Addiction Medicine Made Easy | Fighting back against addiction

An Overview of Psychiatric Medication (and How They Can Help Patients with Addiction)

• Casey Grover, MD, FACEP, FASAM

Share episode

Dr. Casey Grover breaks down psychiatric medications and their role in addiction treatment, explaining how different medications work, when they're most appropriate, and which ones to avoid. He provides a practical overview based on his extensive experience treating patients with substance use disorders.

• Psychiatric medications get developed through research on brain receptors and undergo rigorous testing before FDA approval
• Medications often have "off-label" uses that weren't originally intended but provide benefits in certain situations
• Antidepressants like SSRIs and SNRIs serve as the foundation for treating depression in people with addiction
• Using non-addictive options like hydroxyzine, clonidine, and buspirone is crucial when treating anxiety in recovery
• Trazodone and mirtazapine are preferred for sleep issues over benzodiazepines and "Z-drugs" that can create dependence
• ADHD treatment requires careful consideration when patients have stimulant use disorder histories
• Benzodiazepines should be avoided when possible as they paradoxically worsen anxiety over time
• Medication selection should consider urgency of conditions, past medication responses, and potential side effects
• Some psychiatric conditions may improve with therapy allowing medication reduction, while others require long-term treatment

Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Remember, treating addiction saves lives.

To contact Dr. Grover: ammadeeasy@fastmail.com



Speaker 1:

Welcome to the Addiction Medicine Made Easy Podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.

Speaker 1:

This episode is on psychiatric medication. As you've heard me say, I am a medical director for one of the drug and alcohol treatment programs near me and I give educational lectures once monthly to the staff on various topics in addiction medicine, and last month they asked me to give an overview of psychiatric medications. It was a really big topic, but I did my best to give a high-level overview of the different psychiatric medications. It was a really big topic, but I did my best to give a high-level overview of the different psychiatric medications, including what class they are in, when they are used, how they can be used to treat patients with addiction and which meds are my go-to for when I am treating my own patients. It's obviously not a comprehensive review of the topic, but it gives a nice overview and with that here we go. Okay, so we're going to go through an overview of the different classes of psychiatric medications and I hope it'll be helpful to understand why some meds get used and how we can integrate psychiatric medications into treating addiction. So I think to really understand why there are so many medications, we have to understand how medications get developed, so it's a fairly long process.

Speaker 1:

So scientists are always looking to make new discoveries, understand more about the conditions that we have, and as an example, we'll say that a researcher is trying to understand bipolar disorder and they find a new receptor in the brain that controls emotion in bipolar disorder. And it's a eureka moment. And now drug companies can start to target molecules that mimic this new receptor that affects bipolar disorder. And so now that we've got this new chemical target, this new receptor with bipolar disorder, companies are synthesizing different molecules and seeing how they interact with the receptor. And we'll say, a pharmaceutical company has a breakthrough moment and they find a drug that they think interacts with this hypothetical new bipolar disorder receptor and that it's going to be great to managing mood and emotions in bipolar disorder. And again, none of this is real, it's just hypothetical, just understand the process. And so this company then would apply for an investigational new drug application with the Food and Drug Administration and every country does it a little bit differently, but in America it's the Food and Drug Administration. And then that company takes that new potential medicine and runs it through a series of trials, each getting bigger as it proves safety and efficacy. So the first trial is phase one, usually very small, maybe trying to find the right dose, understanding safety. Then they move on to phase two and phase three and then, if it turns out it's safe and effective, then the medication gets approved for use. And then for me as a doctor, I get notified that a new medication has been approved and I can start prescribing it.

Speaker 1:

Now I will not make a political statement on this, but our medical system in this country is profit-based, meaning if you make a new drug you make lots of money. So essentially what happens is once a new target is found and a new drug is made, that drug is on patent and so that company is going to make a lot of money with their new medicine. And other companies will try to make a similar medicine to target the same molecule, because they want to make their own medicine and maybe it's better and maybe they can make more. And my med school professor called these me too drugs, and the one people might remember is that the first really new antidepressant was fluoxetine, also known as prozac, and all these other drug companies made lots of other similar antidepressants, and so now we have sertraline, which is zoloft, and acetalopram, which is lexapro. Again, it's all about making new medicines to compete with the breakthrough medicine.

