Modern Drug Rehab Computer

Modern Drug Rehab Computer

Comprehensive knowledge companion for individuals in addiction recovery, whether in residential treatment or commuting from home for outpatient programs.

When to Use This Skill

Use for:

• Evidence-based treatment modality information
• Coping strategies and grounding techniques
• Recovery resource navigation
• Understanding medications (MAT, Suboxone, etc.)
• Family dynamics and communication
• Lifestyle and wellness guidance
• Meeting/support group information
• Trigger management strategies

NOT for:

• Prescribing or adjusting medications → consult your medical team
• Active overdose/medical emergency → call 911 immediately
• Replacing your counselor or therapist
• Making treatment decisions → discuss with your care team
• Suicidal ideation → contact 988 (Suicide & Crisis Lifeline)

Crisis Resources

┌─────────────────────────────────────────────────────────────┐
│                    CRISIS NUMBERS - SAVE THESE              │
├─────────────────────────────────────────────────────────────┤
│  911                    - Medical emergency/overdose        │
│  988                    - Suicide & Crisis Lifeline         │
│  1-800-662-4357         - SAMHSA National Helpline (24/7)   │
│  1-800-662-HELP         - Treatment referral                │
│  Your sponsor's number  - [Add to your phone]               │
│  Facility crisis line   - [Get from your treatment center]  │
└─────────────────────────────────────────────────────────────┘

Treatment Modality Guide

Evidence-Based Approaches

12-Step vs. Alternative Programs

┌─────────────────────────────────────────────────────────────┐
│                    RECOVERY PROGRAM OPTIONS                  │
├─────────────────────────────────────────────────────────────┤
│  12-Step (AA/NA/CA)                                         │
│  ├─ Spiritual foundation (Higher Power concept)             │
│  ├─ Sponsor relationship                                    │
│  ├─ Steps and traditions framework                          │
│  └─ Widespread availability, community                      │
│                                                             │
│  SMART Recovery                                             │
│  ├─ Science-based (CBT/REBT)                                │
│  ├─ Self-empowerment focus                                  │
│  ├─ 4-Point Program                                         │
│  └─ No spiritual requirement                                │
│                                                             │
│  Refuge Recovery / Recovery Dharma                          │
│  ├─ Buddhist-inspired, mindfulness-based                    │
│  ├─ Meditation practice                                     │
│  └─ Eightfold Path framework                                │
│                                                             │
│  LifeRing Secular Recovery                                  │
│  ├─ Secular, self-directed                                  │
│  ├─ "Sober self" concept                                    │
│  └─ Peer support focus                                      │
└─────────────────────────────────────────────────────────────┘

Note: These can complement each other. Many people use multiple programs.

Coping Skills Toolkit

Immediate Craving Response (HALT + STOP)

When craving hits, check HALT:
├── H - Hungry? (eat something nutritious)
├── A - Angry? (process the emotion)
├── L - Lonely? (reach out to someone)
└── T - Tired? (rest if possible)

Then STOP:
├── S - Stop what you're doing
├── T - Take a breath
├── O - Observe what you're feeling
└── P - Proceed mindfully

Grounding Techniques (5-4-3-2-1)

For anxiety, dissociation, or overwhelming cravings:

5 things you can SEE
├── Look around, name them out loud

4 things you can TOUCH
├── Feel textures, temperatures

3 things you can HEAR
├── Ambient sounds, near and far

2 things you can SMELL
├── Notice scents in your environment

1 thing you can TASTE
├── Focus on current taste in your mouth

DBT Distress Tolerance (TIP Skills)

For high-intensity emotional moments:

T - Temperature
├── Hold ice cubes, cold water on face
├── Activates dive reflex, calms nervous system

I - Intense Exercise
├── Run in place, jumping jacks, stairs
├── Burns off stress hormones

P - Paced Breathing
├── Breathe out longer than in (4-7-8 pattern)
├── Activates parasympathetic system

P - Progressive Muscle Relaxation
├── Tense and release muscle groups
├── Releases physical tension

Urge Surfing

Instead of fighting the craving, ride it like a wave:

1. Notice the urge (don't judge it)
2. Rate its intensity (1-10)
3. Observe where you feel it in your body
4. Breathe into that area
5. Watch the intensity rise...
6. ...peak...
7. ...and fall (cravings typically last 15-30 minutes)
8. Rate the intensity again

Key insight: Cravings are temporary. You don't have to act on them.

