Addictions and Recovery

I. The goals of pharmacological alternatives

According to the Recovery Research Institute’s website, https://www.recoveryanswers.org/resource/pharmacotherapy-medication-assisted-treatments/, the goals of using drugs for the treatment of alcohol and other modalities of substance misuse are reduce the following:

• The intensity of withdrawal symptoms;
• Alcohol and other drug cravings;
• The likelihood of use or relapse for specific drugs by blocking their effect.

The primary goal of medication-assisted treatment is for the patient to achieve fully-sustained remission.

Pharmacotherapy is often used together with other therapies such as Cognitive Behavioral Therapy (CBT), or 12-Step Facilitation. Medications combined with these other therapies are shown to:

• Improve rates of patient survival
• Increase retention in treatment programs
• Decrease illicit opiate use and substance-related criminal involvement
• Increase patients’ ability to gain and maintain employment
• Improve outcomes in pregnancies affected by substance use

Different medications are used for the treatment of alcohol use disorder, opioid use disorder, and nicotine/smoking cessation:

II. Medications for Alcohol Use Disorder (Please accept my apology for the very lengthy and narrow columns. There MUST be a way to expand the width of a table with the WordPress platform. I just don’t know what it is.)

Medication (and Brand names)	Mode of action	How Taken	For whom	Side Effects
Nalmefene	Works similar to naltrexone, by acting on dopaminer-gic nucleus accumbens circuitry, it may reduce motivation for self-administra-tion and withdrawal-induced alcohol consump-tion.	Orally	“This medication may appeal to patients with goals of reducing alcohol consump-tion and those reluctant to engage in abstinence-based treatment	Dizziness, nausea, vomiting, insomnia, and headache
Baclofen	GabaB agonist, yields higher abstinence rates than placebo.	Orally	May be particularly useful in the treatment of AUD among individuals with liver disease.	Depression, sedation, vertigo, headache, confusion, perspira-tion, muscle stiffness and/or abnormal move-ments, slurred speech and numbness.
Sodium oxybate	Acts as a partial GabaB agonist. Increased abstinence by up to 34% in a sample of 711 participants with very high drinking risk levels	Orally	Reduces relapses when given with naltrexone and escita-lopram. Although SMO has craving and abuse potential, it has shown effective-ness with chronic, treatment-resistant alcohol depen-dence.	Transitory dizziness and vertigo
Varenicline	A nicotinic acetylcho-line receptor agonist used for treatment of nicotine depen-dence. Significant-ly reduces weekly percent heavy-drinking days, drinks per day, drinks per drinking day.	Orally	Especially relevant to heavy-drinking smokers. About 20-25% of current smokers are estimated to also be heavy drinkers. In one study, this drug reduced the number of drinks consumed and increased the likelihood of complete abstinence	Nausea, Trouble sleeping, Strange or vivid dreams, Constipa-tion, Gas, Vomiting.
Aripipra-zole	Antipsych-otic drug, acts as a partial agonist at the dopamine D2 and 5-HT1A receptors and as an antagonist at the 5-HT2A receptor. Reduces the euphoric effects of alcohol and increases sedative effect. One study with 99 participants with AUD showed a reduction in the number of drinks consumed in a bar lab setting, especially among individuals with low self-control	Orally	May be more effective at lower doses and in more impulsive individuals.	Fatigue, insomnia, restless-ness, anxiety, and deficits in attention.
Ondasetron	A 5-HT3 antagonist that is used to treat nausea and vomiting. May address serotoner-gic dysfunction in early-onset AUD, and may reduce alcohol craving, blocks acquisition and mainte-nance of ethanol self-administra-tion.	Orally	May be suitable for individuals with early-onset AUD.	Generally mild side effects: diarrhea, constipa-tion and headache.
Ibudilast	Suppresses pro-inflamma-tory cytokines, increases anti-inflamma-tory cytokines. In one human laboratory cross-over trial, Ibudilast decreased tonic craving, improved mood during exposure to alcohol and stress cues, and reduced the mood-altering and stimulant effects of alcohol among participants with more severe depressive symptoms	Orally		Generally well tolerated. Adverse side effects include nausea, vomiting, abdominal pain and diarrhea
Prazosin and Doxazosin	Both act by blocking noradrener-gic excitation of the reward circuitry. Both are used for the treatment of hyperten-sion and benign prostate hyper-trophy.	Orally	Reduces drinks per week and heavy-drinking days among individuals with higher family history of AUD and higher standing diastolic blood pressure. May also be suitable for those with comorbid post-traumatic stress-disorder (PTSD)	dizziness, headaches, drowsiness, lack of energy, weakness, palpita-tions, and nausea
N-Acetylcys-teine	As chronic and binge drinking inhibit excitatory glutamate levels, this drug restores glutama-tergic tone in brain’s reward circuitry.	Orally	Reduces craving symptoms across a number of substance use disorders. Currently being tested in adolescent AUD.	Nausea and diarrhea
Naltrexone (Revia, Vivitrol)	Blocks the pleasurable effects of drinking	orally, taken daily, or as an intramus-cular injection once monthly	For patients engaged in binge drinking and reward seeking	Nausea, headache, weakness, injection site reactions
Acampro-sate (Campral)	Stabilizes areas in the brain that are disrupted by alcohol misuse & withdrawal	Orally, delayed release tablets taken daily. Only known to work with behavioral therapy or peer support	For patients with liver cirrhosis	Diarrhea, upset gastro-intestinal system
Disulfiram (Antabuse)	Prevents alcohol use by causing extremely unpleasant side effects when alcohol is ingested, e.g. vomiting, headaches.	Orally, taken daily, or as a subdermal implant	Only for highly motivated patients	Drowsi-ness, headache, metallic taste
Semaglu-tide (Rybelsus)	see details in section V below	Orally	Originally developed for the treatment of obesity and diabetes	Nausea, Vomiting, Diarrhea, Stomach (abdomi-nal) pain, Decreased appetite, Consti-pation.
Liraglutide	see details in section V below	Orally	Originally developed for the treatment of obesity and diabetes	Nausea, Vomiting, Diarrhea, Stomach (abdomi-nal) pain, Decreased appetite, Consti-pation.
Topiramate (Not FDA approved), (Topamax, Trakenol, Qudexy)	Anti-seizure medication sometimes used to treat AUD. May encourage moderation & help with mood, anxiety & weight loss	Orally, taken while drinking	For patients that want to cut down on their drinking, but not stop altogether. May help with pain & anxiety	Cognitive dulling, word finding difficulty, ataxia, parasthesia
Gabapentin (Not FDA Approved), (Gralse, Horizant, Neurontin	Anti-seizure medication to decrease number of drinks & number of heavy drinking days	Orally, tablet or liquid forms, taken daily	For patients that want to cut down on their drinking, but not stop altogether. May help with pain & anxiety	Sedation, dizziness, weight gain

