DR. CHOWALLUR
DEV CHACKO

Addictive disorders are a major national public health problem costing billions of dollars annually.

The major drugs of abuse are alcohol, opioids (heroin and narcotics), cannabis, stimulants (methamphetamine), and cocaine (both powder and crack), as well as nicotine.

This is an exciting time when it comes to the medical treatment of addiction to drugs, particularly opioids, alcohol and tobacco.

Treatment for addiction to opioids, alcohol and cigarettes can now be done safely in the office of a physician specializing in addiction medicine.

In recent years the FDA has approved several new medications for the treatment of addiction to opioids, alcohol and tobacco.

The FDA approved medications for treatment of alcoholism include naltrexone (both tablets and monthly injection), acamprosate and disulfiram. In addition to these, several other medications, including topiramate and ondansetron have been found to be useful in treating alcoholism.

These medications help curb the craving for alcohol and attenuate the unpleasant sensations of protracted withdrawal symptoms after cessation of drinking. Patients on these medications are known to both decrease the amount and frequency of their alcohol intake and increase the length of time they remain abstinent between drinking episodes. Of course, the ultimate goal is total abstinence or sobriety.

The exciting new medication for the treatment of addiction to opioids is buprenorphine. In addition, several other medications, including naloxone,naltrexone and clonidine, are found to be helpful in treating narcotic addiction.

When it comes to smoking cessation there are several FDA approved medications, including bupropion, varenicline, nicotine inhaler and nicotine nasal spray. In addition, nortriptyline and clonidine have been found to be helpful to help quit smoking.

There are currently no FDA approved drugs for the treatment of cocaine. However, disulfiram, desipramine, bupropion and modafinil have been used with some success when combined with psychotherapy.

There also are no FDA approved drugs for treatment of methamphetamine addiction. However, bupropion, modafinil, methylphenidate and topiramate have been used in combination with psychotherapy with good results.

All of the above medications can be prescribed in a physician’s office.

Inpatient treatment is rarely necessary.

Patients with substance abuse disorders often suffer from other psychiatric disorders, such as depression or bipolar disorder. Therefore, it is important to evaluate these patients psychiatrically and treat those conditions concurrently.
There are now about 1200 physicians nationwide who are board certified in the addictions field.

The national professional organizations representing specialists in the area of addictions are the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry.

There are several physicians in Central Florida who belong to these professional organizations and /or are board certified in addiction psychiatry.



Dr. Chowallur Dev Chacko, is a Distinguished Fellow of the American Psychiatric Association and a Diplomate of the American Board of Psychiatry & Neurology. He is Board Certified in General, Addiction and Forensic Psychiatry and is an Assistant Professor of Psychiatry at UCF College of Medicine.



June 2008