Medication-Assisted Treatment (MAT)

Understanding Your MAT Options

MAT Myths vs. Facts

MYTH: "MAT is just trading one drug for another"
FACT: MAT is evidence-based medicine that normalizes brain function,
      reduces cravings, and saves lives. It's no different than using
      insulin for diabetes.

MYTH: "You're not really sober if you're on MAT"
FACT: Recovery is not defined by the absence of medication.
      Stability, function, and quality of life are what matter.

MYTH: "You should get off MAT as soon as possible"
FACT: Research shows longer MAT duration = better outcomes.
      The decision to taper should be made with your doctor when stable.

Living Situation Considerations

Residential Treatment

Making the Most of Residential:
├── Engage fully in programming
├── Build relationships with peers and staff
├── Follow the structure (it's there for a reason)
├── Be honest in groups and with your counselor
├── Use free time productively
├── Start planning for aftercare early
└── Practice skills in a safe environment

IOP/PHP (Outpatient - Living at Home)

Commuting to Treatment Challenges:
├── Returning home to triggers daily
├── Managing home responsibilities + treatment
├── Partners/family who don't understand
├── Work/childcare conflicts
├── Isolation between sessions
└── Access to substances

Strategies:
├── Secure your home environment (remove substances)
├── Communicate with family about boundaries
├── Build structure into non-treatment hours
├── Attend extra meetings on non-treatment days
├── Keep your counselor informed of home challenges
├── Have phone numbers ready for crisis moments
└── Consider sober living if home isn't safe

Family & Relationship Dynamics

Communicating with Partners/Family

What families need to understand:
├── Addiction is a brain disease, not a moral failing
├── Recovery is a process, not an event
├── Their role: support, not control
├── Boundaries are healthy for everyone
├── Al-Anon/Nar-Anon exists for them too

What you can communicate:
├── "I'm in treatment and taking this seriously"
├── "This is what I need from you right now: [specific request]"
├── "I understand I've hurt you. I'm working on making amends"
├── "Recovery is my responsibility. I need your support, not your management"
├── "Let's work on this together with a family counselor"

Couples Therapy in Recovery

Why couples therapy matters:
├── Addiction affects the whole relationship
├── Communication patterns need rebuilding
├── Trust takes time and structured work
├── Both partners have healing to do
├── Codependency patterns need addressing

When to start:
├── Usually after initial stabilization (30-90 days)
├── When both partners are willing
├── With a therapist who understands addiction
├── As complement to individual work, not replacement

Holistic Wellness

Daily Recovery Structure

Morning Routine:
├── Gratitude list (3 things)
├── Meditation/prayer (5-15 min)
├── Healthy breakfast
├── Review daily intentions
└── Morning meeting (if helpful)

Throughout Day:
├── Regular check-ins with self
├── Meals at consistent times
├── Movement/exercise
├── Connection with recovery support
└── Practice skills from treatment

Evening Routine:
├── Review the day (what went well?)
├── 10th step inventory (if in 12-step)
├── Prepare for tomorrow
├── Wind-down activities (no screens)
└── Consistent bedtime

Nutrition & Sleep

Nutrition in Recovery:
├── Regular meals stabilize blood sugar and mood
├── Protein helps rebuild neurotransmitters
├── Reduce sugar/caffeine (can trigger cravings)
├── Stay hydrated
└── Consider consulting nutritionist

Sleep Hygiene:
├── Consistent sleep/wake times
├── No screens 1 hour before bed
├── Cool, dark room
├── Limit caffeine after noon
├── Address sleep issues with your doctor
└── Many in recovery have disrupted sleep initially - it improves

Common Challenges & Solutions

"I feel like I don't fit in at meetings"

Options:
├── Try different meetings (they vary widely)
├── Try different programs (SMART, Refuge, LifeRing)
├── Look for specialized meetings (LGBTQ+, young people, professionals)
├── Online meetings offer more variety
├── Focus on similarities, not differences
└── Give it time - connection builds gradually

"My family doesn't trust me"

Understanding:
├── Trust is rebuilt through consistent action over time
├── It's not about proving yourself - it's about being yourself
├── Their caution is protective, not punishing
├── Focus on what you CAN control (your behavior)

Actions:
├── Be where you say you'll be
├── Follow through on commitments
├── Accept accountability without defensiveness
├── Let time and consistency work
└── Consider family therapy when appropriate

"I'm bored without substances"

The Science:
├── Dopamine system is recalibrating
├── Things will feel less pleasurable for a while
├── This is temporary (neuroplasticity!)

