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The Ultimate Guide To Drug Substitution

In Europe and the United States, thousands of drug and alcohol rehabilitation programs and facilities use substitute medications in therapy and treatment. Methadone, for instance, has been used for this purpose of decades. Buprenorphine, on the other hand, is made from Subutex and Suboxone and only came into the marketplace recently.

These two types of drugs are both opioids, meaning that they are similar to opium in chemical structure. However, they are effective at preventing the occurrence of withdrawal symptoms when an addict stops using opiate prescription drugs and heroin.

However, even as you look for answers to drug substitution, you should understand that most of these substitute medications are also addictive and come with a potential for abuse. Although they prevent withdrawal symptoms, their effects might also prove to be problematic down the line.

In Europe, some countries provide heroin addicts with the pharmaceutical grade for heroin - a drug referred to as diacetylmorphine. In most cases, when a program fails to provide lasting recovery from drug and alcohol abuse and addiction, the doctors often resort to the last-ditch effort by reducing the harm done when the patient is addicted to opiates.

Currently, several pharmaceutical companies have been developing drugs for use in recovery therapy among those who are addicted to such stimulants as study drugs (namely Adderall and Ritalin), methamphetamine, and cocaine. However, this begs some questions. What is drug substitution? How does it work? Why are these substitute drugs needed if there are other alternative treatments?

Understanding Drug Substitution Therapy

Drug substitution - otherwise referred to as drug replacement or drug maintenance therapy - has a long history in providing patients struggling with addiction and problematic drug and alcohol use with legal access to those drug they would otherwise obtain illegally.

Today, NIDA (the National Institute on Drug Abuse), SAMHSA (the Substance Abuse and Mental Health Service Administration), the Institute of Medicine, the World Health Organization), and the Centers for Disease Control and Prevention all rely on research to determine the effective of treatments.

Today, all of these organizations have relied on more than 40 years of government-funded and peer-reviewed medical research to repeatedly and unequivocally prove that drug replacement therapies - such as methadone maintenance - are effective at dealing with drug and alcohol dependence.

More particularly, the practice of replacing drugs and alcohol with other safer drugs is expected to create a similar psychological or clinical effect. To this end, drug substitution - also referred to as drug replacement therapy - refers to the practice of prescribing and administering specific medications to help addicts quit or withdraw from another substance.

Among these types of treatments, the most common replacement therapy revolves around the use of methadone to deal with heroin addiction. This drug substitution will be discussed later on.

However, like with any other kind of treatment, drug replacement therapy has sparked some controversy. This is because some people object to the act of switching one addictive substance for a drug - especially in those cases where the patient is young and they have been dependent and addicted for a relatively short time period.

That aside, drug substitution is now being used both for the detoxification period to help addicted patients withdraw from opiate medications and alcohol (among other addictive substances) with fewer or less extreme withdrawal symptoms.

Where this type of drug replacement therapy is administered, patients are typically weaned from the substitute medication over the course of the first 7 to 10 days following treatment.

The other names used for drug substitutions include, but are not limited to:

Why Substitute Drugs?

The use of clinically-oriented pharmaceutical personnel to implement drug substitution among other rehabilitation interventions is crucial to the changing of drug use and abuse behavior. However, many countries frequently overlook this important option.

Trained clinical pharmacists working at both short-term and long-term drug and alcohol rehabilitation facilities have the skills required to evaluate, monitor, diagnose, administer, and make recommendations on how substitute drugs are used as treatments for addiction.

Further, this type of replacement drug therapy is effective because it:

Currently, more than 8 million people in the US alone meet the medical and diagnostic criteria for drug and alcohol dependence and addiction. Another 6 or more million meet the criteria for substance abuse.

As a result, substance use disorders are now considered to comprise a major public health concern. It is also ranked fourth among the major causes of disability. Additionally, prescription, over the counter, and illicit drug dependence and abuse are on the rise.

