Medication Assisted Treatment (MAT)
Medications are prescribed to help manage withdrawal symptoms and cravings, significantly lowering the incidence of relapse.
Medication assisted treatment is evidence-based with ample data to show that this treatment modality can be effective, whether administered in combination with other treatments or – in some cases – as a stand-alone therapy.
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What You Need to Know About Opioid Addiction
Prescription opioids like hydrocodone and oxycodone are frequently given to patients to manage pain.
Other common opioids include morphine and fentanyl, which are most commonly used in a hospital setting. Heroin is a street opioid and not used in hospital or medical settings.
All of these drugs work by binding to opioid receptors in the body, which inhibit pain signals to the brain.
While opioids are frequently prescribed by doctors for a variety of reasons, the use of these substances can be dangerous, especially to someone who is prone to addiction. The euphoric effect of the drugs can prompt people to use them more often than recommended.
What begins for many as a benign and necessary form of pain management, can soon lead to dependence.
People quickly build a tolerance to opioids, which means they need more of the substance to achieve the same feeling or “high” over time.
Long-term use of opiates and opioids cause structural and functional changes to the brain that can eventually lead to addiction. A person using one of these drugs may start to experience cravings or an overwhelming urge to take more of the substance.
When someone tries to stop using the drug after prolonged use (going “cold turkey”), withdrawal symptoms can be severe and even dangerous in some cases. Painful withdrawal symptoms are a primary reason why people continue to use them, even though they know it can be causing problems with their health.
The Basics of Alcohol Addiction
Alcohol use often begins as a harmless social activity – going out after work for drinks with friends or enjoying a glass of wine with dinner.
Increased use of alcohol can become problematic, however, if a person begins turning to the substance daily in higher amounts, or when used as a coping mechanism for stress or depression.
Like opioids, people can develop a tolerance to alcohol, needing more of the substance to achieve the same euphoric effects. Alcohol addiction also creates structural and functional changes in the brain prohibiting judgment and self-control.
At the same time, heavy drinkers may find that if they try to stop using alcohol, intense withdrawal symptoms can make the decision nearly impossible to keep.
Withdrawal symptoms from alcohol can be painful and dangerous, which is why many people addicted to alcohol require medically supervised detox to safely eliminate the substance from the body.
For those with an extremely serious alcohol addiction (excessive daily drinking for many years), detox can be fatal.
What is Medication Assisted Treatment?
Medication assisted treatment does not replace one drug with another, as some critics assert. Instead, MAT uses prescribed medications to address the changes in the brain that lead to both the cravings and the withdrawal symptoms.
Some medications, such as buprenorphine, bind to the same receptors in the brain as other, stronger opioids, to reduce cravings for the stronger drug.
Other medications, including naloxone, block the opioids from binding to the receptors. These types of drugs can also be used in the event of an overdose.
There are other medications that might not be specifically approved for medication assisted treatment but are prescribed off-label to help combat withdrawal symptoms to help individuals detox from the substance and move forward in the recovery process.
For example, antiepileptic medications might be given to someone going through withdrawal from alcohol since seizures can be one of the withdrawal symptoms.
Benzodiazepines, in carefully monitored doses, may also be used during the withdrawal process from alcohol to help people taper off from physical dependency to the substance safely and more comfortably.
When Is Medication Assisted Treatment Used?
The FDA has approved a number of medications for MAT use for both alcohol and opioid addiction treatment.
The medication assisted therapymay be used both during the detox process and in the early stages of recovery to reduce cravings.
Some medications may be prescribed for an extended period, treating the substance abuse disorder as a chronic condition that must be managed, much like diabetics take insulin.
It’s important that all cases of medication use for detox or addiction treatment are supervised and prescribed by an addiction treatment doctor or specialist.
What Types of Medications are Used for MAT?
There are different medications used for MAT, based on whether treatment is for an opioid or alcohol dependency. With a variety of medications to choose from, treatment can be customized to the precise needs of each patient.
