In a perfect world, it would be wonderful if everyone could be abstinent without any medication. However, this is not often possible. In general, by the time patients come to see me, they have been unable to maintain any consistent sobriety, if any, on their own. Fortunately, there are now excellent medications to help patients recover from drug addiction.
Patients who abuse opioids eventually develop tolerance (need more of the drug to get the same effect) and functional impairment (e.g. fail out of school, lose their job, get arrested). One of the main goals in addiction and psychiatric treatment is to improve functional impairment – i.e. to help people “get their life together”.
Suboxone is a medication that can assist in the treatment of opioid dependence. A controlled dose of Suboxone is given in place of the opioid being abused. In contrast to requiring escalating doses of the abused opioid, the patient is maintained on a stable dose of Suboxone. Instead of feeling intoxicated, patients feel “normal” when they are on the appropriate dose of replacement therapy.
Patients frequently ask if they will become addicted to Suboxone. Drug addiction is fundamentally different than physiologic medication dependence. In the latter, the patient will develop a characteristic withdrawal syndrome if the drug is taken away. Many, many, common medications that no one would ever associate with abuse have this feature. For example, if someone takes high blood pressure medication and suddenly stops taking it, their blood pressure will skyrocket to much higher levels than if they had never taken the medication. That is why it is important to taper most medications that you have been on for an extended period of time.
In contrast, drug addiction can basically be defined in that use of the drug causes functional impairment in multiple areas of a person’s life. One can also be addicted to a drug, but not be physically dependent on it. So, the answer is that the patient will become physically dependent on the drug, but will not be addicted to it. Life will actually get better, as the patient will now be free of their maladaptive behaviors and resultant negative sequelae.