These problems are compounded by the discovery and creation of more potent opiate prescription drugs for the pain relief. These medications include Vicodin (hydrocodone) and OxyContin (oxycodone).

Given the fact that people now have easier access to these drugs through the internet and physicians, it is not altogether surprising that abuse and addiction are so widespread based on recent findings from NIDA.

It is also estimated that the annual cost of alcohol and drug use disorders in the US alone goes over and beyond the $510 billion mark. Further, millions of people suffer or have suffered from the ravages of abuse, dependency, and addiction. Millions more suffer as a result of being related - either by marriage, dependency, family, friendship, or work - to someone who abuses or is addicted to drugs and alcohol.

Luckily, addiction treatment has been evolving extensively over the past couple of years. Whereas the primary treatment methods involve 12-step programs, newer therapies are coming up by the day.

Among these include:

Although there is certainly no magic bullet or cure for substance use disorders, treatment has now been shown to be effective at reducing drug and alcohol use and the associated social and health costs. Drug substitution, in particularly, is less expensive in comparison to other alternatives - including but not limited to incarceration and failure to seek treatment.

In the same line of thought, specialized medications for the treatment of drug and alcohol abuse, dependency, and addiction have also made their way into the arsenal of weapons available for fighting this debilitating condition.

Although this is by no means a new concept, using medications in the treatment of substance use disorders and addiction has great potential. The only problem is that it is quite controversial.

The biggest controversy, not ironically, comes from addicts and patients suffering from a variety of substance use disorders. Most of those in 12-step programs do not believe that anyone can get sober and clean if they are required to use other drugs to get off the substances they are addicted to.

While NA (Narcotics Anonymous) and AA (Alcoholics Anonymous) formally support the use of medications in the treatment of the medical issues and mental illnesses related to substance abuse, most of the people undergoing these programs believe that using medications - particularly mood-altering drugs - may put the user's sobriety in question.

In the same way, most of the new medications used for drug substitution are designed for dispensation in primary care settings - including but not limited to clinics and doctors' offices.

Although they potentially offer greater access to a larger population of addicts while simultaneously decreasing the stigma commonly associated with addiction therapy and treatment, many primary care physicians are reluctant to prescribe these drugs.

This is despite the increasing body of scientific study and research showing that such medications are effective at dealing with substance use disorders. However, some healthcare providers and clients question the value that arises from using drugs to treatment alcohol and drug addiction.

That said, drug substitution works - otherwise it would not be commonly used among so many accredited residential and outpatient treatment facilities both in the long and in the short term.

Common Drug Substitutions

To better understand what drug substitution is, you should consider the different types of addictions and substance use disorders as well as the variety of medications used in their treatment. Read on to learn more:


The medications (used to treat alcohol abuse and dependence) include but are not limited to:

a) Disulfiram (Antabuse)

Also referred to as Antabuse, Disulfiram is ranked among the oldest drugs used to treat alcohol addiction and dependence. This drug was designed to provide alcohol drinkers with unpleasant and aversive effects whenever they take a sip of alcohol.

The medication works effectively because it prevents the body from breaking down alcohol. In the process, it creates numerous unpleasant reactions - which might range from nausea to flushing.

The goal of prescribing this drug is to cause the addict to avoid alcohol because they get to fear experiencing these unsavoury effects. However, no evidence currently exists on this drug leading to longer period of alcohol abstinence or higher abstinence rates.

Further, Disulfiram comes with potentially dangerous and even fatal complications and results. To this end, it is not used for everyone who is trying to quit alcohol. Instead, users are education about how to use it safely before being motivated to do so on a regular basis.

Disulfiram might also work well as an addiction tool of support if you are able to safely use it. When you fear the unpleasant side effects that arise when you combine this drug with alcohol, you may get time to think twice before you take another sip.