Medication Assisted Treatment for Opioids and Heroin
Medications used to treat heroin and opioid addiction include:
- Naltrexone – This medication works by blocking the opioid receptors, eliminating the euphoric effects of the opioid drug. Naltrexone can be administered through oral medication or a monthly injection (known by the name Vivitrol). A naltrexone implant is also available for extended release that last for up to three months.
- Buprenorphine (Subutex, Suboxone, Zubsolv) – Buprenorphine is a partial opioid agonist, which works by blocking the effects of other opioids while reducing cravings. Suboxone is a combination of buprenorphine and naloxone and is a common and successful choice for treating opioid addiction.
- Sublocade – Administered by subcutaneous injection, sublocade is a once a month, extended-release form of buprenorphine.
- Probuphine –This medication is administered by implant into the upper arm to help reduce withdrawal symptoms and cravings without any euphoric effects. The implant delivers a continuous, low dose of the medication for six months.
- Methadone –This full opioid agonist is only available at methadone clinics and not offered at hospitals or addiction treatment facilities. It provides the full effects of opioids and is given in the clinic on a prescribed schedule, usually daily.
MAT For Alcohol
Some of the same medications used to treat opioid addiction can also be used in alcohol rehab treatment. However, there are additional medications that can be used for this purpose as well:
- Antabuse (Disulfiram) – Antabuse was the first medication approved to treat alcohol dependency. Although it is not prescribed as frequently today, it can still be helpful for individuals who have not seen positive effects with other medications. Antabuse works by triggering a severe reaction when alcohol is consumed, including nausea, vomiting, chest pain and difficulty breathing.
- Acamprosate (Campral) – This medication is usually prescribed once detox is completed and works by relieving cravings.
- Naltrexone – Like treatment for opioid addiction, naltrexone can be administered orally, by subcutaneous injection or via a patch. The medication is helpful in blocking the euphoric effects of alcohol, reducing cravings.
- Topamax –In addition to treating seizures sometimes associated with alcohol withdrawal, Topamax can also reduce cravings for the substance.
- Neurontin (Gabapentin) –Neurontin is another anti-seizure medication that may be used to manage seizures and convulsions that can occur during alcohol withdrawal. Studies suggest it might also work on symptoms that increase the risk for relapse, such as insomnia, dysphoria, and cravings.
Medication Assisted Treatment Statistics and Efficacy
Despite the controversy and misinformation surrounding medication assisted treatment, the body of evidence to support the practice continues to grow.
In August 2018, the American Medical Association urged policymakers to support alternative methods of treating opioid addiction in light of the alarming statistics showing the problem had reached epidemic proportions.
At that time, the AMA pointed out that in states where MAT had been widely used, medication assisted treatment statistics showed significant decreases in mortality rates.
A report from Harvard Medical School states that the use of MATs in treating opioid addiction has lowered the risk of fatal overdoses by as much as 50 percent. The medications do more than manage withdrawal symptoms and reduce cravings – they also help individuals struggling with addiction make the changes necessary for a healthier lifestyle overall.
One study published in 2013 found that access to medication assisted treatment was associated with a reduction in deaths associated with heroin overdoses.
Another study in 2006 found that long-acting naltrexone was well-tolerated and led to reductions in heavy drinking by individuals diagnosed with an alcohol use disorder.
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the FDA have both stated that use of medication assisted treatment in combination with other treatments like psychotherapy have helped some individuals sustain recovery.
The CDC is currently conducting its own study comparing individuals that use both MAT and counseling in addiction treatment vs. those that use counseling only. Results are expected from that study in 2021.