Speaker 1:

Now, as a doctor, I want to explain to you how we actually prescribe medications. Now, every medication in America is approved by the FDA for a specific indication Again we'll say bipolar disorder and it might work for other indications and those are called off-label. Like the bipolar disorder medicine might turn out to also suppress migraines. So I prescribe it as indicated by the FDA for bipolar, but my patient who has migraines might get it because it suppresses her migraines. And essentially what we find is, as we get more experience with the medicine, we learn that it does other things or that sometimes side effects are useful. Like this new bipolar disorder medication might be really sedating and it turns out it works well for sleep too. So let's actually take a look at some real-life examples, and again I was coming up with a hypothetical example. I would love a new medicine for bipolar disorder, but I'm not aware of said hypothetical breakthrough drug existing in real life.

Speaker 1:

So let's look at Topiramate, also known as Topamax, and then just a level set. I know we all know this, but, just to be sure, medications have a generic name and then they may have one or more brand names. So the generic name is Topiramate, the brand name is Topamax. Now this medication is FDA approved for seizures and migraine prevention and we can use it off-label for binge eating, weight loss, alcohol use disorder and stimulant use disorder. Now, one of the major side effects of tapiramate is that it causes taste changes. So we're actually using a side effect for good in that when you eat, when you take tapiramate, the food tastes different, which is one of the reasons it may be associated with weight loss.

Speaker 1:

Now how did people find out that tapiramate was helpful for alcohol use disorder and stimulant use disorder? Well, we treated people with seizures and migraines and they'd make a comment like hey, doc, does this medicine make you not want to drink alcohol? I have no desire to drink. In fact, one of my staff in my office is on tapiramate for migraine prevention and she actually asked me that exact question hey, does tapirabate make you not want to drink alcohol, and so we learn that these medications do other things.

Speaker 1:

Let's look at a second example. Let's look at trazodone. So trazodone is a generic antidepressant and, believe it or not, there is only one FDA approved indication, and that's depression, which is amazing, because no one uses it for depression. It is too sedating, so we actually only use it for sleep. We almost only use it off-label because it has a beneficial side effect of making people sleepy, so we now use it as a sleeping med. So that's hopefully a good sense of why we have so many medications to understand the drug development process and then the so-called copycat drugs, and then to understand what drugs are indicated for and then how we can prescribe them.

Speaker 1:

Now I'm a pretty simple guy. I like to keep things simple in my brain and we all know lots about cars. Cars are everywhere in our lives, and so usually, when I make analogies to patients about medications, I make analogies to cars, and what I mean by that is you can think of drug classes like different types of cars. So trucks, there's tons of them. There's little, tiny Fords up to big Fords. There's the Toyota Tacoma, there's the Toyota Tundra, but they're all trucks, but they do different things. And then you have SUVs. They're different. They're different than trucks, but similar. And then you have sports cars and sedans. And that's one of the ways that I help patients understand the similarities and differences between medications. So let me give you some examples.

Speaker 1:

So on the screen here you can see a GMC Sierra and a Chevy Silverado. Now I don't know about you, but I don't actually know why GM makes Chevy and GMC, because it seems like the same cars. The differences are very minute. So let's say, a patient is being switched from medication A to medication B and they're very similar. And the patient will ask me, doc, what's the difference? And I usually say, meh, gmc Chevrolet. And they're like oh, okay, I get that, the medications are very similar. There are some subtle differences, but not so big. Now, let's say, the medication difference is slightly bigger.

Speaker 1:

On the screen you can see a Ford F-150 and a GMC Sierra and I'll explain to the patient like well, they're both trucks, but they're different. It's like a Ford F-150 and a GMC Sierra. And the patient's like okay, I get it, they're both big trucks, but there's some nuance. Maybe one has a different appearance, maybe one has more torque. They're similar, but I do understand that there's differences. And then here on the screen you can see a Chevy Silverado and a Chevy Corvette, minus the fact that these two cars are both made by Chevrolet. They are completely different. You have a truck which is for towing and hauling and maybe going off-road, and then you have a sports car. Right, you would not take the Corvette to a dump to pick up junk, just as much as you wouldn't race the Silverado on the racetrack. And that's an example of I'll tell the patient yeah, this is like a truck and a sports car. They're very different. So that's an analogy that I use when I'm trying to explain the differences between different medications.

