Treatment Options

ADDICTION IS A CHRONIC, RELAPSING BRAIN DISEASE1,2

Addiction is a recurring brain disease with physical and physiological effects.1,2 Fortunately, like many other diseases, opioid and alcohol addiction can be treated, and patients can get on a path to recovery.

Understanding how alcohol and opioids affect the brain

Brain regions associated with dependence

Dependence affects both the cortex and the limbic system.2

Cortex

Counseling targets the cortex to help treat the psychological aspects of dependence. The cortex is responsible for:

  • Decision-making
  • Thinking
  • Reasoning
  • Planning

Limbic Region

Medication targets the limbic region to help treat the physical effects of dependence. The limbic region is responsible for:

  • Basic drives or urges
  • Rewards
  • Pleasure

Treatment programs include counseling and social support to treat the psychological aspects of addiction. They may also include medication to help treat the physical effects of addiction.1,2

The Brain and Alcohol Use

Drinking alcohol can cause an increased release of endogenous endorphins, which can bind to opioid receptors and stimulate the dopamine reward system. For some people, this increased dopamine release can cause them to seek out this feeling again and again.3

Rush of
Endogenous
Opioids Alcohol use causes increased stimulation of the brain's dopamine reward system
Increased Stimulation of the Dopamine
Reward System
=
Endogenous Opioid

The Brain and Opioid Use

Heroin and prescription pain relievers are exogenous opioids. When they bind to opioid receptors in the brain, the resulting dopamine release can be 2–10 times greater than the dopamine release associated with natural pleasures. This excess of dopamine has a powerful reinforcing effect on the brain, which is why opioids have a high potential for abuse.2

Opioid use causes excessive stimulation of the brain's dopamine reward system
Excessive Stimulation of the Dopamine
Reward System
=
Endogenous Opioid
=
Opioid

What is MAT?

Medication-assisted treatment (MAT) is a combination of medication and therapy used to treat substance use disorders, including opioid use disorder and alcohol use disorder.4 Types of MAT for opioid dependence:

Full opioid agonists

Full opioid agonists attach to and activate opioid receptors in the same way as opioid drugs, such as heroin, triggering the brain's pleasure response.4,5

Does not require detox before initiation

Full opioid agonist MOA
Excessive Stimulation of the Dopamine
Reward System
=
Endogenous Opioid
=
Agonist Therapy

Partial opioid agonists

Partial opioid agonists activate the same mu-opioid receptors as full agonists, triggering a more limited response of dopamine.5

Does not require detox before initiation

Partial opioid agonist MOA
Excessive Stimulation of the Dopamine
Reward System
=
Endogenous Opioid
=
Partial Agonist Therapy

Opioid antagonists

Opioid antagonists competitively bind to mu-opioid receptors and block opioid drugs from binding to these receptors. The blockade prevents the opioid drug from stimulating the dopamine reward pathway.5,6,7

Requires detox before initiation

Opioid antagonist MOA
Excessive Stimulation of the Dopamine
Reward System Is Blocked
=
Endogenous Opioid
=
Opioid (eg, Heroin and Pain Relievers)
=
Antagonist Therapy

HOW VIVITROL WORKS

VIVITROL is an opioid antagonist.7 Learn more about offering VIVITROL and counseling as part of your program.

Find out how VIVITROL works

EFFICACY AND SAFETY

Learn more about the benefits and risks of VIVITROL.

View the data

VIVITROL Q&A

Have questions about VIVITROL? Check out our Q&A section for answers that may help.

See VIVITROL Q&A

VIVITROL is not right for everyone. There are significant risks from VIVITROL treatment, including but not limited to, risk of opioid overdose, injection site reaction and sudden opioid withdrawal. See Important Safety Information below.

See Prescribing Information
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See Medication Guide
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References:

  1. National Institute on Drug Abuse. Treatment Approaches for Drug Addiction. https://www.drugabuse.gov/sites/default/files/drugfacts-treatmentapproaches.pdf. Updated July 2016. Accessed August 7, 2017.
  2. National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addictions. NIH Publication No. 14-5606. https://www.drugabuse.gov/sites/default/files/soa_2014.pdf. Revised July 2014. Accessed August 8, 2017.
  3. Herz A. Endogenous opioid systems and alcohol addiction. Psychopharmacology (Berl). 1997;129(2):99-111.
  4. Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Program (TIP) 43. DHHS Publication No. (SMA) 12-4214. 2005.
  5. Office of National Drug Control Policy. Healthcare Brief: Medication-assisted treatment for opioid addiction. https://obamawhitehouse.archives.gov/sites/default/files/ondcp/recovery/medication_assisted_treatment_9-21-20121.pdf. September 2012. Accessed August 8, 2017.
  6. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20.
  7. VIVITROL [prescribing information]. Waltham, MA: Alkermes, Inc.; rev December 2018.