Benefits of Medication Assisted Treatment
Research has shown that medication assisted treatment can offer numerous benefits for those walking the addiction journey. While the results can vary from person to person, some of the advantages of adding MAT to the treatment protocol might include:
- Reduction in withdrawal symptoms, making the detox process safer and more comfortable
- Elimination of the need for hospitalization, as the individual may be able to tolerate detox and reduce the risk for relapse without inpatient therapy in some cases
- Reduction or elimination of cravings, which tend to be most prevalent in the early stages of the recovery process
- Increase in those remaining in treatment, also increasing the odds of long-term recovery
- Reduction in the risk of relapse, ensuring individuals maintain a positive recovery whether MAT is continuous or only administered during the early withdrawal and recovery process
Combining MAT with Other Therapies
MAT is most effective when it is combined with other evidence-based, addiction treatment therapies.
Alo House Recovery Centers offer a variety of treatment modalities that allow for the tailoring of the treatment to the unique needs of each client. Customized treatment is essential for beginning a long-lasting recovery journey:
- Dialectical Behavior Therapy(DBT), Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy
- Motivational Therapy and Motivational Enhancement Therapy
- Person-Centered Therapy
- Meditation Teaching Program
- Neurofeedback, EMDR and Somatic Experiencing
- Existential Therapy and Existential Psychotherapy
- Relapse Prevention Therapy
- Psychodrama and Seeking Safety Therapy
- Rational Emotional Behavioral Therapy and Psychodynamic Therapy
- Equine Therapy
5 Myths vs. Facts About Medication Assisted Treatment Therapy
The biggest myth surrounding the use of MAT is the fact that it is substituting one drug for another.
While the medication is given in place of the substance of abuse, the replacement is much safer and usually allows an individual to return to work and other daily activities while reducing the risk for relapse and an overdose.
Other myths regarding medication assisted treatment include some of the following:
1. MAT Keeps a Person from Experiencing True Recovery
The idea that MAT replaces one drug for another can cause some to assume that a person is not in true recovery if MAT is used. This is based on the abstinence-only models of treatment that have been the predominant methodology until recently.
Today, experts realize that helping individuals deal with the physical effects of addiction with medication can make the difference between successful recovery and relapse.
2. Medication Assisted Therapy Can Lead to Abuse of Other Substances
The medications used during addiction treatment are typically less addictive than those that lead an individual to treatment in the first place.
For example, suboxone is only a partial agonist, which means the euphoric effects produced by suboxone are much less than the symptoms that result from other opioids.
While addiction is possible, it is much more unlikely, and the benefits can outweigh the risks for many individuals.
3. MAT Increases the Risk for Overdose
Because the medications used for addiction treatment are not as potent as those that require treatment, an overdose is also unlikely.
In fact, studies have shown that the use of MAT reduces the incidence of opioid overdoses, including fatal overdoses, in many cases.
4. MAT is Only Effective if Other Treatments are Offered at the Same Time
Medication assisted therapy is most effective when it is used in combination with other treatment modalities customized to the unique needs of each individual.
However, only about 10 percent of those struggling with addiction seek treatment at all. It may be unrealistic to assume that everyone that chooses MAT will seek other forms of treatment.
On the other hand, those individuals that begin MAT might realize they need more coping skills to continue the recovery journey, which may lead them to seek additional treatment once the MAT is underway.
5. MAT is a Short-Term Solution
For some struggling with addiction, MAT may be a short-term treatment to help them get through the detox process and the earliest stages of recovery. Others may find that using medications over the long-term help to keep their cravings under control and reduce their risk for a relapse in the future.
By looking at addiction as a chronic condition, the use of long-term medications may be more acceptable, similar to the way insulin or blood pressure medications are used for other conditions.
Medication assisted treatment is quickly becoming a mainstream treatment for addiction as the evidence continues to show the benefits of this modality. NIDA and most medical associations and addiction treatment organizations highly recommend MAT as one of the most successful ways for treating heroin addiction and opioid dependence.
When used correctly and under close medical supervision, MAT may be a useful tool for those struggling to overcome the grip of addiction and greatly improve the quality of their life.
Call us toll-free at (888) 595-0235 to find out more about Medication Assisted Treatment for Addiction in southern California.