This extra time may help you avoid the impulsive drinking that might have been source of your addiction to begin with.

b) Naltrexone (ReVia)

Naltrexone (also referred to as ReVia) was approved for the treatment of alcohol dependence and addiction by the FDA (Food and Drug Administration) in 1994. This was after it was shown to be effective at reducing alcohol intake and the likelihood of relapse.

The drug is a basic opioid antagonist. As such, it works by blocking the effects of most opiate drugs and substances. Naltrexone is also thought to be effective at reducing the behavioral responses to alcohol intake.

It affects several aspects of the alcohol drinking sequence. For instance, taking Naltrexone may lower your cravings, decrease the reinforcement of drinking, and increase nausea and headaches. In the process, it will reduce the amount of alcohol you take.

Studies show that this medication is quite effective at reducing the amount of alcohol addicts take. It also prevents relapse in the case of addiction to alcohol and other intoxicating substances by reducing the cravings you might have for drinking.

The only problem with Naltrexone use revolves around compliance. More specifically, patients may suffer from low motivation and try to avoid the unpleasant side effects that come from using this drug. Others engage in willful neglect or suffer cognitive impairments.

To deal with this noncompliance, Vivitrol (a longer acting injectable form of the drug) was released into the market. Clients typically receive an injection lasting a month instead of having to take the daily oral doses of the drug. This form of Naltrexone is more effective according to recent clinical trial.

c) Acamprosate (Campral)

Acamprosate is also used in the treatment of alcohol dependence and addiction. It works like Naltrexone in the sense that it will reduce cravings for alcohol and prevent relapse.

However, it is different in chemical structure. The drug also comes with agonist effects on the gamma-aminobutyric acid receptors as well as inhibitory effects on the N-methyl-D-aspartate receptors of the brain.


There's also drug substitution for treating opiate abuse, dependence, and addiction. This type of addiction usually comes in two main forms, namely:

The most commonly abused prescription opiates are OxyContin and Vicodin. Addicts often start taking these drugs after a doctor prescribes them only to end up using them in the long term or at a dosage higher than the doctor advised.

At one point, you may become physically tolerant and dependent on the drug. As a direct result, you might continue using and abusing the substances just to avoid their adverse withdrawal symptoms.

Although withdrawal from opiates is by no means life-threatening, it might prove to be unpleasant. Most of these symptoms are flu-like and may vary from the most moderate to the most severe.

Some users will try to quit their opiate abuse and addiction cold turkey with no support or medication. Although some of them are successful, an even greater number may relapse due to their inability to tolerate the withdrawal symptoms or overcome the intense cravings for opiates.

Today, drug substitution is applied to ameliorate these withdrawal symptoms as well as replace the illicit substances. These include but are not limited to:

a) Methadone

Methadone is commonly used in the treatment of opiate replacement and withdrawal. Since the 60s, this drug has helped thousands of addicts quit their opiate dependence altogether or simply replace their drug use (and corresponding behavior and lifestyle) with normal functioning.

Although methadone works well in dealing with some of the withdrawal symptoms you are likely to experience when you undergo opiate detox, it is better known for its credibility in the long-term maintenance of sobriety.

A typical treatment course will involve daily visits to an outpatient drug and alcohol addiction facility or clinic for the single dose of the drug. This dose will offset any withdrawal symptoms and physical cravings you might be feeling.

Theoretically, you should also receive therapy and psychosocial support services. These include drug testing to check that you have been abstaining from using other drugs. Although this might be the desired approach, it is not used in all programs.

The main advantage that methadone maintenance over continued opiate and heroin abuse lies in the fact that you will receive a regular standalone dose of the drug. This means that you no longer have to engage in undesirable or illegal behavior to secure your daily dose. Unfortunately, unless you stay disciplined (or if you are not monitored) and you receive the right psychosocial support, you might continue abusing drugs and engaging in the associated lifestyle.

b) Levo-alpha Acetyl Methadol (LAAM)

LAAM is the main alternative to methadone. It is primarily used as another one of the main drug substitutions for opiate addiction. Some users and doctors also prefer it to methadone because the dosing is less frequent. This allows for fewer visits to the clinic or outpatient treatment facility.

