Pharmacotherapy

1) Opioid Dependence Methadone-federally regulated through Opioid Treatment Programs, opioid receptor agonist for substitution therapy Buprenorphine-office based opioid treatment or Opioid Treatment Programs, federally regulated, partial opioid receptor agonist for substitution therapy Naltrexone (extended release naltrexone)—office-based and substance use treatment programs when opioid abstinence is possible and without significant relapse risk, opioid receptor antagonist for relapse prevention

2) Alcohol Dependence Naltrexone (extended release naltrexone)—an “anti-craving” agent, opioid receptor antagonist, reduced reward effect, with daily use, new forms are long acting Acamprosate—an “anti-craving” agent that normalizes glutamatergic neurotransmission, slow acting, attenuates relapse Disulfiram—a “vicarious” aversive medication supporting complete abstinence to alcohol that blocks complete oxidation of alcohol with accumulation of acetaldehyde and resultant unpleasant “allergic” physical symptoms when alcohol is absorbed (e.g., flushing, headache, and vomiting).

3) Nicotine Dependence a) Nicotine replacement therapy, many over the counter, such as patches, gum and inhalers used to replace the daily physical requirement for nicotine and may be used for nicotine withdrawal or maintenance.

b) Buproprion—an antidepressant also found to be an “anti-craving” agent that reduces the psychological craving for tobacco.

c) Varenicline—a partial nicotine receptor agonist FDA approved for treatment of nicotine dependence and relapse prevention.

Behavioral Therapy

1) Brief interventions-for 1 to 3 visits (low intensity), for early drug use and substance abuse, in many different outpatient settings 2) Motivational enhancement interviewing and therapy 3) “12-step” facilitation 4) “stage of change” model interventions 5) Long term multi-modal and multi-dimensional comprehensive therapies and interventions—to restructure belief and cognitive systems, enhance coping strategies, change friendships and environment, and change behavior

1) Individual interpersonal therapy such as cognitive behavioral therapy and insight-oriented psychotherapy 2) Group therapy—such as family or faith based, Therapeutic Communities 3) “12-step” programs and “clean and sober” recovery living environments where peer groups interested in sobriety mutually help one another stay sober