6.8 Psychoactive Substances and Medications to Treat Substance Use and Withdrawal

Information about the effects of substances such alcohol, cannabis, and illicit drugs is discussed in the “Substances: Use, Intoxication, and Overdose” section of the “Substance Use Disorders” chapter.

Medications to treat alcohol use disorder and opioid disorder include buprenorphine-naloxone, methadone, naltrexone, acamprosate, and disulfiram. These medications are discussed in the “Treatment and Recovery Services” subsection of the “Substance Use Disorders” chapter.

Medications used to manage symptoms of substance withdrawal/detoxification include buprenorphine, methadone, and Alpha-2 adrenergic agonists (such as clonidine and lofexidine). In the case of alcohol withdrawal, benzodiazepines (such as lorazepam or diazepam) remain the first-line treatment, particularly for preventing seizures and delirium tremens. In certain cases—especially in ICU-level care—dexmedetomidine (Precedex) may be used as an adjunct for sympathetic overactivity, though it does not treat seizures and must be used with close monitoring. Read more about these medications in the “Withdrawal Management/Detoxification” section of the “Substance Use Disorders” chapter.