Prairie Doc Perspective Week of April 19th, 2026
By Kelly Evans Hullinger, MD
Substance use disorders like alcohol and opioid use disorders can be diverse, and every patient has a different story when it comes to their addiction. Social factors, genetics, history of trauma or mental health disorders, and many other contributors may be at play, which can make treatment of substance use disorders challenging.
Because of these challenges, successful treatment of substance use disorders often requires multiple approaches. Just like a patient with diabetes is best treated with diet, exercise, education, and medication, a patient with a substance use disorder is most effectively treated with a multi-disciplinary plan. For many patients, medication can be an important piece of the approach.
I have had several recent experiences with patients successfully abstaining from alcohol and opiates with the help of medication. The most common example that I see is alcohol use disorder, which can range from alcohol dependence to binge drinking behavior which causes disruption in a person’s social and family life and often leads to other medical problems.
One evidence-based option that I often use for patients with an alcohol use disorder is an oral medication called naltrexone. Recently, a patient who previously struggled with binge drinking described the effect of this medication to me, which was an enlightening explanation. “Doc, I’ve always been someone who, if I had one beer I was going to have 6 or 12 more. But on this med I can have one or two beers with my friends and I just don’t feel like having any more.” As a quite safe and accessible medication, naltrexone is an option I discuss frequently in my primary care clinic.
Another common and sometimes devastating problem is opioid use disorder. We have very good evidence that medications can significantly improve the probability of a patient being able to stay off opioids, and those options are gradually becoming easier to access as well. One of my patients who for many years struggled with opioid use disorder, even as it wreaked havoc on their life from a medical and legal perspective, has done extremely well with medication assisted therapy. They described the effect of medication as, “the first time I can remember that I have gone days without thinking about finding opioids.”
A current area of research is around GLP-1 agonists (commonly used in diabetes and obesity) as potential treatment for substance use disorders. While the verdict is still out on these, we may soon have some data on whether they hold up as effective treatment options for this group of patients as well.
While social support, therapy and counseling, and other facets of treatment will always be important, medications to help patients with some forms of substance use disorder are an essential piece of the puzzle. I have witnessed many of my own patients who have hugely benefited from those treatments. I am hopeful that medications will become easier for patients to access and have more options in the future.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).