Solutions:
├── Exercise (natural dopamine boost)
├── New hobbies (guitar, art, gaming, sports)
├── Service work (helping others)
├── Social connection (even when you don't feel like it)
├── Accept boredom as part of healing
└── Structure your time intentionally

Integration Points

• sober-addict-protector: Daily protection strategies
• partner-text-coach: Communication with partners/family
• jungian-psychologist: Shadow work and deeper psychological exploration
• hrv-alexithymia-expert: Emotional awareness and regulation

---

Core Philosophy: Recovery is possible. You are more than your addiction. This skill exists to provide information and support - but your treatment team, your sponsor/supports, and YOUR commitment are what make recovery real. Use this as a resource, not a replacement for human connection and professional care.

Coping Skills & Exercises

Grounding Techniques

5-4-3-2-1 Sensory Grounding

Purpose: Bring attention to the present moment when feeling anxious, dissociated, or craving.

FIND AND NAME:

5 things you can SEE
├── Look around the room slowly
├── Name them out loud: "I see a brown desk, a green plant..."
├── Notice colors, shapes, textures
└── Really look, don't just glance

4 things you can TOUCH
├── Feel your feet on the floor
├── Touch the chair beneath you
├── Notice temperature, texture
└── "I feel the cool metal of this chair..."

3 things you can HEAR
├── Close your eyes if comfortable
├── What's in the background?
├── Near sounds and far sounds
└── "I hear the AC humming, birds outside..."

2 things you can SMELL
├── What's in the air?
├── Bring something to your nose if needed
├── Coffee, lotion, fresh air
└── "I smell coffee from the break room..."

1 thing you can TASTE
├── What's in your mouth right now?
├── Take a sip of water
├── Notice subtle flavors
└── "I taste mint from my toothpaste..."

When to use: Panic attacks, dissociation, intense cravings, flashbacks, overwhelming emotions.

Box Breathing (4-4-4-4)

        Inhale 4 seconds
            ┌─────┐
            │     │
Hold        │     │  Hold
4 sec       │     │  4 sec
            │     │
            └─────┘
        Exhale 4 seconds

INSTRUCTIONS:
1. Breathe IN through nose for 4 seconds
2. HOLD breath for 4 seconds
3. Breathe OUT through mouth for 4 seconds
4. HOLD empty for 4 seconds
5. Repeat 4-8 cycles

WHY IT WORKS:
├── Activates parasympathetic nervous system
├── Lowers heart rate and blood pressure
├── Interrupts panic/anxiety cycle
└── Used by Navy SEALs for stress management

4-7-8 Breathing (Relaxation)

Inhale: 4 seconds (through nose)
Hold:   7 seconds
Exhale: 8 seconds (through mouth, with whoosh sound)

BEST FOR:
├── Falling asleep
├── Calming after a stressful event
├── General anxiety reduction
└── Not ideal during acute panic (too slow)

DO 4 CYCLES MAXIMUM when starting.
Can feel lightheaded at first.

Body Scan Meditation

PROGRESSIVE BODY SCAN (10-15 minutes)
─────────────────────────────────────

Lie down or sit comfortably. Close eyes.

Start at the top of your head.
Notice any sensations: tension, warmth, tingling.
Don't try to change anything. Just notice.

Move slowly down:
├── Forehead
├── Eyes, cheeks
├── Jaw (often holds tension)
├── Neck and throat
├── Shoulders (breathe into tension)
├── Arms, hands, fingers
├── Chest (notice breath)
├── Belly (let it soften)
├── Lower back
├── Hips
├── Thighs
├── Knees
├── Calves
├── Feet, toes
└── Whole body together

If mind wanders, gently return to body.
No judgment. Just noticing.

DBT Skills

TIPP (Temperature, Intense Exercise, Paced Breathing, Paired Muscle Relaxation)

For crisis moments when emotions are overwhelming.

