Provigil (modafinil) is a central nervous system stimulant drug that is approved by the Food and Drug Administration (FDA) to treat the excessive daytime sleepiness that is associated with individuals who have:
- Obstructive sleep apnea: Modafinil does not treat this condition directly, but helps to treat the daytime sleepiness associated with individuals who have it.)
- Narcolepsy: This is a sleep disorder that results in individuals falling asleep numerous times during the day for short periods.
- Shift work disorder: This is a sleep disorder that develops as a result of working nighttime hours that interfere with one’s normal sleep schedule.
The drug is also touted as a cognitive enhancer (see below).
Modafinil is classified as a Schedule IV controlled substance by the United States Drug Enforcement Administration (DEA). All of the drugs classified in this category are considered to have moderate potential for the development of abuse and physical dependence in individuals who use or abuse them.
Modafinil is a stimulant that has far milder effects than other stimulant medications, such as amphetamine. As a result, the medication also has a number of off-label uses that are associated with treating fatigue, sleepiness, and issues with lethargy that are associated with depression or other disorders.
Some of these uses include:
- Treating fatigue in individuals with multiple sclerosis
- Treating fatigue and lethargy in individuals with Parkinson’s disease
- Treating fatigue and lethargy in individuals with certain forms of cancer
- Treating lethargy that is associated with the development of depression for any condition, including major depressive disorder
- As an adjunctive treatment for individuals with attention deficit hyperactivity disorder (ADHD)
The mechanism of action of modafinil is believed to involve a number of different neurotransmitters that include dopamine, norepinephrine, glutamate, serotonin, and GABA. Provigil is available in pill form, and the dose can be adjusted to fit the needs of the specific case.
Because modafinil has a relatively low abuse potential and is associated with a relatively minor potential for the development of physical dependence (although this drug can certainly be abused and result in physical dependence in individuals who use or abuse it), it has a number of other potential medicinal uses.
The Utility of Modafinil in Addiction Recovery
Research indicates that modafinil may have utility in individuals who are recovering from:
- Cocaine abuse: A number of research studies have demonstrated that use of modafinil does have utility in addressing any lethargy and sleepiness in individuals recovering from a cocaine use disorder.
- Methamphetamine abuse: Research has demonstrated that modafinil has utility in treating lethargy and sleepiness associated with recovery from methamphetamine (crystal meth).
- Other amphetamine abuse: Scattered research studies have found that modafinil is also useful in addressing the sleepiness associated with withdrawal from other forms of stimulant medications.
Because modafinil is a stimulant medication that is considered to be at a relatively low risk for the development of abuse, it has been used as an adjunctive treatment for individuals in recovery. Its use has primarily been focused on the treatment of sleepiness and lethargy in individuals recovering from stimulant use disorders, as these individuals often experience lethargy, daytime sleepiness, and problems with concentration once they discontinue their drug of choice.
In addition to being useful in treating lethargy and sleepiness associated with the withdrawal process from stimulant drugs, there is some research that suggests that modafinil may have some utility as a withdrawal management medication for individuals with stimulant use disorders in the same way that Suboxone has utility as an opioid replacement medication. The research results appear mixed, but there is some evidence that using Provigil as a replacement medication for cocaine and methamphetamine may have promise to assist these individuals in negotiating the early stages of recovery. In this capacity, modafinil would be used in the initial stages of recovery for individuals with stimulant use disorders and would be administered as a replacement medication to assist in the control of any withdrawal symptoms and to reduce cravings during the withdrawal period. Physicians would then slowly taper the dose of the modafinil at specified intervals to allow individuals to wean themselves off the drug.
The goal of the withdrawal management program is to assist the individual in decreasing or eliminating any withdrawal symptoms, avoiding relapse, and eventually being able to address their issues without the use of stimulant medications. The research is tentative and promising at best, and there is no formal protocol described by the American Society of Addiction Medicine for this procedure at this time. Moreover, the drug is not formally approved for this purpose. More research needs to be performed in order to elucidate its usefulness in this capacity. Although the use of modafinil is not heavily researched for treating sleepiness associated with recovery from other substances, it obviously has potential uses in this capacity.
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Modafinil as a Cognitive Enhancer
It is important to understand that the designation of a substance as a cognitive enhancer or “smart drug” is somewhat of a misnomer. Stimulant medications improve an individual’s ability to focus and pay attention; however, they do not directly increase an individual’s capacity to learn or solve problems. Often, people are under the impression that simply taking the drug makes them smarter. This is not true. Their designation as “cognitive enhancers” is simply based on their ability to help individuals to better focus and pay attention, which enables them to be able to more efficiently encode information during the learning process. In order to actually get smarter, one actually has to read, learn, and memorize things.
Other drugs that have stimulant properties have this effect, and modafinil is not unique in this capacity. For example, caffeine has been long recognized as a cognitive-enhancing substance. There is no magical process associated with the ability of stimulants like modafinil to assist in learning. In addition, stimulant medications typically have this effect when they are used at low to very moderate doses. Using a stimulant medication at high doses actually results in the opposite effect; individuals become distracted, hyperactive, and unable to focus.
Because Provigil is a relatively mild stimulant compared to other drugs in its class, it has the potential to help individuals improve their capacity to pay attention. This may be extremely useful for individuals with a number of different substance use disorders. For example, research has suggested that modafinil may be an important adjunctive treatment for use in enhancing the mental capacities of individuals who are recovering from alcohol use disorders.
Other research suggests that modafinil may have utility as a cognitive enhancer in individuals recovering from methamphetamine abuse and cocaine abuse. Potentially, it may have utility in addressing some of the cognitive issues that occur in individuals who have chronic issues with benzodiazepine abuse. Individuals who have cognitive problems that are associated with the development of a stroke or other neurological issues as a result of any form of substance abuse may be able to benefit from using low doses of modafinil.
However, modafinil is only one of many drugs that may have this capacity. It may not represent the best choice due its potential for abuse and the development of physical dependence.
Modafinil may be a useful adjunctive medication for treating lethargy and sleepiness that occurs in recovery from certain types of substance use disorders (most often, stimulant use disorders). Modafinil may also have potential utility as a stimulant replacement medication used in withdrawal management treatment for individuals who suffer from serious stimulant use disorders to cocaine, methamphetamine, and other amphetamines. Due to its stimulant properties, the drug may also have utility as a cognitive enhancer for individuals who suffer from issues with attention associated with prior substance use disorders.
Modafinil is not a drug that would be considered to be a frontline treatment for any substance use disorder, and its utility as a potential adjunctive treatment in the above situations has not been fully demonstrated in research trials. More research needs to be performed to determine its exact capacities and usefulness in treating recovery from substance use disorders.
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