Naltrexone (Trexan or Revia) blocks opiate receptors. It is used in the treatment of alcoholics as well as opiate addicts.

The regular use of naltrexone has been shown to reduce the frequency and severity of relapses in alcoholics. It blocks the pleasurable sensation associated with the use of opiates and is therefore thought to be useful for recovering opiate addicts.

It may also reduce the strength of cravings. It must be taken daily. Longer-acting preparations are being developed.

If you have an addiction to heroin or other opiates, you may be placed on methadone maintenance. The doctor figures out the dose of methadone you need to avoid symptoms of opiate withdrawal, and this is given two or three times a week in a controlled outpatient clinic. Well-run methadone clinics also offer ongoing counseling and therapy, and some people are able eventually to achieve full abstinence through these programs. Longer-acting drugs similar to methadone and other variations of the methadone molecule are being introduced that allow for more flexibility in the clinic routines where methadone maintenance programs are being carried out.

So far there is no drug available that can correct the emotional, psychological, and spiritual problems associated with addiction. I don’t think there ever will be. Drug therapy that can help reduce relapses and keep people focused on treatment issues is useful, and should be considered as part of your treatment plan. After initial detoxification, however, many people do well without any additional medication. The use of medication in recovery is an individual decision to be made by you and your doctor.

What about sleep? In the first few weeks of treatment consider yourself lucky if you sleep, especially if you are coming off alcohol, depressants, marijuana, or opiates. If you are coming off cocaine or amphetamines you might sleep all the time at first but later have trouble getting to sleep.

Addictive drugs tend to disrupt the natural process of sleep. If we do a brain wave recording while a person is sleeping, we can see that brain waves go through several distinct stages over and over again throughout the course of the night: light sleep, dreaming sleep, and deep sleep, with the cycle then repeating itself. These cycles each last about ninety minutes. Alcohol and depressants suppress the dreaming part of sleep. Other drugs deplete the stores of chemicals that are needed to generate sleep cycles, and it takes time for these to build back up.

The bad news about this is that your doctor is probably not going to give you anything to make you sleep. Sometimes nonmood-altering antidepressants such as trazodone (Desyrel) are used at night and help with sedation, especially if there is a problem with depression or anxiety. But you might just be told to grin and bear it. The good news is that no one ever died from sleep deprivation at a treatment center, and it will get better with time. A peaceful night’s sleep without chemicals is one of the blessings of recovery.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information