Medication-Assisted Treatment (MAT)
Drug and alcohol addictions are widely recognized as one of the most severe public health problems in the United States. According to the National Survey on Drug Use and Health, roughly 22 million adults in the United States suffered from substance use disorders in 2014 alone. Since then, that number has continued to skyrocket, leading to countless damaged lives and over 70,000 overdose deaths per year.
Quality rehab programs for substance addiction offer a wide variety of treatment modalities for recovery. One critical component of many recovery plans is medication-assisted treatment (MAT). Medication-assisted treatment is a treatment modality that combines behavioral therapy with specific medications. These medications have been clinically shown to reduce withdrawal symptoms, mitigate drug cravings, and help people remain committed to their rehab program.
Medication-assisted treatment is widely supported by research. As an evidence-based practice, MAT is clinically very effective. Unfortunately, stigmas surrounding MAT make many patients hesitant to make use of this treatment regimen. Many clients worry that making use of medications is simply replacing one drug with another. The reality couldn’t be farther from this. Unfortunately, the percentage of heroin addicts making use of MAT has gone from 35% to 28% since 2002, and overdose rates continue to rise.
Read on to find out more about medication-assisted treatment, and how this clinically effective treatment modality can help you or your loved one recover from addiction.
What is Medication-Assisted Treatment?
Medication-assisted treatment, often known as MAT, is a treatment approach that combines several elements. Most frequently, it involves the utilization of behavioral therapies alongside medication. A medication-assisted treatment program can make use of a wide variety of different behavioral therapies, often simultaneously. The types of medications also vary widely. As such, MAT programs can be tailored to different clients’ needs and continually altered as these needs change. These customizable programs are suited for individualized treatment plans.
While the term “medication-assisted treatment” contains the word “medicine,” it is important to stress that the most important aspects of a MAT plan are the behavioral therapies. As the name implies, the medications are indeed only meant to assist. By alleviating withdrawal symptoms and reducing cravings, medications help clients benefit more from both group and individual therapy. Medications can also reduce relapse rates and help clients remain involved in their rehab long enough to develop a strong foundation of coping tools.
Medication-assisted treatment is particularly useful for individuals struggling with very physically addictive substances like alcohol or opioids. Several prescription drugs currently exist that are specifically designed to treat physical dependence on alcohol and opioids.
Medications used in medication-assisted treatment are generally used for a wide range of purposes of goals, among them:
- Mitigating cravings during early recovery
- Reducing withdrawal symptoms during detox
- Preventing recreational drugs from producing euphoric effects
- Making relapse less appealing by causing painful effects when drugs are consumed
While taking these medications, clients participate in a wide range of therapies, including individual and group counseling. During this time, clients work on recognizing and addressing the underlying reasons behind their addiction. At the same time, they take steps toward building new lives in sobriety. Medications smooth this process by reducing the distractions and discomforts that often accompany early recovery. By the time a person is ready to wean off their medication, they will have a strong foundation of sober skills and a strong sober social support system, thanks to group counseling, 12-step meetings, and one-on-one therapy.
Medication-assisted treatment is one of the most comprehensive and holistic treatment approaches for addiction. It addresses the immediate effects of physical dependence while simultaneously tackling the root causes of addiction, allowing clients plenty of time to develop the skills they need to avoid relapse and rebuild their lives.
Medication-Assisted Treatment for Opioid Addiction
Every day, the opioid epidemic takes lives and wrecks communities throughout the United States. In fact, the National Institute on Drug Abuse estimates that 115 people fatally overdose on opioids in the US every day. Even those who do not die of overdoses suffer severe consequences, including physical and mental health problems, divorce, loss of child custody, unemployment, and homelessness.
Opioids are difficult to quit in part because of the severity of withdrawal symptoms. When a person stops taking opioids, they experience a wide range of physical and emotional side effects that can be excruciatingly painful. With each passing day, these symptoms become more painful, and cravings become stronger. The promises of sobriety can seem increasingly abstract in comparison. As a result, many people relapse even after committing to staying drug-free.