As a direct result, you might be able to better expand your integration into family and work life, as well as the other rehabilitative activities you have been engaging in since you left rehab.

The treatment outcomes for those who use LAAM can be compared to methadone. This is particularly with regards to the reduction of the opioid use, abuse, dependency, and addiction. However, retention rates happen to be higher among those who receive methadone treatments.

c) Buprenorphine

Relatively new, two main forms of this drug have been approved for use in the treatment of opioid abuse, dependency, and addiction. The two drugs classified as Buprenorphine are Subutex and Suboxone - both of which are effective at drug maintenance and detoxification treatment. They are also available as sublingual tablets that you can self-administer.

The outcomes are quite similar to methadone. Some studies also show that these drugs are effective. For starters, clients no longer have to visit registered clinics and treatment facilities several times every week. This increases convenience and access.

However, this also means that clients might choose to avoid the drug or fail to understand the importance of concurrent psychosocial rehabilitation and support. When physicians wish to prescribe the drug, they are required to meet specialized training and experience criteria because it is quite addictive.

That said, most of the patients who receive treatment with Buprenorphine have reported improved results and compliance. This is even in those situations where some have experience failure in the past with regards to using methadone and other treatments as the drug substitution of choice.


When drug substitution is used to protect patients from their heroin addiction, it is referred to as HAT (or heroin-assisted treatment). This type of therapy works best for drug users who have been unsuccessful with methadone.

HAT programs are usually administered as part of a more comprehensive treatment strategy. As such, it is designed to provide substantial benefits to those who have been using heroin over the long haul but have also failed to respond to other types of treatment.

Recent studies show that those who enrolled in heroin-assisted treatments demonstrated a steep reduction in their use of the drug. They also showed a stark improvement in overall mental and physical health.

On the other hand, a number of studies show that individuals participating in these programs reduced their participation and involvement in criminal and illicit activities - thereby generating greater social cost savings.

To this end, heroin maintenance may be the most feasible, efficient, and cost-effective strategy for anyone looking to reduce their drug use or the harm related to the drug among long term heroin abusers. This is particularly true in those situations where other types of treatment have failed.

Does Drug Substitution Work?

Drug replacement therapy is quite divisive in the substance use and addiction rehabilitation community. To better understand its effectiveness - or lack thereof - it is vital that you go through a discussion of the two sides of the argument.

The ideal behind drug substitution is that it is designed to provide long term treatment and maintenance. The most common example is among those who struggle with opioid addiction, some of whom receive prescriptions for methadone. Alternatively, they might be prescribed with Suboxone - another form of DRT (drug replacement therapy).

Consider the following pros and cons:

PROS of Drug Substitution

a) Patient Protection

When heroin and opioid drug users receive an alternative medication, it follows that they do not have to use the illicit/prescription drugs to feed their addiction. In many cases, this means that they no longer need to beg, steal, or engage in any illegal activity to achieve the high they crave.

b) Individualized Treatment

When an addict signs up for drug substitution, it may be easier for them to receive the treatment they require. This has the added benefit of improving their overall health over the long haul. This type of slow but gradual change may lead to additional benefits down the line.

c) Change

Drug replacement therapy may also lead to lasting change. Proponents of this type of treatment believe that there are higher chances of patients seeking rehabilitation when they use alternatives such as Suboxone and methadone as opposed to when they use illicit substances.

d) Easier Withdrawal

Those who are for drug substitution believe that long term recovery is pegged on the management of withdrawal symptoms. Some of these symptoms are so severe that addicts often resume their drug seeking and use to deal with withdrawal.