Speaker 1:

Okay, now, I love this graphic. It's obviously a hamster trying to swallow a whole carrot and not able to do so because it's too big. And the reason I say this is this is an enormous topic. There's no way I can actually give you all of the medications in detail. So we're really going to look at just some drug classes and then we're actually also going to look at the medications that I use most and talk about why.

Speaker 1:

Okay, so our first big drug class are the antidepressants, and, as an example, you can think of these as trucks. Right, they make a small Ford Maverick, they make a giant GMC Sierra Super Duty. They're both trucks. You can use them to haul and pull stuff. But there's differences. All of these medications can be used for depression and we've actually found over the years that they also have other benefits. They help with binge eating disorder and anxiety and they help with OCD. There's a lot of benefits.

Speaker 1:

So let's go through the classes. So you have your SSRIs, or selective serotonin reuptake inhibitors, and if you switch between medicines in that class that's where I tell people GMC and Chevrolet You're switching within the same class of antidepressants. Minute differences, not major differences. Now the next class are the serotonin and norepinephrine reuptake inhibitors, and that would be like going from a Toyota Tundra to a Ford F-150. Big truck to big truck from a different manufacturer. They do different things from a different manufacturer. They do different things. Now. Ssris some examples would be Sertraline or Zoloft, fluoxetine or Prozac, acetalopram or Lexapro and the SNRIs, the serotonin and norepinephrine reuptake inhibitors. Some examples would be Venlafaxine, also known as Effexor, or Duloxetine, also known as Cymbalta.

Speaker 1:

Next we have the two older classes of antidepressants the tricyclic antidepressants. That's named for the shape of the molecule. There's a triple cyclic structure within the molecule. And then there are the monoamine oxidase inhibitors. We really don't use the MAOIs, the monoamine oxidase inhibitors, very much anymore because of some bad side effects. And we occasionally use the tricyclics much anymore because of some bad side effects and we occasionally use the tricyclics, but we largely use the SSRIs and SNRIs and then other antidepressants mirtazapine is also known as remeron, and bupropion also known as well buterin or zyban. I'm going to talk about those individually a little bit later.

Speaker 1:

Now this is a screenshot from a company that I have zero financial ties to, called GeneSight, and what they do is what's called pharmacogenomic testing. So this is a test I do in the office I swab your cheek and we collect cheek cells and then I send it off to the company and then they extract the DNA from the cheek cells and then they actually look to see, based on your genetics, how you metabolize different meds and we can actually choose which meds you are likely to have the most predictable response to. And the reason I use their screenshots is it lists all of the dozens and dozens of names of antidepressants and it puts them very nicely in a graphic. So thank you, genesight, for doing this. But you can see there's tons of different antidepressants. A lot of these I have to look up on my own, but again, high level. You can think of these as trucks. They all kind of do a similar thing.

Speaker 1:

Okay, let's move on to the next class of psychiatric medications, which are anxiolytics and hypnotics. So these are medications that are basically just general sedatives and we can say these, for example, are sedans. They're dissimilar from trucks, they're both cars, they both have uses, but we use them for different things than we do a truck right. So these are medications that are generally used for anxiety and sleep. The ones people know the most are the benzodiazepines diazepam or valium, alprazolam or Xanax, clonazepam or Klonopin. We have the Z drugs. The one people know the most is Zolpidem, which is Ambien, and I apologize, I don't remember the generic names off the top of my head, but the other two Z drugs that are in America their brand names are, I think, lunesta and Sonata. Buspirone is a little bit different, it's in this class but it acts differently. And then we also have the antihypertensives, which I'll talk about. So, again, these are all medications that we use to suppress anxiety and promote sleep.

Speaker 1:

The benzos and the Z drugs act in a particular way to make the brain's natural downer chemicals work more. They function, quite frankly, almost exactly the same as alcohol. So I often tell people, when they say Xanax is so helpful, I say, well, it's not great because it's basically alcohol and a pill. Boosperone's a little bit different. We haven't fully figured out why it works for anxiety, but it's something that when it's taken over time it has a little bit of an antidepressant-like effect in helping anxiety, but it also can provide relief in the moment when someone just needs to calm down and need a little bit of a downer effect. And then the last two, propranolol and clonidine, are actually used to control blood pressure, and the way they do that is by reducing the amount of stress hormones that the brain releases. So clonidine we use for opioid withdrawal, we use for PTSD triggering, and the reason we do is because it actually takes the amount of adrenaline, the stress hormone, coming out of the brain and it reduces it. So therefore it doesn't bring the blood pressure up as much but it also blunts the stress response of withdrawal and then the PTSD stress response.

