Substance Abuse Treatment

Substance Abuse Treatment

Substance abuse is a significant public health concern in the United States. Continued drug and substance abuse is the leading cause of the growing cases of major depressive episodes (MDEs) among adolescents and young adults, the mental illness crisis experienced in the U.S., and the highly prevalent suicide rates and suicidal ideations. The U.S. Department of Human Services (2023) reports that as of 2021, an estimated 1 in every 5 adolescents had a major depressive episode in 2020. 1 in 4 adults aged above 18 years of age have suffered a substance-related mental health illness. Additionally, over 12.3 million adults aged above 18 had serious thoughts of suicide in 2020, while 3.5 million planned for suicide, and 1.7 million had attempted suicide (U.S. Department of Human Services, 2023). There are various pharmacological methods for substance abuse treatment. The commonly used medications for treating substance abuse include methadone and Buprenorphine. On the other hand, Naltrexone is used in psychiatric care for patients with mental illnesses related to substance abuse. This article reviews the current substance abuse in the U.S. and the mechanisms of action for methadone and Buprenorphine, as well as how Naltrexone aids in the treatment of substance abuse.

Current Substance Abuse Prevalence in the U.S.

The rate of prevalence of substance abuse in the U.S. is alarming. The most commonly abused substance is marijuana. An estimated 18.7 percent of adults and 10.1 percent of Americans below the age of 18 have abused marijuana (National Center for Drug Abuse Statistics, 2023). Other commonly abused substances are opioids, especially those prescribed for pain management, cocaine, LSD, sedatives, and methamphetamines.

The National Center for Drug Abuse Statistics (2023), based on the 2021 statistics, reported that at least 50 percent of Americans aged as low as 12 years have abused substances at least once. On a year-over-year count, 13.5% of the people aged 12 and above were reported to have used drugs monthly in 2020, indicating a 3.8% increase (National Center for Drug Abuse Statistics, 2023). The Substance Abuse and Mental Health Services Administration (SAMHSA) report shows that an estimated 61.2 million Americans, representing 21.9 percent of the U.S. population, used illegal drugs in020 (U.S. Department of Human Services, 2023). Consistently, an estimated 9.2 million Americans above 12 were reported to have misused prescription opioids in 2021 alone.

The number of people abusing specific substances keeps on growing. The SAMHSA report indicated that as of 2021, 138.522 million Americans aged above 12 were active alcohol drinkers, of which 28.320 million or 20.4 percent of this population had a diagnosed or undiagnosed alcohol use disorder (National Center for Drug Abuse Statistics, 2023). Another 57.277 million Americans were actively abusing tobacco products.

The overall mental health and economic outcomes of the prevalent substance abuse in the U.S. are undeniable. An estimated 46.3 million Americans above 12 can be described with a substance use disorder based on the DSM-5 criteria (U.S. Department of Human Services, 2023). A total of 29.5 million people across the population have already been classified as having an alcohol use disorder (National Center for Drug Abuse Statistics, 2023). The highest population bracket for people with possible substance use disorder are aged between 18 to 25. Trends show reduced substance use disorders with age. Ninety-four percent of the people with substance disorders as of 2021 had not received any treatment for the disorders. An estimated 700 thousand Americans have so far died of substance abuse, and the economy has suffered an estimated USD 35 billion as of 2021 (National Center for Drug Abuse Statistics, 2023). In 2019 alone, a total of 70,630 people succumbed to drug abuse, a 29.4 percent rise from the previous year (National Center for Drug Abuse Statistics, 2023). The impact of the COVID-19 pandemic, combined with the tough economic times on people’s mental health, is expected to lead to increased substance abuse in the post-pandemic period.

Treatment Options

Substance abuse can be treated using either pharmacological and non-pharmacological therapies or a combination of both. Medication-assisted therapy (MAT) is usually used to manage the symptoms and complications associated with drug withdrawals. The majorly used medications in MAT are methadone and Buprenorphine. Methadone is a synthetic long-term opioid agonist medication (Chow & Issa, 2022), while Buprenorphine is a partially synthetic opioid agonist (Kumar et al., 2023). Methadone and Buprenorphine are both effective for substance abuse treatment. However, they have contrasting mechanisms of action, contraindications, and varying pros and cons, forming the main basis for decisions on the option to include in the MAT.

