Management of substance use disorders is challenging, there are no
medications that directly treat the use disorders, substitution therapy in opioid use
disorders and potential anti-craving medications for alcohol use disorder are the closest
available. Successful management of withdrawal syndromes and craving can improve
the chances of sobriety. The presence of underlying medical and psychiatric disorders
can derail attempts at long term sobriety if not managed. This chapter provides
information on medications commonly used in the management of withdrawal
symptoms and co-morbid psychiatric disorders, such as depression and anxiety, in the
dually diagnosed patient. Tables of medications from the following classes are
included: benzodiazepines and other antianxiety agents, antidepressants, mood
stabilizers, anticonvulsants and antipsychotic medications. Key points in the patient
specific selection, dosing and monitoring of these medications and management of their
side effects are identified. Insomnia can derail sobriety and needs to be addressed.
Information on sleep hygiene and medications for insomnia are also presented.
Information on the individualization of treatment is also discussed. It is important to
note that many of the medications presented in this chapter are being used for both US
FDA labeled and off-label indications.
Keywords: Anticonvulsants, Antidepressants, Antipsychotic, Anxiety, Benzodiazepines,
Depression, Insomnia, Mood stabilizers, Psychotic symptoms.