III. Medications for Opoid Use Disorder

Medication (and brand names)	Mode of action	How taken	For Whom	Side effects
Injectable Naltrexone (Vivitrol)	Blocks the pleasurable effects of opiates to reduce the likelihood of relapse & opiate overdose	Intramus-cular injection once monthly	For patients that may struggle to remember to take a daily medication	Nausea, headache, weakness, injection site reactions
Buprenor-phine (Buprenex, Bulbuca, Butrans, Probuphine, Subutex)	Prevents opiate withdrawal & cravings, also blocking against opiate overdose	Orally, take daily or transder-mally (skin patch) worn daily.	For patients with low likelihood of misuse potential	Headache, dizziness, trouble sleeping, tingling sensation
Buprenor-phine + Naloxone (Suboxone, Zubsolv, Bunavil)	Prevents opiate withdrawal & cravings, also blacking against opiate overdose. The added naloxone decreases the misuse potential	Orally – sublingual tablets or films taken daily	For patients with opioid use disorder with access to an office-based licensed prescriber. Misuse potential.	Constipa-tion, dizziness, drowsiness, headache
Methadone (Dolophine, Methodose)	Prevents opiate withdrawal and cravings, but at prescribed doses, does not create opiate-like effects.	Orally – taken daily, admini-stered by a SAMSHA certified treatment program or clinic	For patients with the proximity & availability to attend a clinic daily. Misuse potential	Sleep problems, anxiety, restless-ness, dry mouth, nausea, decreased sex drive.
Naloxone (Narcan)	Counters the effects of an opiate overdose	Injection or oral spray – admini-stered only during an overdose emergency	For opiate users during an overdose.	Chest pain, shortness of breath, nausea, headache, anxiety, confusion

