An addictive personality has a substance of choice, or many substances. Should a clinician add another medication with possible risk of addiction? This is an excellent question that has many twists and turns. At all times the patient’s health is of the utmost importance. With that in mind one needs to look at benefit versus risk ratio. It clearly depends on the substance of choice, length of time of abuse, tolerance level, and age of the patient, kidney function, liver function and dedication towards treatment.
Recently I treated an individual, who was addicted to cannabis. Every time he stopped, he would break into a full blown panic attack. Xanax XR at 1mg. a day for one month with a slow taper over the remaining three weeks helped him stop. There was no residual effect and after six months, remains clean, voluntarily committing to urine screens. Of course, all is not this easy on the addictive front lines.
Alcohol detoxification is another ballgame. Years ago some physicians would detoxify with Valium 5-10 milligrams, two to three times a day. If the patient stopped suddenly, it would not be uncommon for a seizure to occur. Librium became somewhat of a safer drug of choice; however, similar side effects could not be unconsidered. Severe alcohol detoxification should occur with inpatient treatment. There are tighter controls over the patient and compliance with medication. Benzodiazepines are still used effectively with detoxifying alcohol addiction. Rarely should these medications be used on an outpatient basis. Medications have their place, and can be used safely. There needs to be an understanding of the trust distrust issue with any addictive personality. All too common the health care provider is at fault as well as the patient.
Patients can be manipulative, and come up with a variety of symptoms should they become addicted to the medications they use to get off an addictive substance. I have even encountered patients who feign kidney stone pain by slightly cutting their finger, putting a drop of blood in their urine for a specimen to help confirm a stone. This is done just to try and get more narcotics.
Pros of medication for detoxification:
1. Helpful in the withdrawal state
2. Depending on the severity, crucial in reducing physiological pain and psychological symptoms.
3. May reduce the time of dependence.
4. Inpatient treatment best as opposed to outpatient.
5. Save the patient money and time from work lost.
Cons of medication for detoxification:
1. Risk addiction and or dependence on new medication used.
2. Can affect liver and kidneys.
3. Sedation and potentiating the affects if the patient continues the abuse.
4. Sudden stoppage of medication can result in moderate to severe side effects.
5. Can be expensive, especially if admission required.
There are always pros and cons of all treatment interventions, not just with addictions. There is no one black and white treatment modality. Good judgment, taking each patient as an individual, looking at their drug of choice, age, length of abuse and physical ailments are all important before starting detoxification. One should not close their eyes to the benefits of modern pharmacology, but use good judgment.