T - TEMPERATURE
───────────────
├── Hold ice cubes in your hands
├── Splash cold water on your face
├── Hold a cold can against your neck
├── Take a cold shower
└── WHY: Activates dive reflex, rapidly lowers heart rate

I - INTENSE EXERCISE
────────────────────
├── Run in place for 1 minute
├── Do jumping jacks
├── Sprint up and down stairs
├── Any vigorous movement for 5-10 minutes
└── WHY: Burns off stress hormones (cortisol, adrenaline)

P - PACED BREATHING
───────────────────
├── Exhale longer than you inhale
├── 4 seconds in, 6-8 seconds out
├── Breathe from your belly
├── Slow down your exhale
└── WHY: Activates parasympathetic response

P - PAIRED MUSCLE RELAXATION
────────────────────────────
├── Tense a muscle group for 5 seconds
├── Release and notice the difference
├── Pair with slow exhale on release
├── Work through body: fists, arms, shoulders, face, etc.
└── WHY: Can't be physically tense and relaxed simultaneously

Opposite Action

When emotion doesn't fit the facts or acting on it would be harmful.

EMOTION          URGE                OPPOSITE ACTION
────────────────────────────────────────────────────
Fear             Avoid/escape        Approach what you fear
Anger            Attack/yell         Gently avoid, take space
Sadness          Withdraw/isolate    Get active, reach out
Shame            Hide/avoid          Share with safe person
Guilt            Apologize/fix       If unjustified: let it go
                                     If justified: make amends

EXAMPLE:
Feeling: Fear of calling sponsor
Urge: Avoid, "I'll call later"
Opposite: Call NOW

The action changes the emotion over time.

Radical Acceptance

RADICAL ACCEPTANCE
──────────────────

WHAT IT IS:
├── Fully accepting reality as it is
├── Not approval or agreement
├── Not giving up or being passive
├── Stopping the fight against what IS
└── "It is what it is"

WHAT IT'S NOT:
├── ❌ "This is okay"
├── ❌ "I like this"
├── ❌ "I give up"
├── ❌ "I won't try to change things"
└── ❌ "I deserved this"

THE FORMULA:
Pain + Non-acceptance = SUFFERING
Pain + Acceptance = PAIN (which passes)

PRACTICE:
"This moment is exactly as it is."
"I cannot change what has already happened."
"I can accept this AND work to change the future."
"Fighting reality doesn't change it."

BODY PRACTICE:
├── Relax your face, especially forehead
├── Unclench your jaw
├── Drop your shoulders
├── Open your hands (no fists)
├── Half-smile (changes brain chemistry)
└── Willing hands (palms up, accepting)

Cognitive Techniques

Thought Records

THOUGHT RECORD TEMPLATE
───────────────────────

SITUATION: What happened? (Just facts)
_________________________________

EMOTION: What did you feel? (0-100%)
_________________________________

AUTOMATIC THOUGHT: What went through your mind?
_________________________________

EVIDENCE FOR the thought:
_________________________________

EVIDENCE AGAINST the thought:
_________________________________

ALTERNATIVE THOUGHT: What's a more balanced view?
_________________________________

EMOTION NOW: (0-100%)
_________________________________

EXAMPLE:
─────────
Situation: Sponsor didn't return my call for 2 hours

Emotion: Rejected (80%), Anxious (70%)

Automatic thought: "They don't care about me. No one does."

Evidence FOR: They usually call back faster. I've been
calling a lot lately.

Evidence AGAINST: They have their own life and job.
They've shown up for me many times before.
2 hours isn't that long.
They called back eventually.

Alternative thought: "They're busy and will get back to me.
Past behavior shows they do care."

Emotion NOW: Rejected (30%), Anxious (20%)

Cognitive Distortions Checklist

COMMON THINKING TRAPS
─────────────────────

□ ALL-OR-NOTHING: "I relapsed once, I'm a total failure"
  → Reality is usually shades of gray

□ CATASTROPHIZING: "If I mess up, everything will fall apart"
  → What's the evidence? What's most likely?

□ MIND READING: "They think I'm pathetic"
  → Can you actually know what they think?

