The Evolving Landscape of SUD Treatment
- Michael Delman MD, FACP, FACG, DFASAM
- Jun 29
- 2 min read
Substance Use Disorders (SUDs) are complex illnesses, but they are treatable. While many are familiar with "front-line" medications like Naloxone (Narcan) for overdose reversal or Buprenorphine (Suboxone, Sublocade, Brixadi) for opioid dependence, there is an entire toolkit of other medications used to support recovery.
At Seafield, we utilize a variety of established pharmaceuticals that have been safely used for years to treat other conditions but are now proving invaluable for SUDs: Below are the main ones used but there are others.
Gabapentin: Originally for nerve pain and seizures, it helps stabilize nerve transmission and can reduce cravings or anxiety in early recovery.
SSRIs (e.g., Zoloft/Sertraline): These help manage the underlying depression and anxiety that often co-occur with or trigger substance use.
Anti-hypertensives (e.g., Clonidine): Useful for managing the physical "fight or flight" symptoms of withdrawal, such as racing heart and agitation.
Baclofen and Topiramate have been used for alcohol use disorder, cocaine use and binge eating
Benzodiazepines (e.g., Valium, Ativan): We use these strictly for short-term withdrawal assistance (detox). Because they can be highly addictive, we avoid long-term use. This is especially critical for those with Alcohol Use Disorder, as "benzos" and alcohol affect the brain in similar ways.
The "New Frontier" of Research
We are also keeping a close eye on emerging research. There is significant excitement around GLP-1 medications (originally for diabetes and weight loss). Recent studies in early 2026 suggest they may "quiet the noise" of cravings by targeting the brain's reward centers. While it is still too early to confirm long-term outcomes for SUD specifically, the preliminary data is promising.
The Human Element
Medication is a powerful tool, but it isn't the whole story. The psychosocial approach remains the bedrock of lasting recovery.
Cognitive Behavioral Therapy (CBT) helps patients rewire thought patterns without pharmaceuticals.
Group meetings and peer support provide the community connection that medicine cannot replicate.
Every patient presents differently, and at Seafield, we believe the best approach is a tailored combination of the most effective medical and psychological tools available.
Interesting to see how medications originally developed for other conditions are being repurposed for SUD treatment. The point about benzodiazepines being used strictly short-term for detox really stands out, especially since they can mirror alcohol's effects on the brain so closely. It reminds me of how in krillion, you have to think quickly about the connections between seemingly unrelated prompts to score well — sometimes the most useful tools come from unexpected places. Appreciate the breakdown of the full toolkit beyond the front-line meds.
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