IV. Medications for Nicotine or Smoking Cessation

Medication (and brand names)	Mode of action	How taken	For Whom	Side effects
Nicotine Replace-ment Therapies (NRT)	Aids in smoking cessation by providing similar effects of tobacco use to decrease cravings, tapering or decreasing dose over time	Patches, gum, lozenges, nasal spray & inhalers	For patients seeking to quit smoking by means of satisfying nicotine cravings over time	Racing heartbeat, headache, nausea, throat/skin irritation, nervous-ness.
Varenicline (Chantix)	Gives mild nicotine-like effects & eases symptoms of withdrawal. Neutralizes the effects of nicotine if patient smokes while taking this medication	Orally – taken daily for 12 weeks	For patients seeking to quit smoking by means of a 12-week medication program	Trouble sleeping, vivid dreams, headache, nausea, gas, behavioral changes
Buproprion (Welbutrin, Zyban, Buproban, Fortivo)	Aids in smoking cessation by reducing the severity of nicotine cravings & withdrawal symptoms. Also functions as anti-depressant	Orally – variety of doses & release patterns	For patients who smoke 10 or more cigarettes per day. May be used in combina-tion with NRT	Increase in risk for dry mouth, nausea, vomiting, weight gain/loss, stomach pain

V. Semaglutide and Liraglutide were originally developed for the treatment of type-2 diabetes and obesity. How did they end up here, among medications for the treatment of alcohol use disorder?

Semaglutide (AKA Rybelsus) and Liraglutide are Glucagon-like Protein-1 Receptor agonists, which have multiple targets and effects:

As food enters the small intestine, cells in the small intestine secrete GLP-1, which then affects the stomach, brain and pancreas:

• Gastric emptying in the stomach slows down;
• Various parts of the brain are affected resulting in a reduced appetite; and
• The pancreas is stimulated to secrete insulin to remove glucose from the bloodstream, but is inhibited from secreting glucagon

Among humans, some variants of the GLP-1 receptor gene are associated with AUD. Furthermore, these variants in the GLP-1 receptor gene have been shown to be involved in many pathways related to craving and reward.

It stands to suggest that the use of a drug which enhances or mimics the effects of GLP-1 may exert a beneficial effect on individuals diagnosed with Alcohol Use Disorder, AUD.

In fact, Lahteenvuo et. al. (2025) did that with a study of 227,866 individuals diagnosed with AUD in Sweden between January 2006 to December 2023. Of them, 6,276 also used one of three GLP-1 agonists, including semaglutide, liraglutide, and dulaglutide.

All individuals who were thus diagnosed with AUD were monitored from initial AUD diagnosis to death, emigration or end of data linkage, whichever came first. The main outcome measure was hospitalization due to AUD. Secondary outcomes were hospitalization due to substance use disorder (SUD), hospitalization due to somatic reasons, and hospitalization due to suicide attempt.

Of the 227,866 individuals in the study, 133,210 were hospitalized because of AUD and 138,390 because of any SUD at least once. Use of semaglutide was associated with the lowest risk of hospitalization and liraglutide was associated with the second lowest risk.

Furthermore, a total of 83,166 individuals were hospitalized for somatic reasons and 22,231 for suicide attempt. Use of semaglutide was associated with the lowest risk, and use of liraglutide with the second lowest risk of somatic hospitalization. Use of either of these drugs was not associated with a statistically significantly altered risk of suicide attempt.

Burnette, E.M.; Nieto, S.J.; Grodin, E.N.; Meredith, L.R., Hurley, B., Miotto, K., Gillis, A.J.; Ray, L.A. (2022). Novel Agents for the Pharmacological Treatment of Alcohol Use Disorder. Drugs 82:251-274. https://doi.org/10.1007/s40265-021-01670-3.

Lahteenvuo, M.; Tiihonen, J.; Solismaa, A.; Tanskanen, A.; Mittendorfer-Rutz, E.; Taipale, H. (2025). Repurposing Semaglutide and Liraglutide for Alcohol Use Disorder. JAMA Psychiatry 82(1):94-98. doi: 10.1001/jamapsychiatry.2024.3599.

P.S.: The song is called “Antabuse”:

P.P.S.: “I overdosed on you”, Bon sez…