Reference — Mental Health
Substance Use Disorder Medications Reference
Medication treats substance use disorders, not just the withdrawal from them. Each agent has a mechanism that drives its teaching — and a couple carry safety traps (a disulfiram reaction, a too-early antagonist) that are exam and bedside favorites.
Educational use only. Selection, dosing, and induction timing are provider-directed; some agents are dispensed only through regulated programs. This is a study and teaching aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Alcohol Use Disorder
| Drug | Mechanism | Key Teaching |
|---|---|---|
| Naltrexone | Opioid antagonist; reduces craving and reward | Also used for opioid use disorder; must be opioid-free first; monthly injectable option aids adherence |
| Acamprosate | Modulates glutamate/GABA; eases protracted abstinence symptoms | Renally cleared (caution in kidney disease); started after abstinence achieved |
| Disulfiram | Blocks alcohol metabolism → acetaldehyde buildup | Aversion therapy: any alcohol causes flushing, throbbing headache, nausea/vomiting, tachycardia. Avoid all hidden alcohol — mouthwash, cologne, sauces, OTC elixirs |
Opioid Use Disorder
| Drug | Mechanism | Key Teaching |
|---|---|---|
| Methadone | Full opioid agonist; suppresses craving and withdrawal | Regulated program dispensing; watch QT prolongation and respiratory depression with other CNS depressants |
| Buprenorphine (± naloxone) | Partial agonist with a ceiling effect (safer in overdose) | Start only in objective withdrawal (adequate COWS) or it precipitates withdrawal; sublingual — let it dissolve |
| Naltrexone | Opioid antagonist; blocks the effect (relapse prevention) | Requires full detox first — too early precipitates withdrawal |
| Naloxone | Opioid antagonist; reverses overdose | For respiratory depression + pinpoint pupils; short-acting, so repeat dosing/monitoring needed; send home with at-risk patients |
The Two Traps
Disulfiram reaction: the patient must avoid every hidden source of alcohol, not just drinks — the reaction can be triggered by mouthwash, aftershave, cooking wine, and alcohol-containing OTC liquids. Teach label-reading.
Antagonist timing: naltrexone (opioid antagonist) and buprenorphine (partial agonist) both precipitate withdrawal if started while opioids are on board. Confirm the patient is opioid-free (naltrexone) or in objective withdrawal (buprenorphine) first.
NCLEX Pearls
- ✦Disulfiram + any alcohol = flushing, severe headache, vomiting, tachycardia — avoid hidden alcohol (mouthwash, sauces, aftershave).
- ✦Naltrexone (antagonist) needs a fully detoxed patient; buprenorphine needs objective withdrawal — both precipitate withdrawal if started too soon.
- ✦Naloxone reverses opioid overdose but is short-acting — monitor for re-sedation and re-dose as needed.
- ✦Methadone is a full agonist (QT and respiratory caution); buprenorphine is a partial agonist with an overdose-protective ceiling.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Psychiatric Association (DSM-5-TR) · American Psychiatric Nurses Association (APNA) · SAMHSA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →