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June 23rd, 2008
01:39 PM ET

Rehab medication

By Caleb Hellerman
CNN Medical Senior Producer

When it comes to drug and alcohol addiction, we all know the way to get clean is through the 12 steps, and if you can afford to check yourself into rehab, all the better. If Amy Winehouse can just stick it out in the hospital, she’ll be fine.... right? We “know” these things until we hear from people like Dr. Mark Willenbring, who runs the division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism.

Dr. Willenbring is full of surprises. For one thing, he told me that for most people, “rehab” – a hospital stay - doesn’t work any better than outpatient treatment. A scary thought for those pricey centers to the stars, where a stay can top $40,000 a month.

He also likes to talk about medication, which gets touchy. Last year on Larry King Live, Willenbring argued with Susan Ford, chair of the Betty Ford Center in Arizona, after she said she’s still waiting for evidence that medication is helpful in fighting addiction. The Ford center isn’t alone; I’ve talked to several people who went through prominent treatment centers who say the option of medication was mentioned either very little, or not at all.

But Willenbring says a therapist who doesn’t believe in using medication to treat addiction is like a cardiologist who doesn’t believe in using drugs to lower blood pressure. Every case is different, but in clinical studies, two drugs - naltrexone and topiramate - have been shown to sharply improve the effectiveness of treatment. They seem to work best in conjunction with therapy, but Willenbring says in 20 years we’ll largely treat addiction the way we treat depression now – in an outpatient setting, often by a primary care doctor and often with a pill.

Have you ever struggled with addiction? How did you get clean?

Dr. Willenbring will be part of an upcoming Dr. Sanjay Gupta Special Investigations Unit hour on new treatments for drug and alcohol abuse.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


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soundoff (25 Responses)
  1. GF

    Isn't Dr. Willenbring substituting one drug addiction for another? We already have people hooked on prescription drugs so how will this be any different?

    June 23, 2008 at 13:57 | Report abuse | Reply
  2. Carol P.

    If medication can help someone get off of alcohol and the benefits are positive (ie staying off alcohol) it should be used. My husband died 10 years ago from Cancer related to his alcohol consumption. He went through detox 3 times in an inpatient setting and several times at home with him hallucinating. It is sad to watch someone killing themselves when a medication could have saved them.

    June 23, 2008 at 14:50 | Report abuse | Reply
  3. DM

    After doing some research and talking with my doctor I started using the anti-depressant Wellbutrin to help me with addiction problems. I can honestly say it has made a big difference in dealing with addiction, and my overall quality of life. I just don't feel like drinking or doing drugs anymore, and for that I am greatful. As far as trading one addiction for another...Wellbutrin will never make me drive erratically and risk mine and other innocent peoples lives. Wellbutrin doesnt cloud my mind and help me to make bad decisions. In fact, it makes me think more clearly,and overall makes me a much happier person.

    June 23, 2008 at 19:34 | Report abuse | Reply
  4. Mary T.

    Naltrexone is a miracle drug. I can't help but think of all the years I wasted and struggled trying to get sober in self flagellating AA meetings when there was a drug that cured the disease for me. Its amazing, I finally had an 'off' switch thanks to the makers of this drug.

    June 23, 2008 at 20:15 | Report abuse | Reply
  5. A Mom

    He is absolutely correct. Heroin addicts use Methadone to kick the habit and then kick methadone. (it worked for my daughter) 5 yrs clean.

    Prozac and Xanex cured me of drinking. 5 yrs clean

    June 23, 2008 at 21:18 | Report abuse | Reply
  6. Cammy S. Kinstedt

    As a bi-polar alcoholic, I tried to kill myself. Anyone who is bi-polar will not think too much of that...it is part of the disease. When I came around after my aborted attempt of killing myself, I was given an ultimatim from my boyfriend – him or the booze which was seconded by two of my doctors. So, I went to AA, and prayed like I had not prayed in a long time. I worked the 12 steps and had a few incidents of white knuckles when I forgot the Serenity Prayer. I have over 2 years of clean abstinence – with no special pills to sustain me. I do have a new insight into my life compliments of the AA program. The dark manic depressions are gone – I still get a little blue at times, but nothing like they were. Life is good and I attribute that to coming clean, staying clean,and the love of a good man. – Cammy

    June 23, 2008 at 22:22 | Report abuse | Reply
  7. Jim

    I agree that different strategies work for different people. I have a friend that tried various methods to quit smoking and it was a pill that finally did the trick for him. I didn't think I would ever stop drinking. At age 54, I couldn't think of one single full day that I went without drinking. I was drinking a 30 pack of beer every 2 days (ever since they came out with 30 packs). My hands were shaky at times and by 7 or 8PM my speech was often slurred. I was also taking Paxil and Lorazapam daily to prevent panic attacks. Then, last December, I fell down the basement stairs and banged myself up pretty badly. I fractured my scull, collar bone and a couple of ribs. I was unconsious and bleeding from my ears, lying in a heap at the bottom of the stairs. My wife called an ambulance and Ispent the next 2 days in the hospital and then insisted on being discharged. I haven't had a drink since and there haven't been many times that I've even thought about it. I guess I'm thinking about it right now or I wouldn't be here! They say youv'e got to hit bottom before you can quit drinking and get better. For me, it was the bottom of the stairs.

    June 23, 2008 at 23:08 | Report abuse | Reply
  8. JR

    I've been on naltrexone for almost 10 months now for alcoholism and it has been working very well for me (no drinks, no cravings). I was a heavy drinker for almost 20 years and never would have gone the 12-step or 'therapy' route. This medication may end up saving my life.

    June 24, 2008 at 04:17 | Report abuse | Reply
  9. Alex

    I went outpatient rehab when I was 18 for addiction to cocaine and ecstasy (ridiculous i know), i decided to do this rather than in patient because I had just finished my first semester at school and desperately wanted to continue school. With drug testing 3 times a week for 6 months and therapy 3 times a week I managed to kick my addiction within a year. I didn't use any sort of detox miracle drug, mostly because i felt treating a drug addiction with another drug made no sense. Will power and support was my "anti-drug". I know this isn't as easy for others struggling with alcohol and opiate addiction in which withdrawl can be fatal (those cases are an exception to my point), but I think people should be more open to recovery without the help of other drugs. You learn a lot about yourself with a complete clear head, and during recovery you need to have a clear head. I've been clean since January 3rd 2006, and I just wanted to share my story.

    June 24, 2008 at 10:19 | Report abuse | Reply
  10. Erin

    I think it would have been best to explain what naltrexone (opiod antagonist, used for overdose and will prevent a user from being able to get high if they were to use while on it, also, naltrexone assists with the behavioral parts of opiod withdrawl) and topiramate (an anti convulsant). Alcohol withdrawl is dangerous and the detox portion should be medically monitored. Opiod withdrawl isn't a fun experience either. Trading one addiction for another is incorrect. These two medications can save their lives and increase the liklihood of a successful recovery. As a drug addict and alcoholic in recovery I'm an advocate for medication during detox and the first stages of recovery coupled with mental health and AODA counseling, determined on a case by case basis. It's another thing that people who are not addicts do not understand. It is not as easy as "just not using."

    June 24, 2008 at 11:14 | Report abuse | Reply
  11. maxwell

    Whatever makes your life better. I used Suboxone in conjunction with the other "traditional" methods to get clean. Only used the medication for two months but it was crucial to my recovery. If the way of treating addcition in the future is medication taken life long....then so be it.

    Whatever keeps and addict/alcoholic above ground and happy. right?

    June 24, 2008 at 13:24 | Report abuse | Reply
  12. Lynda

    Yes, and most of the folks being treated for depression with a pill stay in treatment and on a pill, changing from one pill to the next, until they finally realize that they NEED therapy as well. Some need therapy and medication, others just need therapy.

    June 24, 2008 at 13:42 | Report abuse | Reply
  13. Sandra

    My brother has severe and constant pain from a back injury. He is still able to walk, sit, and stand; but only for short periods. With pain medication he does better, but the doctors have treated him with the same medication for more than five years and now they tell him he's an addict because he's addicted to the pain meds. I sincerely believe he could beat the addiction if he had something else for the PAIN!!! The doctors don't offer him any alternatives... they will give him something to help him through the withdrawals, but as to the back pain, he's supposed to take tylenol. That doesn't work and hasn't for a long time. That's why he needed stronger pain killers in the first place. He is on MediCal and the only local doctors who accept it are the ones at the clinic. He has even tried going to another city, but they get the reports from the clinic here. Any suggestions?

    June 24, 2008 at 15:15 | Report abuse | Reply
  14. michael

    Speaking as some one who went through rehab and whos drug of choice was prescription drugs. I think that those same drugs being talked about does the same as an anti-deppresent does. Helps lesson the affects of depression and ocd. However i would be very interested in seeing some research on this topic. I believe that the 12 steps of alcholics anounomous will keep me clean and sober.

    June 25, 2008 at 17:02 | Report abuse | Reply
  15. Elizabeth Smith

    I was a heroin addict for many years. Thank God for Methadone.
    Now, I know it is addictive but taken for short period of time, it's a life saver. It enables you to stop and focus on your life, get back to work
    and start living a normal life again. I did not participate in a 12 step program. I just stopped taking anything addictive. I have been clean for 20 years and proud of it. I am not saying medication is the way to go but for some people it is a last resort.

    June 26, 2008 at 03:19 | Report abuse | Reply
  16. Lee, Yorktown Virginia

    The drugs that are used to treat depression, now, do not work for more than half of people. Comparing future drugs for addiction to current drugs for depression isn't very reassuring.

    June 26, 2008 at 11:14 | Report abuse | Reply
  17. JL

    Stopped drinking, went to meetings, toughed it out! THANK GOD i didn;t go to Rehab and get out knowing it all and on meds. It's been over 18 years and I've never seen that rehab provides any advantage. Sooner or later one must face oneself and put froth some effort there is no easy path.
    I am, however, a staunch supporter or medications for mental disorders that increase or interfere with addictive behavior such as BiPolar, schizophrenia etc......

    June 26, 2008 at 11:27 | Report abuse | Reply
  18. Lauren R.

    Caleb,

    I don't mean to underemphasize the dangers of crack addiction on the lungs–but this would be a great point in time to talk about antitrypsin definciency emphysema, one of the most commonly underdiagnosed and inherited gene problems among Caucasians, because one of the most telling symptoms is the acquisition of emphysema in persons much younger than normally would be expected to get emphysema, and it is treatable with IV therapy. And I just gotta wonder if Ms. Winehouse has been checked for this? It's only a simple blood test. Thanks for letting me tell people about antitrypsin deficiency emphysema.

    June 26, 2008 at 21:36 | Report abuse | Reply
  19. Patti Spring Lake NJ

    I tried everything. I was went to five rehabs, tried AA, spiritual healers, hypnotism, antidepressents as well as campral and the pill form of naltrexone. I have been receiving a monthly shot of VIVITROL and have been sober for over 8 months now. I am living a normal like now and I thank God for VIVITROL every day. It has taken away my desire to drink. It is my miracle! You just get the shot and forget about it , no pills to remember to take. I wish more people knew about it. Hopefully you can get the message out there when you have your special on TV.

    June 27, 2008 at 07:51 | Report abuse | Reply
  20. SAY

    Kicking addiction is in done in-between the ears and with a complete change in your behavior...................you can't think your way into sober living................you have to live your way into sober thinking....a phrase right out of an AA meeting. You can't just change your thinking.....via a pill.......you have to change your behavior....radically! There is absolutely no way that a pill can help the recovery process, except during the detox process. From then on....its up to the individual to give up, hit their knees, , change their playground and playmates and suit up and show up to AA meetings every single day for years. However, I do believe if there is an underlying mental illness or brain chemistry imbalance such as manic depression, chronic depression, bi-polar disorder, etc. that the ancillary addition of prescribed medication is warranted. AA literature addresses that.