By taking part in MAT therapy, it is far easier to quit recreational opioids. MAT therapy is associated with a significantly increased likelihood of sustaining long-term recovery from opioid addiction. Drugs can be used to curb cravings, alleviate withdrawal symptoms, and even block the effects of recreational opiates.
Types of Opioid Addiction Medications
Opioid replacement therapy is a type of medication-assisted treatment that involves taking non-recreational opioids. These medications help people stay off of recreational opioids by activating the same opioid receptors in their brains that recreational opioids activate. However, unlike drugs like heroin and fentanyl, opioid replacement drugs do not cause a high. This makes it possible for a person to switch to these medications and begin leading “sober” lives. Once they have developed a stronger set of recovery tools and a strong social support system, they can slowly wean off of their opioid replacement drugs under careful medical supervision.
While opioid replacement therapy is the most common type of MAT for opioid addiction, other drugs can be used for other purposes. Medications like naltrexone, for instance, work by blocking the effects of recreational opioids. Should a person choose to relapse, they simply won’t experience anything! Another important medication is naloxone, which can be used to immediately reverse potentially fatal opioid overdoses, though it can also be added to opioid replacement therapy drugs to reduce the likelihood of abuse.
When used in the context of a medication-assisted treatment plan alongside behavioral therapies, these drugs can help clients develop long-term sobriety and rebuild their lives.
Methadone is one of the earliest and most common opioid replacement drugs. Physicians prescribe it to alleviate opioid withdrawal symptoms and reduce cravings. Methadone offers patients a mild — and very controlled — dose of opioids. It is also less pleasurable than recreational opiates like heroin. Physicians prescribe methadone in the lowest dose possible, depending on a client’s needs and level of physical dependence. Methadone can be taken using multiple routes of administration, including liquid, pills, and wafers, and it is most commonly taken daily. Methadone’s effects generally last between four to eight hours.
While methadone is a highly effective tool in the context of MAT, it should be noted that the drug does have a high potential for abuse when not taken under careful supervision. Moreover, the National Institute on Drug Abuse advises clinicians to ensure that clients stay on methadone for at least 12 months. This allows them to fully reap the benefits and also significantly decreases the likelihood of abuse. After this 12 month period is over, physicians can supervise a gradual weaning-off process, known as tapering. By taking this process slowly, physicians can ensure that withdrawal symptoms are mild or even nonexistent.
Buprenorphine is a newer medication used for opioid replacement therapy. Buprenorphine is at least as effective as methadone. It can also be used for many of the same purposes, including reducing cravings and withdrawal symptoms. However, buprenorphine works differently than methadone. Buprenorphine is an opioid partial agonist, which essentially means that it does not fully activate opioid receptors. As such, while buprenorphine does offer some mild euphoria, there is a ceiling for these effects. Even if a person tries to abuse buprenorphine by taking more than prescribed, they will not get high. This “ceiling effect” limits the potential for abuse and improves its safety. The long-lasting effects of the drug also make it very effective for weaning off opioids.
Since 2017, a once-monthly injectable form of buprenorphine has been available. Known as Sublocade in the United States, this medication can be used to reduce relapse rates. Moreover, it is far easier for clients to go in for a once-monthly injection than it is to take daily doses of buprenorphine or other medications. For these reasons, research indicates that Sublocade may reduce drop-out rates in treatment programs.
Suboxone is a combination drug that contains both buprenorphine and naloxone. While it is true that buprenorphine’s “ceiling effect” makes it difficult to use, enterprising drug abusers can get high from buprenorphine by altering the medication and injecting it. The presence of naloxone in Suboxone makes this impossible — or at the very least unpleasant. Naloxone, which is a full opioid antagonist, not only blocks the effects of opioids at receptor sites but also completely reverses the effects of opioids. When a person injects Suboxone, the naloxone will send them into immediate opioid withdrawal. This effectively disincentivizes misuse and abuse of the medication.
Naltrexone is an opioid addiction medication that suppresses cravings. Unlike buprenorphine, Suboxone, and methadone, naltrexone does not activate opioid receptors. Unlike opioid replacement drugs, naltrexone works by binding to opioid receptors and blocking them. Not only does naltrexone reduce cravings, but it is also useful in another respect. When a person tries to use a recreational opiate during a relapse, naltrexone makes it physically impossible for them to get high. This risk-free medication cannot be abused, since taking higher doses of naltrexone will only block opioid receptors further!
