.  Disulfiram (Antabuse)
 Naltrexone (ReVia)
◦ Blocks opioid receptors so the reward effects from the
endogenous opiates and dopamine are reduced
◦ Vivitrol—Extended Release injectable naltrexone
 Acamprosate (Campral)
 Newer Medications
◦ Ondansetron
◦ Nalmefene
◦ Gabapentin

16.  Reduces Post Acute Withdrawal Symptoms
 Upregulates (turns on) glutamate receptors
reducing depression
 Creates an imbalance between Glutamate and GABA
◦ Increasing anxiety, mood lability, insomnia, tremors
 There was a noted increase in adverse events of a suicidal
nature (suicidal ideation, suicide attempts and/or completed
suicides) during the clinical trials.

17.  Third-Party Payer Acceptance:
◦ Does qualify for the Patient Assistance Program
through Forest Laboratories, Inc. Covered by most
major insurance carriers, Medicare, Medicaid, and
the VA (if naltrexone is contraindicated)

18.  Makes patients physically sick if they drink
 Third-Party Payer Acceptance:
◦ Covered by most major insurance carriers, Medicare, Medicaid,
and the VA
 Disulfiram blocks the enzyme acetaldehyde
dehydrogenase
◦ alcohol is broken down in the liver to acetaldehyde;
◦ acetaldehyde is converted by the enzyme acetaldehyde
dehydrogenase to acetic acid.
◦ This causes acetaldehyde to accumulate in the blood at 5 to 10
times higher than alcohol alone leading to toxcicity

19.  The acute toxic reaction lasts about an hour, but will linger while
there is alcohol in the blood
 Can be triggered by alcohol containing products like cough syrup
 Patients taking disulfiram should not be exposed to ethylene
dibromide or its vapors, paint fumes, paint thinner, varnish or
shellac
 Exercise extreme caution when applying aftershave, mouthwash,
lotions, colognes and rubbing alcohol
 The disulfiram-alcohol reaction can be triggered up to two
weeks after the last dose of disulfiram
 PATIENT and S.O. EDUCATION IS VITAL

20.  Decreases the pleasurable effects of alcohol or
opiates by blocking opiate receptors
 Alcohol abstinence is not required, but opiate
abstinence is
 Naltrexone will cause opiate withdrawal in
dependent users
 Third-Party Payer Acceptance:
◦ Oral is covered by most major insurance carriers,
Medicare, Medicaid, and the VA
◦ Vivitrol is not covered in many cases

21.  ONDANSETRON
◦ Sold under the name Zofran, and works through the
serotoninergic system especially in regard to the
serotonin3 receptor and its effect on dopamine.
◦ In alcoholics, it is possible that there is a heightened
sensitivity of the serotonin3 receptor making alcohol
more rewarding.
◦ If this receptor could be blocked, there would be a
decrease in alcohol-induced dopamine release, resulting
in a decrease in alcoholic-drinking behavior.

22.  NALMEFENE
◦ is an opioid antagonist similar to naltrexone (ReVia)
without the risk of liver toxicity, and it is longer
acting.
 GABAPENTIN (Neurontin)
◦ is being used for pain management, anxiety, &
insomnia, problems very common among alcohol-
dependent patients.

23.  Anxiety
◦ SSRIs
◦ Buspar
 Insomnia
◦ SSRIs
◦ Gabapentin
◦ Atypical Antipsychotics
 Depression
◦ SSRIs
◦ Atypical Antipsychotics
 Pain
◦ SSRI/SNRI/Tricyclics
◦ Anticonvulants

24.  Both opiates and alcohol activate opiate
receptors
 MAT is used to make sobriety more rewarding
and reduce relapse triggers in early recovery
 It is essential to address comorbid conditions
in addition to the substance

25.  http://www.naadac.org/assets/1959/storie_
mat_alcohol.pdf
 https://www.oasas.ny.gov/AdMed/meds/me
ds.cfm