When an addict struggles with dependency, their withdrawal symptoms might be too severe if they stop using their drug of choice. Abusing opioids over the long term, in particular, may damage the mind and body in such a way that normal life might be hard to attain.

In such situations, drug replacement therapy might be the turning point between certain health and condemning the user to a life of continuous dependency, addiction, or even eventual death.

CONS of Drug Substitution

a) Drug Swapping

However, some say that drug replacement therapy is similar to swapping illegal drugs with legal ones. Among these are those that claim that most of the drugs that are used as substitutes are also highly addictive.

This means that the user might develop dependence on the medication, which will only ramp up the addiction instead of slowing it down. As such, those who are against this form of therapy believe that the drug substitution will not help the addict. Rather, it may even perpetuate their addiction.

Understanding Drug Addiction

While most addicts believe that they only have a problem with one drug or alcohol, the behaviors and thoughts underlying their addiction is common to almost everyone who suffer from substance use disorders.

These thoughts support or lead to addiction. They may include the belief that the substances are the gateway to improved productivity, greater creativity, a source of stress relief or relaxation, or even as the perfect salve for painful emotional states. Others use drugs as respite from the boredom of daily living.

The behaviors that support or lead to addiction, on the other hand, may include:

At the core of these addictive behaviors and thoughts is the unconscious or conscious desire to alter the brain's chemical makeup. This may be because using substances changes how the brain works, and the feelings it generates (including euphoria and happiness).

At some point, recovering and active addicts may decide to switch from one addictive substance to another to prove that they are not addicted and that they are able to change their actions according to their needs and preferences.

Others substitute one substance for another to stave off or offset the effects of unintentional or intentional drug withdrawal while some cycle from one or more drugs to experience their different effects.

It is also common for addicts to switch their preferred substances for something they consider to be more acceptable to their current social and economic circumstances. In fact, NAATP (the National Association of Addiction Treatment Providers) asserts that there are countless reasons why addicts may decide to switch drugs.

Additionally, addicts may use more than one addictive substance simultaneously or even combine their drug habit with other addictive behaviors - such as compulsive sexual activity or gambling.

When drug substitution isn't done as part of a comprehensive treatment plan, it might prove to be dangerous or even fatal. While the addict might believe that the substitution will free them from addiction, this action will do nothing to change the underlying behaviors and thoughts that led to and supports their substance use disorder. Addict-led substitution will also do nothing to change the urge that you may feel to alter the basic functional chemistry of your brain.

For these reasons and more, when you switch drugs, you will only transfer the problems underlying your condition to a superficially new or different situation. However, nothing will really change.

In fact, this new situation may create an extra layer of deluded thinking or denial. As a direct result, it may make things worse for you than they were before. Ultimately, it might offset your ability to seek treatment and start your journey towards recovery and sobriety.

To this end, drug substitution should only come in the form of drug replacement therapy. In this way, you will receive the extensive help you need from trained professionals and addiction specialists.

You will also get the opportunity to better understand and recognize the behavioral and thought patterns underlying and associated with your particular type of substance use disorder and addiction.

Ongoing help may also help you create new behavioral patterns and thoughts to replace your old ways. As such, drug replacement therapy in combination with other treatments for addiction may even provide you with a new lease on life and a fresh sense of fulfillment. These changes may ultimately change the cycle of drug and alcohol addiction.

At the end of the day, you need to seek treatment in every format you can afford. Drug and alcohol abuse, tolerance, dependence, and addiction are dangerous conditions that may ruin your life or even lead to death through overdose and being involved in accidents while intoxicated.

Through drug substitution, you can slowly but surely get rid of the harmful effects of the substances you have been abusing - all the while dealing with any withdrawal symptoms that might arise in the process.

If you are a recovering addict (or you know someone who is an addict), ask the treatment facility where you intend to undergo therapy whether they provide drug substitution. If they do, you may have higher chances of recovering and proceeding to lead a life that is fulfilling, happy, and free of the substances you used to abuse.

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