Nonetheless, it is important to stipulate here that naltrexone cannot be used to assist with a detox regimen. In fact, withdrawal must be complete for naltrexone to be administered. Generally, this means waiting seven to ten days after quitting opiates. Once administered, however, naltrexone can help people stay committed to the recovery process. It is available in injectable extended-release forms like Vivitrol as well as pills like Deparde and ReVia.
Naloxone, which is an important component of the drug Suboxone, is also a medication that is often sold under the brand name Narcan. Taking naloxone, which is an opioid antagonist, can completely reverse the effects of an opioid overdose. It can be administered easily even to an unconscious person since it is available in the form of an intranasal spray. Naloxone can also be injected under the skin or into the muscle. After a few minutes, naloxone binds to opioid receptors and prevents additional opioids from activating them. When a person is overdosing, they can die from respiratory depression, but naloxone reverses respiratory depression.
Having this drug on hand can save lives. Individuals who know or work with opioid addicts should always carry naloxone, just in case they encounter an overdose. Moreover, individuals in rehab often take naloxone regularly (as a component of Suboxone or another opioid replacement drug). Rehabs also carry naloxone at all times in case a client relapses.
Medications for Alcohol Addiction
Alcohol is the most widely abused substance in the United States. While alcohol abuse is normalized in many settings, the fact remains that the substance has extremely high rates of addiction. In fact, physical alcohol dependence can be so intense that it can lead to life-threatening symptoms, such as seizures and delirium tremens (DT).
Recovering from alcohol addiction can be difficult due to the intensity of withdrawal symptoms and cravings. Medication-assisted treatment, however, can make the process of recovering from alcohol use disorder far smoother. By making use of counseling and other behavioral therapies while taking medications, clients can achieve much healthier results.
The most common medications prescribed for alcohol use disorder in the context of MAT are naltrexone, acamprosate, and disulfiram.
Naltrexone not only has uses in the treatment of opioid use disorder but it is often prescribed for individuals recovering from alcohol use disorder as well. Naltrexone works by blocking the euphoric effects of alcohol. It does so by blocking the receptors in the brain that alcohol activates. In fact, not only does alcohol offer no pleasure to someone taking naltrexone, but it will not even intoxicate them. The diminished effects of alcohol can help disincentivize individuals from consuming alcohol. They will stop associating alcohol in their heads with pleasurable feelings. This helps clients become more committed to their recovery journeys.
Naltrexone is most commonly administered in injectable forms like Vivitrol and tablet forms like Depade and ReVia, though other formulations exist as well. Naltrexone treatment is rarely used on its own; it is most effective as part of a MAT plan combined with counseling and group therapy.
Acamprosate is suitable for individuals who have already finished the initial stages of alcohol withdrawal. It does not help people get off alcohol in the first place. However, acamprosate can help people stay off alcohol. It reduces cravings and thereby increases clients’ commitment to their recovery programs and rehabs. Acamprosate can be administered after five days of physical abstinence from alcohol, and it gradually becomes more effective, eventually reaching peak efficacy after eight days. This drug is most commonly administered three times a day in tablet form.
While acamprosate is clinically effective, researchers are still unclear about its mechanism of action. Nonetheless, this evidence-based medication significantly reduces cravings and improves a person’s chances of staying sober from alcohol, as long as it is used in conjunction with behavioral therapies.
Disulfiram, like acamprosate, is an effective drug for individuals who have already passed through the initial stages of alcohol withdrawal. It can support them during the early stages of recovery by increasing clients’ commitment to recovery and reducing the likelihood of relapse. Disulfiram is generally administered once a day in tablet form. When taken regularly, disulfiram causes alcohol to produce unpleasant effects rather than euphoric effects. These side effects include:
- Chest pains
- Problems breathing
These side effects are not designed to be dangerous — merely extremely annoying and unpleasant. However, it should be noted that many contemporary alcohol rehabs avoid prescribing disulfiram due to medical complications that can result.