Speaker 1:

Here again are some names on the screen from the gene site report and you can see again there's lots of these. I usually have to to look them up. Okay, the next class of medications we'll call these COOPS. These are antipsychotics. There's three basic generations.

Speaker 1:

For thousands of years, schizophrenia was not something that we could treat Basically people would hear voices and be disorganized and paranoid, and there was nothing we can do about it. And then we synthesized the first antipsychotics decades ago, and it was an incredible breakthrough. The first generation are medications that are much older. You might know Haldol or haloperidol. That's one of the first-generation antipsychotics and it helps treat schizophrenia and other conditions of psychosis. Now the older meds had a lot of side effects, and so the drug companies went back and innovated and changed the molecules around and they created the second-generation antipsychotics, which were better. They had fewer side effects. In some cases they were more effective, and examples of these would be olanzapine, also known as Zyprexa, and Seroquel, also known as Cotopine. There are obviously others. And then we've now even innovated to a third generation which is even better in terms of its side effect profile than either the first or second generation, and the one that people most know of in this class or this generation is aripiprazole, also known as Abilify.

Speaker 1:

And again, these are medicines we use for significant mental health conditions. We can use them sometimes for bipolar disorder, particularly the second and third generation, but usually it's for schizophrenia. They tend to be very sedating. Here's a list of all of them. And because they're sedating, sometimes we can use them for sleep. Seroquel or cataepine, in particular, is very commonly used for sleep. Again, that's using a positive side effect of sleepiness as a benefit.

Speaker 1:

Okay, the next drug class mood stabilizers. We'll say these are SUVs Again, a totally new class here. These are really used for bipolar disorder and just a level set. Bipolar disorder is a condition where the mood is unstable. So the mood goes down and there's depression and then the mood comes up and that's mania. And mania is really really destructive to someone's life. If you've never seen it, people are just their mood is so far up, they are completely out of reality. They are spending thousands of dollars, they are buying multiple cars at the same time, they are staying up all night. They're on Tinder getting as many sexual partners as possible. Staying up all night, they're, you know, on Tinder getting as many sexual partners as possible. It is really destructive to someone's life. So a lot of these mood stabilizers are really meant to keep people out of mania, but they can also help to level up the mood and blunt some of the depression.

Speaker 1:

It's kind of a mixed group. A lot of these are actually anti-seizure medications that were found to be helpful over the years when we treated people with seizures and we saw it had effect on bipolar disorder. I don't use a ton of these in my practice. If someone has significant bipolar disorder, I usually refer them to psychiatry because, again, an unmanaged manic state is just really destructive. Okay, I think this is the last class. Okay, so this is our last class. We'll just say arbitrarily, these are race cars. Again, we're just trying to highlight that these are all different classes of drugs, like different classes of cars, to remind us that they're different.

Speaker 1:

So, adhd medications we have two main classes. We have the stimulants and non-stimulants. And if you've ever wondered why taking hyperactive, fidgety, distractible people and giving them stimulants makes them focus, if you've ever wondered why that is, it's a really interesting phenomenon. So if you've ever had a patient tell you that meth calms them down, I used to hear that and I would look at, look at people and be like, no, you must be lying. That doesn't calm anybody down. That's an upper, and it turns out that a lot of people who gravitate towards stimulants Actually have untreated adhd and they use the stimulant to actually self-regulate. If you didn't know, the generic name for the adhd medication, adderall, is amphetamine. We are literally giving uppers to people with adhd and it works. I'm not 100 sure that we know why. Maybe it, maybe someone does, I I personally don't. But but yes, the other class of medications would be non-stimulants and these work through a different mechanism.

Speaker 1:

Here are some examples the stimulant medications. There's really three of them Methylphenidate, amphetamines and lisdexamphetamine. And then the non-stimulants adamoxetine, guanfacine, vilocizine and clonidine. You can see all the brand names on the screen. For me, really, if somebody has a history of stimulant addiction, I really do not go down the stimulant route. For this. I focus on the non-stimulants because it can be really triggering for them to have a stimulant in their system.