□ FORTUNE TELLING: "I know I'll relapse eventually"
  → The future isn't written yet

□ EMOTIONAL REASONING: "I feel like a failure, so I am one"
  → Feelings aren't facts

□ SHOULD STATEMENTS: "I should be over this by now"
  → Says who? Replace with "I'd prefer" or "I'm working on"

□ LABELING: "I'm an addict, that's all I am"
  → You are more than any single label

□ PERSONALIZATION: "They look upset, it must be my fault"
  → Other people have their own stuff going on

□ DISCOUNTING POSITIVES: "That doesn't count because..."
  → Let good things count!

□ MAGNIFICATION/MINIMIZATION: Making negatives bigger,
  positives smaller
  → Try to see things at actual size

Urge Surfing

The Complete Script

URGE SURFING MEDITATION (10-15 minutes)
────────────────────────────────────────

Find a comfortable position. You can close your eyes
or soften your gaze.

Notice that you're having an urge or craving right now.
This is uncomfortable, and that's okay.

First, let's acknowledge: this urge is just a sensation.
It's a wave that will rise, peak, and fall.
It cannot hurt you. It cannot make you do anything.

Now, find where you feel the urge in your body.
Is it in your stomach? Your chest? Your throat? Your hands?
Just notice where it lives.

Rate the intensity from 1 to 10. ___

Breathe into that area. Don't try to push the sensation away.
Just breathe and notice.

Imagine you're sitting on a beach, watching waves.
This urge is a wave. Watch it approach.

Notice how the intensity rises...
(pause)
And rises...
(pause)

Now notice: is it still rising, or has it peaked?
Cravings typically last 15-30 minutes.
They always pass.

Keep breathing. Keep watching.

Notice the intensity now. Has it changed?
Rate it again from 1 to 10. ___

You are not your urge. You are the observer of the urge.
The wave is passing through you, not destroying you.

(Continue breathing for 5-10 minutes)

When you're ready, notice:
├── You survived this urge
├── You didn't have to act on it
├── It rose and fell, just like waves do
└── Each time you surf an urge, you get stronger

Slowly return your attention to the room.

Crisis Planning

My Personal Crisis Plan

MY CRISIS PLAN
──────────────

WARNING SIGNS (I notice I'm getting into trouble when):
1. _________________________________
2. _________________________________
3. _________________________________

TRIGGERS TO WATCH FOR:
1. _________________________________
2. _________________________________
3. _________________________________

COPING STRATEGIES THAT WORK FOR ME:
1. _________________________________
2. _________________________________
3. _________________________________

PEOPLE I CAN CALL:
├── Sponsor: _____________ (phone)
├── Support person: _____________ (phone)
├── Therapist: _____________ (phone)
├── Treatment center: _____________ (phone)
└── Crisis line: 988 (always available)

PLACES I CAN GO THAT ARE SAFE:
1. _________________________________
2. _________________________________

THINGS TO AVOID WHEN IN CRISIS:
1. _________________________________
2. _________________________________
3. _________________________________

REASONS TO STAY SOBER (Why am I doing this?):
1. _________________________________
2. _________________________________
3. _________________________________

I commit to using this plan when I'm struggling.

Signed: _________________ Date: _________

---

Remember: These skills work better with practice. Try them when you're calm so they're available when you're in crisis. Talk to your counselor about which ones work best for you.

Medication-Assisted Treatment (MAT) Deep Dive

Overview

MAT combines FDA-approved medications with counseling and behavioral therapies. It's evidence-based, reduces mortality by up to 50%, and is considered the gold standard for opioid use disorder treatment.

Medications for Opioid Use Disorder

Buprenorphine (Suboxone, Subutex, Sublocade)

How It Works

• Partial opioid agonist: Activates opioid receptors partially
• Ceiling effect: After a certain dose, effects plateau (overdose protection)
• High receptor affinity: Blocks other opioids from binding

Formulations

Induction Protocol

BUPRENORPHINE INDUCTION (Traditional)
─────────────────────────────────────
PREREQUISITE: Must be in withdrawal
- COWS score ≥ 12 (moderate withdrawal)
- Last short-acting opioid use: 12-24 hours
- Last methadone use: 24-72 hours
- Last fentanyl use: 72+ hours (longer half-life)

DAY 1:
├── Start with 2-4mg sublingual
├── Wait 1-2 hours, assess response
├── If still withdrawing: add 2-4mg
├── Max Day 1: 8mg typically
└── Goal: Comfort, not sedation

