Pharmacotherapy

Blocking Agents:

Naltrexzone is a medication that blocks the effects of drugs known as opioids (a class that includes morphine, heroin or codeine), alcohol and nicotine. It was also found very effects in many compulsive behaviors including pathologic gambling (PG) and internet addiction. Naltrexzone competes with these drugs for opioid receptors in the brain. It was originally used to treat dependence on opioid drugs but has recently been approved by the FDA as treatment for alcoholism. In clinical trials evaluating the effectiveness of naltrexone, patients who received naltrexone were twice as successful in remaining abstinent and in avoiding relapse as patients who received placebo-an inactive pill. Naltrexone blocks action of heroin and other opiates and helps treat the addiction and diminishes cravings.

At NaltrexZone hospital, Belgrade we use depot forms of naltrexone (implants). This method of administration has been far more reliable and superior than 50 mg naltrexone tablets. Implants are placed in the subcutaneous tissue under local anesthesia. Naltrexone implants provide steady level of medication in the bloodstream during the life of an implant. We use implants that last three, six and up to twelve months. Dr. O'Neal and his specialists at the University of Western Australia and are currently working on the 24-month implant and once new formula is approved we will offer it to our patients.

At NaltrexZone hospital, Belgrade we use depot forms of naltrexone (implants). This method of administration has been far more reliable and superior than 50 mg naltrexone tablets. Implants are placed in the subcutaneous tissue under local anesthesia. Naltrexone implants provide steady level of medication in the bloodstream during the life of an implant. We use implants that last three, six and up to twelve months. Dr. O’Neal and his specialists at the University of Western Australia and are currently working on the 24-month implant and once new formula is approved we will offer it to our patients.

Considering that alcohol and nicotine express their addiction potential by stimulating endogenous opiate receptors, blocking those receptors with naltrexone helps treating alcohol and tobacco dependency.

Substitution therapy:

The goal of substitution therapy is to replace street opiates (heroin) with buprenorphine. Methadone was used for this purpose in the past and is still being used in some countries. Many addictologists no longer use methadone and consider this treatment outdated.

Naltrexone therapy is used in the treatment of opioid addiction. Opioids are semi-synthetic and synthetic substances with effects similar to those of opiates, such as methadone, buprenorphine, narcotic analgesics, heroin etc.

Duration of substitution therapy varies from a few weeks to a few years. Several factors determine the duration of such therapy. They include: the type of substance abused, family support, individual's maturity level, ability to find a job, financial capabilities, social support systems, etc.

Buprenorphine DOES NOT cause the feeling of euphoria which is at the core of the addictive power of heroin and other opiates. The majority of patients who have experienced the effects of buprenorphine claim that it eliminates the desire to use heroin and, most importantly, patients feel that they have returned to the "normality" of life.

Substitution therapy is administered in three phases:

• Induction
• Stabilization
• Substitution

1. In the induction phase (3-4 days)- we determine the dose necessary to prevent a withdrawal syndrome.

2. Stabilization phase (period of 2-3 weeks)- we adjust the dose depending on the presence or absence of cravings.

3. During the substitution phase (continuous treatment)- the dose is determined only as a biochemical basis for psycho-social rehabilitation. Substitution therapy with Suboxone is safe. One consideration for its use is pregnancy, since it has not been extensively tested. These pharmacological properties must be presented to the patients and their family.

Deterrent therapy:

This therapy is most frequently used for the treatment of alcoholism. After careful evaluation, our physician can administer disulfiram (antabuse) with great caution. This medication disrupts alcohol metabolism by blocking an enzyme leading to accumulation of acetic acid in tissues. If, during the treatment, patients with alcohol problem consume alcohol they will experience severe "hangover" (pulsating headache, flushing, tachycardia, nausea, vomiting, confusion). Disulfiram also blocks the dopamine metabolism causing unpleasant effects in the cocaine addicts. This is an advantage particularly since cocaine is commonly combined with alcohol.

Details about deterrent therapy are presented to the patient before initiation of treatment. Simply put, by taking this medication, the patient consciously puts a chemical barrier to consuming alcohol. By doing so this adds additional strength to the weakened willpower in maintaining the abstinence. With time and psychotherapy, abstinence becomes regular.