While benzodiazepines are effective anti-anxiety workhorses for many patients, most guidelines tell us to avoid prescribing them to substance abusers. The concern is that the benzo high will remind patients of their substances of choice, and that benzo withdrawal symptoms will lead to old substance abuse habits.
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One good way to think of benzodiazepines is that they are literally, physiologically anyway, alcohol in a pill. Especially the fast-onset/fast-offset benzodiazepines like alprazolam (Xanax) have a very similar pharmacologic profile to alcohol. This discussion with Dr. Alex Stalcum covers strategies of using benzodiazepines as anxiety treatments for substance-abusing patients.
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Second only to alcohol, marijuana is the most common reason people enter substance abuse treatment. And unlike alcohol dependence, there are virtually no effective medications available for those addicted to it. It’s not from a lack of trying. A recent review of 14 drug studies for cannabis dependence revealed little benefit from antidepressants, anticonvulsants, or anxiolytics.
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When physicians are diagnosed with opioid or other drug dependence, they are required to receive treatment from special physician health programs (PHP) if they want to keep their medical licenses. Unlike treatment programs for the general population, PHPs do not use opiate agonists, such as methadone or buprenorphine.
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Dr. Capurso is the Assistant Director of Addiction Services at Connecticut Valley Hospital and an associate clinical professor of psychiatry at the Yale University School of Medicine. Prior to joining Connecticut Valley Hospital, he was the medical director of the Detoxification & Addiction Stabilization Service and the Psychosocial Residential Rehabilitation Program at the West Haven Veterans Administration Hospital. He completed medical school, psychiatry residency, and addiction psychiatry fellowship at Yale.
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