Benefits of Medication-Assisted Treatment
There is no single cure for substance use disorders. In most cases, clients require a broad array of different treatment approaches. Over time, they can address the underlying issues that are motivating them to abuse drugs and alcohol, develop new coping skills, and even overcome difficult cravings. Medications cannot directly cure addiction, but they can certainly help with many of the most painful obstacles facing recovering addicts. More importantly, medication-assisted treatment can make behavioral therapies far more effective.
Among evidence-based treatment modalities, medication-assisted treatment has one of the highest success rates. Research studies have shown that among opioid users, making use of buprenorphine and methadone maintenance treatments results in a significant drop in mortality rates. Another study that examines the effect of making MAT more available found that increasing the number of rehabs offering MAT in Baltimore, Maryland led to a reduction in heroin overdose deaths.
Some of the other benefits of medication-assisted treatment include:
- Increased social functioning. Clients find it easier to interact with others when they are not going through severe physical withdrawal. This allows them to strengthen their peer support systems, which ultimately aids their recovery and quality of life.
- Increased retention in treatment. Severe withdrawal symptoms cause many clients to drop out of their rehab programs before they have begun to experience the benefits. By helping clients get through the initial few weeks in rehab, MAT can help them develop the skills they need for long-term sobriety.
- Decreases opioid use. MAT makes people less likely to abuse opioids overall.
- Decreases opioid-related overdose deaths. Even when clients do relapse, MAT makes opioid abuse less dangerous. It is therefore an essential component of any harm reduction plan.
- Decreases criminal activity and infectious disease transmission. Illicit drug use is often criminal in itself, but it can also lead to further criminal behaviors. It can also be associated with adverse health effects, such as infectious disease transmission when drugs are being injected.
- Improved outcomes for babies. When pregnant women suffer from opioid use disorder, MAT is associated with far fewer symptoms for their babies. MAT has been found to reduce the symptoms of neonatal abstinence syndrome.
- Better employment prospects. In the absence of withdrawal symptoms, individuals find it far easier to get their lives on track.
Myths About MAT
Unfortunately, only about 50% of private rehabs offer medication-assisted treatment, and only 33% of clients at these rehabs are prescribed medications. The number of treatment plans that incorporate MAT has been steadily declining since 2002. Despite a growing body of research showing the safety and efficacy of MAT, both clinicians and clients are increasingly reluctant to utilize this treatment modality. Why is this?
The reason why many clients and even practitioners hesitate to use MAT is that many popular misconceptions about MAT exist. Perhaps the most prevalent myth about medication-assisted treatment is that it involves replacing one drug addiction with another. When a person switches from heroin to buprenorphine, Suboxone, or methadone, they are indeed switching from one opioid to another — but the substances are not equivalent, and their effects are completely different.
While recreational opioids lead to addiction and cause euphoric highs, opioid replacement drugs do not get people high. Moreover, these medications help balance brain circuits that are damaged by addiction. By taking these drugs, individuals can heal their brains while taking daily steps toward recovery.
Medication-Assisted Treatment at NuView Treatment Center
NuView Treatment Center, one of West Los Angeles’ preeminent outpatient treatment centers, takes an evidence-based approach to addiction and mental health recovery. We understand that clients who are suffering from substance use disorders or mental health conditions often need medications to help with the symptoms. We believe that medications are often an integral part of a recovery plan, helping reduce risks, alleviate cravings and withdrawal symptoms, and ensuring the clients get the most out of behavioral therapies.
Our on-site physicians offer medication-assisted treatment plans for all levels of care. Outpatient programs at NuView Treatment Center include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
At the same time, our masters-level counselors and clinicians work with clients to ensure that they are getting the behavioral therapy that they need. While engaging in group therapy and one-on-one therapy, clients address underlying issues, develop new skills and coping tools, and take positive steps toward rebuilding their lives. Our staff members take a whole-person approach to addiction and mental health treatment. Our individualized treatment plans are holistic and compassionate — never one-size-fits-all.
If you or a loved one is struggling with drug or alcohol addiction, it is never too late to reach out for help. Contact NuView Treatment Center today for a free and confidential consultation.