DAY 2:
├── Give Day 1 total dose at once
├── May increase by 4mg if needed
└── Target: 12-16mg total

DAY 3-7:
├── Titrate to comfort
├── Most stable at 16-24mg
└── Max approved dose: 24mg/day

COMMON MISTAKE:
Starting too early → precipitated withdrawal
Wait for REAL withdrawal, not just anxiety about withdrawal

Precipitated Withdrawal Warning

PRECIPITATED WITHDRAWAL
───────────────────────
What happens: Buprenorphine has HIGHER affinity than full agonists.
It kicks fentanyl/heroin OFF receptors → sudden withdrawal.

Symptoms (within 1-4 hours of first dose):
├── Severe anxiety, agitation
├── Vomiting, diarrhea
├── Muscle cramps, bone pain
├── Sweating, goosebumps
├── Elevated heart rate
└── Often WORSE than natural withdrawal

Treatment:
├── Supportive care (fluids, comfort meds)
├── May need to add more buprenorphine
├── Very rarely: full agonist (controversial)
└── Prevention: WAIT for true withdrawal

With fentanyl (the new challenge):
├── Fentanyl stores in fat → slow release
├── Traditional 24-hour wait often insufficient
├── Some providers use micro-dosing protocols
└── Discuss with your medical team

Micro-Dosing Protocols (Bernese Method)

MICRO-INDUCTION (for fentanyl users)
────────────────────────────────────
Allows starting buprenorphine WITHOUT full withdrawal.
Patient continues using while slowly adding buprenorphine.

Day 1: 0.5mg buprenorphine
Day 2: 1mg
Day 3: 2mg
Day 4: 4mg
Day 5: 8mg
Day 6: 12mg
Day 7: 16mg (stop other opioid use)

WHY IT WORKS:
Low doses gradually occupy receptors without
displacing all the fentanyl at once.

CAUTION:
├── Should be done under medical supervision
├── Not appropriate for everyone
├── Requires patient to follow complex schedule
└── Discuss with your provider

Methadone

How It Works

• Full opioid agonist: Fully activates receptors
• Long half-life: 24-36 hours (once daily dosing)
• No ceiling effect: CAN cause overdose if misused
• Heavily regulated: Dispensed at specialized clinics

Dosing

METHADONE DOSING
────────────────
INDUCTION:
├── Start: 20-30mg on Day 1
├── Observe for 2-4 hours
├── Max Day 1: 30-40mg usually
└── Low and slow (peak effects at 3-4 hours)

TITRATION:
├── Increase 5-10mg every 3-5 days
├── Wait for steady state (3-5 half-lives)
├── Typical range: 60-120mg
├── Some need higher (fast metabolizers)
└── Goal: No cravings, no withdrawal, no sedation

SPLIT DOSING:
Some patients metabolize fast and need twice-daily dosing.
Signs: withdrawal symptoms in evening, not lasting 24 hours.

Clinic Structure

METHADONE CLINIC PHASES
───────────────────────
Phase 1 (New patient):
├── Daily clinic visits
├── Observed dosing
├── Building trust and stability
└── Duration: 90 days typically

Phase 2:
├── 2-3 take-homes per week
├── Regular counseling
├── Clean UDS required
└── Duration: 6+ months

Phase 3:
├── 6 take-homes per week
├── Monthly counseling minimum
├── Long-term stability
└── Years of compliance

TAKE-HOME CRITERIA:
├── Clean urine drug screens
├── Counseling attendance
├── No behavioral issues
├── Time in treatment
└── Varies by state/clinic

Naltrexone (Vivitrol)

How It Works

• Opioid antagonist: BLOCKS receptors completely
• No agonist activity: Cannot get high on opioids while taking
• Not addictive: No withdrawal from naltrexone itself
• Also used for alcohol: Reduces cravings, blocks "high"

Formulations

Important Considerations

NALTREXONE REQUIREMENTS
───────────────────────
MUST be opioid-free before starting:
├── 7-14 days from short-acting opioids
├── 10-14 days from methadone/buprenorphine
└── Naloxone challenge test can verify

WHY THE WAIT:
Naltrexone will precipitate withdrawal if ANY opioids
are still on receptors. Unlike buprenorphine,
naltrexone has ZERO agonist activity to provide comfort.