    Good luck and God Bless to all those recovering alcoholics who have been to Hell and have come back to us.....and for those active alcoholics who have not yet found their way.

    SAY – ATL

    June 27, 2008 at 09:28 | Report abuse | Reply
  21. Michael

    People who have dual diagnoses (depression & drugs, bipolar and alcohol) should not try to "white-knuckle" their sobriety without checking with a doctor. Many underlying psychiatric disorders are chemical imbalances that no amount of AA can cure: that being said, it's a chicken-or-the-egg proposition–I've seen many people eventually be able to go off their meds after a long, healthy period of sobriety. Relying on antidepressants or bipolar medication is not copping out–however AA would usually discourage certain forms of drugs–anti-anxiety agents, for instance, can be abused. The jury is still out on antabuse and other drugs that claim to help alcoholism–the disease is definitely not just a physical one, but a mental and spiritual one as well and and long-term sobriety is usually doubtful without the kind of whole-life transformation that AA espouses (although one day at a time!). I myself had so many issues (bipolar, social phobias, and an eating disorder) that I was simply unable to even get myself to AA until I had the short-term support of medication. It's a complicated issue, and I wish more physicians were as informed as they should be. I can't tell you how many MDs gave me the wrong advice and the wrongs meds.

    June 27, 2008 at 13:38 | Report abuse | Reply
  22. Sylvia

    Response for: Sandra June 24th, 2008 3:15 pm ET

    Sandra I hope this information is helpful to your brother with back pain. I broke my back 27 years ago. At the time there wasn't anything developed to repair my type of injury. Today there is. Anyway, 5 years after dealing the chronic pain from that injury, I entered a pain management program @ Cedar Sinai Hospital in Los Angeles. It was under development. This wasn't developed for drug addiction as we know it, but for the purpose of helping patients understand the influence we each have on our own health and comfort.

    I had a team including a medical doctor, physicatrist, physchologist, dietician, pharmacist, nurse, physical therapist, occupational therpist, bio-feedback therapist and myself, the patient. There was a weekly meeting to set and agree upon goals. The medication strength that patients used was converted to a liquid form and combined with a syrup. Every couple of days or so the strength was weakened as the patients strength was regained via the other therapies and patients efforts. I found it to be very empowering and I was quite successful.

    Subsequently, 12 years ago i was reinjured. My back eventually broke more severely & my neck was near breaking. I have had 4 spinal surgeries to stablize my spine.

    It was extremely difficult trying to find a pain program that incorporated the same theories as before. Though there are thousands of "pain management" programs available, I found that they are prone to putting the "management" into the hands of doctors who write prescriptions for very addictive drugs too freely, rather than addressing the cause of the pain. This process continues as long as the insurance company will pay. The moment it is no longer covered, the doctors won't even speak to the patients.

    Strengthened from my own experiences, I remained persistent & was referred to Rehabilitation Pain Management @ Long Beach Memorial. There are approximately 30 programs similar to this in the US. I suggest your brother seek out this type of program. They acknowledge and addresses the physical causes of pain as well as a holistic approach to put the power back into the hands of patients. The doctors @ RPM specialize in pain psychology and have a team that recognize the physical manifestations of pain as they relate, not just to the physical reasons, but frustrations and compiliation of challenges that increase pain and offer thereapies to assist the body in releasing the accumulation of symptoms. This is similar to the program I participated in 27 years ago.

