Very high expense and unpleasant side effects make this form of nicotine replacement therapy difficult to recommend as a first-line option since no single therapy has been shown to be more effective than another. 

First-line intervention for those patients who can stop smoking at initiation of therapy; nicotine in the form of gum or lozenge may act as a substitute oral activity, which may aid in behavior modification.

Naltrexone, an opioid antagonist, is the first-line medication for alcohol use disorder—though it is also approved for opioid use disorder.

Opioid replacement therapy via methadone reduces or eliminates illicit use of opioids and criminality associated with opioid use, supporting health and social functioning. 

Opioid replacement therapy via methadone reduces or eliminates illicit use of opioids and criminality associated with opioid use, supporting health and social functioning. 

Disulfiram is an aversive treatment, causing a buildup of ethanol’s metabolite acetaldehyde in the serum, which in turn causes symptoms such as flushing, dizziness, nausea, and vomiting.

The combination product is preferred over buprenorphine alone for maintenance because the addition of naloxone affords it a lower potential for injection misuse. 

Buprenorphine alone was previously preferred for initial (induction) phase of treatment, with buprenorphine/naloxone combination preferred for maintenance treatment (unsupervised administration).

Acamprosate and naltrexone show similar reduced rates of relapse, but acamprosate is associated with more diarrhea, while naltrexone is associated with more nausea, fatigue, and somnolence; acamprosate is preferred in patients with hepatic impairment.

The primary treatment of substance use disorders in teens remains behavioral therapies, particularly motivational interviewing, as well as harm reduction measures.