Addiction pharmacotherapy

Domain IX · Biomedical, neuro & digital

What it is

Addiction pharmacotherapy is not a psychotherapy. It is a group of prescribed medicines for opioid, alcohol and tobacco dependence, delivered by prescribers, opioid treatment programmes (OTPs), specialist drug and alcohol services, primary care and stop-smoking services. This guide is written for…

Format

• There is no fixed session count. Medication for opioid dependence is often long-term; alcohol and tobacco medicines run for a course the prescriber decides. Below is the pathway as the therapist meets it, with the therapist's goals at each stage. Moving between stages is a shared clinical decision…
• Stage A. Recognition and referral. Goal: notice opioid, alcohol or tobacco dependence, explain that medicines exist, and connect the client to a prescriber. Format: within ordinary therapy sessions. Move on when the client has an assessment appointment or has declined after an informed conversation.

Who practises it, and how they are trained or regulated

• Stage B. Assessment and treatment entry (prescriber-led). In US OTPs the 2024 rule removed the requirement for a one-year history of opioid addiction; admission now rests on clinical criteria such as active moderate-to-severe OUD, OUD in remission, or high risk of recurrence or overdose. Telehealth assessment is permitted for starting buprenorphine (audio-visual or audio-only) and for starting methadone by…
• Stage D. Stabilisation and integrated psychosocial treatment. Goal: psychosocial treatment alongside medication, such as motivational work, CBT or behavioural therapies, contingency management where the service offers it, family or couples work, linkage to mutual aid, and treatment of co-occurring depression, anxiety or trauma. US OTPs must offer counselling, medical, vocational and educational services onsite or by…
• Stage E. Maintenance, review and recovery-building. Goal: relapse prevention, recovery capital, work, relationships, health. The NHS alcohol guideline sets prescriber review every 6 to 12 months or sooner if clinically indicated. Decisions to continue, change or end medication belong to the prescriber and client.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• your own beliefs leaking into tone. Working when the client speaks about their medication without shame.
• clients dropping out at transfer points. Working when there is no week without contact through the transition.
• assuming smoking is "the least of their problems"; mood dips during quitting. Working when the client makes a supported quit attempt.
• your own reluctance to ask about substance use; clients minimising. It is working when substance use becomes a routine, unembarrassed topic.
• persistent gut upset or rash, mood change, and whether the client is drinking (relapse is information for the prescriber, not a reason to judge).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.