    There is an increase of pain receptors in the brain that deveop with prolonged use of pain medication, so just stopping isn't realistic and and can be quite dangerous. A gradual decrease under the supervision of a doctor who specializes in this is crucial. There are the physcological fluctuations that come with withdrawls and again a doctor who specializes in and participates in the team effort is crucial as well in supporting the patient through the physiological changes that come with transitioning to being drug free, but continue to cope with the causes of physical pain. When an injury exists, covering it up with pain medication doesn't fix a thing, it just hides it which can lead to the worsening of an injury because a person can't assess their limits correctly. Those causes need to be addressed and treated also.

    You mention that he is on MediCal, so it probably it won't be covered. If I were him, and I'm pretty much am, I'd get a referral to RPM or a program closer to him, then unceasingly petition & appeal Medi-Cal to get it covered. The squeaky wheel gets the oil. Seek organizations who can help him with that or to help him find a way to fund it. Each success will be empowering and each challenge overcome can offer him more strength. He could research this type of pain management and find a doctor within the parameters of MediCal that is willing to work with him to create a real plan that empowers him rather than continues to challenge & weaken him with med only treatment. It's a difficult place to be, but not an impossible place to rise from.

    For those who say nothing else can be done regarding pain control except using meds, try to recognize those are people who just don't know "what" can be done. That's all. I have overcome very serious life altering challenges for myself as well as for one of my children that are viewed as miraculous because I recognized those who didn't have answers, just meant "they" didn't have the answer. No one person does anyway. By refusing to accept those limits for myself, my children and our future, our quality of life is better than it would have been had I surrendered to the opinions of others, however well meaning. To you and your brother remember there is always something that can be done, either you just haven't found who knows what it is, or just have not found a way to create or develop it.

    My opinion summarized: Take back your power, find a program or create a plan with a qualified medical/holistic team to safely decrease meds and uses various methods that support all parts of your health and well being. I hope this was helpful to you as well as to other readers.

    June 27, 2008 at 14:00 | Report abuse | Reply
  23. Darren

    This is the paradox of 'freedom'. To rid ourselves of self-medicating habits, we submit to another chemical routine.

    The problem with outpatient procedures is that it leaves the addict with the responsibility to keep from backsliding once they are out of refills.

    If we truly wanted to be responsible about it, perhaps we would encourage a progressive process complete with therapy. Through therapy, they might learn alternate behaviours to break the connection between 'triggers' and their detrimental habits.

    Even though we say we treat depression as an outpatient procedure, far too many doctors are content to prescribe the medication without treating the underlying cause.

    Medications of this type are most commonly facilitators which allow someone to learn to cope. As a crutch, it's not necessarily supposed to be permanent.

    Like any rehabilitation, it's something you have to continue to work at. It will be hard, but that's life.

    June 30, 2008 at 09:51 | Report abuse | Reply
  24. margaret

    After smoking a pack a day for over 40 years and making numerous attempts to quit, a relatively new medication called Chantix finally did it. It actually makes your brain unresponsive to the nicotine by blocking dopamine receptors (I think), I've been smoke-free for 10 months and am finally able to say that without wanting to start smoking again. I stayed on the Chantix for 6 months instead of the 3 months recommended by the drug company. They also have a pretty good online support program. It is a bit pricey and, of course, not covered by any insurance, but worth it for sure. Only time will tell,

    July 4, 2008 at 07:43 | Report abuse | Reply
  25. Channe

    I work for a private Dr who does detox with the Suboxone and Subutex and it has been a mircle drug for those who reallly want to be clean, and just another addiction for those who really do not put 100% into changing there lives, and therefore the medication can just become another addiction.

    There is no quick fix, Suboxone is like a stepping stone for get you through the first part of withdrawals when you are really sick from withdrawals.
    This medication will stop sickness,cravings, and you will feel 110% normal, better then you ever felt on whatever you were addicted too..

    But if you stay on Suboxone too long, it becomes a crutch, sooner or later you will have to learn to deal with cravings, and saying NO and the longer you stay on Suboxone the harder it will get to finallly get off and DO THE LIFE CHANGING WORK TO STAY CLEAN.

    July 10, 2008 at 11:22 | Report abuse | Reply

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