Comparison of Mechanisms of Action

Methadone, although a synthetic long-term opioid agonist, works by binding to the same brain receptors as other naturally occurring opioids. It then the receptors and induces a downstream effect with related protein signaling, creating an analgesic effect (Chow & Issa, 2022). Due to its long half-life, methadone can effectively reduce cravings for opioids, especially in pain management. On the other hand, Buprenorphine as a short-acting opioid agonist combines the same neuroreceptors as other opioids. Due to its short life, it only partially activates the opiate receptors creating a short-lived effect (Kumar et al., 2023).

Comparison of Contraindications

Methadone is contraindicated for patients using other medications with depressant effects, such as opioids, benzodiazepines, alcohol, and antipsychotics, as well as in patients with respiratory and cardiac issues (Chow & Issa, 2022). On the other hand, Buprenorphine is contraindicated due to hypersensitivity reaction. It is also contraindicated for use in patients using long-term opioid agonists and with liver problems (Kumar et al., 2023).

Comparison of Pros and Cons

The pros of methadone are that it has a long half-life, which creates longer-lasting effects. Hence, fewer doses are administered. It is also presented in liquid form; hence easy to adjust drug formulations. Methadone cons include the need for professional administration and a higher risk for long-term side effects due to its prolonged presence in the system (Chow & Issa, 2022). On the other hand, buprenorphine pros include its presence in various forms and administration methods, giving patients a choice for use. It also reduces the risk of addiction and other side effects due to the short-term effects. Its cons include the need for regular dosing due to its partial effects.

Naltrexone as an Alternative

Naltrexone as an opioid antagonist, helps to treat alcohol use disorder and opioid dependence by blocking the opioid receptors in the brain (Singh & Saadabadi, 2022). By binding on the opioid sites, it reduces the available receptors for opioids to bind to. This effectively reduces the effects of the opioids on the brain hence the reinforcement of opioid-related excitement and cravings. Unlike methadone and Buprenorphine, Naltrexone does not have any opiate effects on the brain and has no risk for dependency (Singh & Saadabadi, 2022).

Conclusion

Substance abuse significantly affects Americans’ social, physiological, psychological, and economic well-being. MAT options include the use of methadone and Buprenorphine. Both are effective. However, the choice should be based on the efficiency of each medication and the side effects each induces. Naltrexone, due to its mechanism of action and reduced risk of significant side effects, can be a better alternative for treating substance abuse.

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References

Chow, R. M., & Issa, M. (2022). Methadone. Pain Medicine: An Essential Review, 157–158. https://doi.org/10.1007/978-3-319-43133-8_38

Kumar, R., Viswanath, O., & Saadabadi, A. (2023). Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/

National Center for Drug Abuse Statistics. (2023). Substance Abuse and Addiction Statistics. NCDAS: https://drugabusestatistics.org/

Singh, D., & Saadabadi, A. (2022). Naltrexone. StatPearls [Internet], 1–3. https://www.ncbi.nlm.nih.gov/books/NBK534811/

U.S. Department of Human Services. (2023). SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021. HHS. https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html

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For this assignment, you will write a paper related to substance abuse and the current treatment options available.

Include the following information in your paper:

Introduction

Current substance abuse prevalence in the U.S. (trends, stats, etc.)

Treatment options

Compare and contrast methadone and buprenorphine for substance abuse treatment. Include the mechanism of action, contraindications, and the pros or cons of each option.

Naltrexone is often used in psychiatric mental health care for many reasons related to addiction and/or impulse control. It is also occasionally used to help patients with self-injurious behaviors or needed weight loss as well. Considering the mechanism of action of naltrexone; how does it aid in substance use treatment?

Conclusion