NOT APPROPRIATE FOR:
├── Active opioid use (can't get opioid-free)
├── Chronic pain requiring opioids
├── Those not ready for abstinence-based approach
├── Unreliable for daily oral (injection preferred)
└── Liver disease (check LFTs)

OVERDOSE RISK AFTER STOPPING:
When naltrexone wears off, tolerance is GONE.
Using previous dose after stopping → overdose risk.
Critical education point.

Medications for Alcohol Use Disorder

Naltrexone (for Alcohol)

NALTREXONE FOR ALCOHOL
──────────────────────
Same medication, different mechanism for alcohol:
├── Blocks endorphin release from drinking
├── Drinking becomes less pleasurable
├── Can continue drinking (Sinclair Method)
├── Or use for abstinence support
└── 50mg oral daily OR monthly Vivitrol

SINCLAIR METHOD:
├── Take naltrexone 1 hour before drinking
├── Continue drinking as usual
├── Brain learns drinking ≠ reward
├── Gradual reduction over 6-12 months
├── 78% success rate in Finnish studies
└── NOT abstinence-based (controversial)

Acamprosate (Campral)

ACAMPROSATE
───────────
HOW IT WORKS:
├── Restores glutamate/GABA balance
├── Brain chemistry disrupted by chronic alcohol
├── Reduces post-acute withdrawal symptoms
└── Supports abstinence maintenance

DOSING:
├── 666mg three times daily (1998mg total)
├── Start after alcohol withdrawal complete
├── Takes 5-7 days to reach effectiveness
└── Continue for 12 months typically

BEST FOR:
├── Maintaining abstinence (not reducing)
├── Those who have detoxed
├── Post-acute withdrawal symptoms
├── Can combine with naltrexone
└── Safe with liver disease

Disulfiram (Antabuse)

DISULFIRAM
──────────
HOW IT WORKS:
├── Blocks alcohol metabolism
├── Acetaldehyde builds up → very sick
├── Creates aversion to drinking
└── Deterrent effect (fear of reaction)

THE REACTION (if you drink):
├── Flushing, headache
├── Nausea, vomiting
├── Rapid heartbeat, low BP
├── Difficulty breathing
├── Can be severe/dangerous
└── Starts within 10 min, lasts hours

DOSING:
├── 250-500mg daily
├── Must wait 12 hours after last drink
├── Effects last 1-2 weeks after stopping
└── Cannot have ANY alcohol (cooking, mouthwash)

BEST FOR:
├── Highly motivated patients
├── Those with external accountability
├── Supervised administration works best
├── NOT for impulsive drinkers
└── Medical monitoring recommended

Medication Comparison Table

Common Myths vs. Facts

MYTH: "MAT is just substituting one drug for another"
FACT: MAT medications are evidence-based treatments that:
      - Normalize brain function
      - Don't produce euphoria at therapeutic doses
      - Allow people to work, parent, live fully
      - Reduce mortality by 50%+

MYTH: "You're not really sober on MAT"
FACT: Recovery is not defined by medication status.
      Stability, quality of life, and function matter.
      Would you say a diabetic isn't "healthy" on insulin?

MYTH: "You should get off MAT as quickly as possible"
FACT: Research shows longer MAT duration = better outcomes.
      Tapering is a personal decision made with your doctor.
      There's no rush. Stability first.

MYTH: "MAT is only for severe addiction"
FACT: MAT is appropriate across the severity spectrum.
      Earlier intervention often means better outcomes.
      Don't need to hit "rock bottom."

MYTH: "I'll be on MAT forever"
FACT: Duration is individual. Some stay on long-term (fine!).
      Others taper successfully after years of stability.
      This is between you and your treatment team.

Questions to Ask Your Provider

1. Which MAT option is best for my situation? 2. What are the side effects I should watch for? 3. How long should I expect to be on this medication? 4. What happens if I relapse while on MAT? 5. Can I take this medication if I'm pregnant/planning pregnancy? 6. Will this interfere with my other medications? 7. What's the plan if the first medication doesn't work? 8. How will we measure if this is working?

---

Remember: MAT is a tool, not a crutch. Combined with counseling and support, it saves lives. Talk to your medical team about what's right for you.