Speaker 1:

I used to not think that ADHD was that big of a deal, but if you can imagine you're trying to do therapy or focus in a 12-step meeting and you're constantly distractible and you can't focus, it's really hard to do the recovery work. So I try to be really aggressive in treating ADHD in people with addiction because the recovery work is much easier for them. So I'll talk about which are my go-to meds in just a sec. Okay, so that's again the overview. We have our antidepressants, our antialytics and hypnotics, we have our mood stabilizers, we have our antipsychotics and then we have our ADHD medications. So depression, as we all know, is a major issue in recovery.

Speaker 1:

My first-line medications are usually the selective serotonin reuptake inhibitors Sertraline or Zoloft, acetalopram or Lexapro, fluoxetine or Prozac. That's usually what I go to. If I've tried a couple of meds or the patient's tried a couple of meds in that class, then I'll usually go to the SNRIs. That's again the serotonin norepinephrine reuptake inhibitors. Usually what I go to there is venlafaxine or Effexor or a medicine called desvenlaf.

Speaker 1:

Mirtazapine, also known as Ramiron, is very sedating. We'll come back to that in a sec. We tend to use it for sleep. And then Welbutrin or Bupropion. I tend to use this when a person has a history of stimulant use disorder, adhd or smoking. So Welbutrin is very activating, it tends to help people feel mentally really up and awake and so it works for people who use stimulants to get going. It also can work for ADHD. So again, it might help someone who uses stimulants because of ADHD. And then it's also approved for smoking cessation and the brand name for that in America is called Zyban.

Speaker 1:

So these are the meds I go to my go-to medications for anxiety. I'm going to start in the middle section here. The antidepressants actually work very well for anxiety and the way to think of it is, let's say, somebody feels overwhelmed really easily. The antidepressant basically takes that threshold to be overwhelmed and brings it up. It's almost like it builds in a little bit of emotional resilience. In other words, it takes more to trigger their anxiety. The other meds just tend to be mildly sedating.

Speaker 1:

Hydroxazine I'm sure you've all given to clients too many times to count. It's an antihistamine like for allergies, and it tends to have a mild sedative effect. It doesn't cause addiction. It doesn't have a withdrawal syndrome. It's a very effective medication. So that's one I use pretty frequently.

Speaker 1:

For people with a lot of PTSD I tend to use medicines that make triggering less, like clonidine or propranolol. Those are the ones that reduce the stress hormones in the brain. Buspirone works great for some people, not as much for others. Definitely worth trying for someone in anxiety. And then gabapentin. And the best way to manage anxiety is to give people an antidepressant, because it starts to work over time and gives them some daily relief from the anxiety, and then also to give them something as needed, like a clonidine or a hydroxyzine or a gabapentin that they can take when they're feeling overwhelmed.

Speaker 1:

My go-to medications for sleep, the two antidepressants that I use the most, are trazodone and mirtazapine. Again, mirtazapine is also known as Remeron. They are basically just antidepressants that are very sedating and they tend to be very effective. They may also help mood a little bit. Hydroxazine is an antihistamine that can be a little bit sedating we often give a bigger dose at bedtime and that can help with sleep. And then we haven't talked about this one yet, but romeltion is a non-scheduled, non-addictive sleep medication that works by modulating the melatonin system, and melatonin is one of the hormones that helps us regulate our sleep-wake cycle. So these are the ones I go to for sleep.

Speaker 1:

Now, what classes of meds do I avoid? Benzos, benzos, oh, benzos, benzos, benzos, benzos are really really hard. So benzodiazepines are extremely effective for anxiety and insomnia, but they work in a way that actually paradoxically lead to anxiety over time, and here's the way I think about this. So we are wired as human beings for threat. So we've been living for thousands and thousands of years in small villages as hunters and gatherers. Okay, the modern world has only been about maybe 200 years. Our brains still see the world as though we are living in small, primitive villages. And when we were living in small, primitive villages we were potentially going to be victims of attack from a neighboring tribe or a wild animal, and so we, like a squirrel who knows he could be eaten, we are constantly scanning the world around us for threat. The benzodiazepines are so effective at suppressing that threat response by changing how the brain works In other words, it increases the natural downer chemicals in the brain that basically the threat response is suppressed and the brain doesn't like it. The brain doesn't want to have the threat and scanning for threat response suppressed to that level. So the brain actually dials up the anxiety. The brain dials up the fight or flight response because it's worried that if it's too sedated it won't be able to actually respond in the case of a true threat. The other anxiety medications that I went over don't affect the brain in the same way, and we see this with alcohol. Right, you get people who drink alcohol because of anxiety and their anxiety just gets worse over time and they have to drink more and drink more and they just cannot control their anxiety. And benzos are very similar. So what we see is, over time, people come up with no other coping skill besides their benzo and their brain's anxiety. Over time, people come up with no other coping skill besides their benzo and their brain's anxiety over time gets worse, which is one of the reasons why getting off benzos is so painful, because there was such an emergence of the anxiety and insomnia they were originally prescribed for.

Speaker 1:

Now, the Z drugs I try to avoid as well. Again, these are the benzodiazepines similar sleeping medications like Zolpidem or Ambienz, the one everyone thinks of these medications. If you don't sleep on them, it can do some really weird things. People can hallucinate. There's been cases of people buying cars in a trance-like state while they're under the influence of these medications. People sometimes have been reported to gamble online while they're under the influence of these medications. People sometimes have been reported to gamble online while they're under the effect of these medications. I really try to avoid them unless absolutely nothing else works, and then it's really only for a short period of time. I really try to avoid the Z drugs as well.

Speaker 1:

Now, how do we, as doctors, decide which medication of all the ones we just went over. Which one do we choose? Well, the first thing is what conditions do they have? Do we have the right diagnosis? Do we understand what mental health conditions have contributed to their addiction? And then, with that, which of the conditions is most urgent to treat? So let's say somebody has know PTSD and ADHD and alcohol use disorder. We might say, okay, well, there's a lot of PTSD and that triggering is what's making the person drink. Let's really focus on the PTSD first, kind of reduce their alcohol consumption, and then we'll come back to the ADHD. So I really try to prioritize and with some of these, these patients who have a lot of different conditions, we might be talking about getting to having them on six to seven medications. Starting them all at once is going to be overwhelming, so we might just start one or two at a time.

Speaker 1:

And then one of the most useful questions I can ask is what meds have you been on before? Were they helpful or were they not? I love it when somebody comes in and they say, dr Grover, oh my gosh, hydroxyzine was so helpful. Can you restart it? Yes, that's so easy. Or, gosh, dr Grover, I took hydroxyzine and it was not helpful at all. We got to try something different. Great, no-transcript. Okay.

Speaker 1:

So we've started the patient on a medication. Let's say I'm seeing them at their two-week follow-up visit. So the first thing we have to really ask is is this medication giving them really bad side effects? Do we need to take them off of hydroxyzine because they're sleeping through their recovery meetings? We start by really assessing are the side effects manageable or intolerable or non-existent? And if the side effects are intolerable, we're going to have to discontinue that med and try something else. Now let's say the patient says the medication's helping Great. If they feel like they've had a really good response to it, then we might leave the dose there. But if they say it's helping a little, then we're probably going to bring the dose up. And if they say it's not helping at all, we'll probably try to bring the dose up. And then, if it's not helping at all, even with an increased dose, we'll probably leave that class of medications behind. And then let's say somebody's doing really well with their PTSD on their clonidine and they've stopped drinking. Now is the time to say can we add in another medication to treat your ADHD? Now, some of these medications are very much long-term.

Speaker 1:

Schizophrenia is a chronic mental illness. There is no cure. We can just manage it with the medications that we have. However, other conditions do get better with time. Post-traumatic stress disorder might need a lot of medication initially, but with trauma therapy and building a strong support network a person might be able to come off some of their medications as they've learned to emotionally self-regulate. And this is where therapy and counseling and support meetings can be so helpful.

Speaker 1:

And then the other thing is in the world of addiction we have long-acting injectable medications, and these are medications that are given once a month because the patient can't remember to take them. So, for schizophrenia, if somebody forgets to take their medicine or has paranoid delusions about their medicine and stops taking it, they will get a lot worse and they will decompensate. So long-acting injectable medications can be given once a month to ensure compliance, and that's very common with schizophrenia. Just as a reminder, the ones we use in addiction medicine Vivitrol is long-acting injectable naltrexone for alcohol use disorder or opiate use disorder. And then there's long-acting injectable buprenorphine for opioid use disorder and that's either Brixati or Sublicate. Okay, I think I'm going to stop there, because that was a ton of information and I want to get a sense of where we need to pause and clarify, but I'm hopeful that that was a good overview of the various classes of psychiatric medication.

Speaker 1:

Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction, and a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction. You're doing life-saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives.