The magnitude and the terrible effects of the opioid epidemic are growing every year. While it looms over like a shadow over the United States, other drugs continue to be a problem like alcohol and methamphetamine. Some are also seeing significant increases in addiction and overdose rates. With the growing problem, researchers, doctors, scientists, and clinicians are working hard to apply current treatment methods, develop new treatments and strategies, and make the strategies that work more available. Today, there are a lot of addiction treatment options and there is still a lot to learn. But the variety of treatment approaches has sparked plenty of debate over the best possible approach to treatment.
One such debate is over the use of medication-assisted treatment (MAT) in addiction recovery programs. Specific medications can be used to treat opioid addiction and alcoholism but there are some concerning drawbacks. How far should the use of medication in treatment go and how does MAT measure up to traditional treatment models? Learn more about the truth behind MAT and how it can be an extremely helpful tool when used correctly and safely.
What is Medication-Assisted Treatment?
Medication-assisted treatment is the use of medications specifically designed to treat a substance use disorder alongside counseling and behavioral therapies.
Medical detoxification often involves the use of medication to alleviate uncomfortable symptoms and facilitate a safe and comfortable recovery. For instance, withdrawal from stimulants like cocaine and methamphetamine can often cause severe depression that can be treated with antidepressants. Other drugs can cause withdrawal symptoms including nausea, headaches, insomnia, and tremors that can all be treated with medical interventions. However, MAT typically refers to the use of medications that are designed to treat withdrawal or addiction itself, while other interventions treat symptoms.
MAT is mostly used to treat opioid addiction and most U.S. Food and Drug Administration approved MAT drugs are approved for opioid addiction treatment. Typically, prescribed medications normalize brain chemistry and allow you to continue on the path to recovery. The goal of medication-assisted treatment is a full recovery. Addiction is a widely-common disease and opioid use disorders alone are responsible for millions of addicted people. According to the American Society of Addiction Medicine, 2 million people had a substance use disorder (SUD) involving prescription opioid painkillers and 591,000 had a SUD involving heroin.
Is MAT Effective?
MAT has shown to be an effective treatment option for opioid addiction, with the ultimate goal of full recovery. MAT has been shown to be effective in a number of different goals in treatment including:
Improving A Person’s Likelihood Of Survival.
Opioids in moderation don’t have a high likelihood of medically dangerous effects. However, overdose is deadly and the nature of opioid addiction leads to a very high probability of overdose. Illicit heroin is unpredictable in its strength. Dealers routinely cut heroin to increase profits and the substances it is cut with are sometimes hazardous. It also produces weaker heroin. If a person becomes used to heroin that is diluted by inert substances, they may not realize their dosage is fairly high for normal heroin. If they get a new batch of purer product, they are at risk for overdose.
One common ingredient in cut heroin is another opioid called fentanyl that is 50 times stronger than heroin itself. It’s cheap and easy to make so it often makes its way into heroin to boost its potency or to mask the fact that it has been diluted. However, even an amount of fentanyl lighter than a snowflake can cause the average person to overdose. Every time you get a bag of heroin you are gambling with your life. There is no way the average person can know what they are injecting until it’s too late.
MAT saves lives by reversing opioid overdose with naloxone and replacing heroin with opioids that are more easily regulated and controlled. For instance, methadone and buprenorphine can be used to replace a potentially harmful opioid and then tampered off while or after a person goes through the continuum of care.
Increase Treatment Retention
If a treatment program proves to be more of a challenge than a client expects, they might feel the urge to stop treatment and relapse. For people that have suffered from chronic relapse, abstaining from drug use while going through treatment might be extremely difficult. Instead, people who go through behavioral therapies and other traditional treatment approaches alongside medications like methadone and buprenorphine can approach treatment differently. They are able to put off withdrawal and cravings until after they have been removed from a lifestyle of drug use, gotten to the root of their addiction, and learned relapse prevention. Then medications can be slowly tapered off.
A Decrease In Criminal Drug Use
Illicit drug use is especially dangerous for someone who is addicted or dependent on the drug. Addiction is closely related to criminal activity. The most common criminal offense in the United States is a drug violation. Addiction increases the likelihood that you experience crime related to drug possession. MAT can decrease your chances of experiencing the crime related to the side effects of drug use by removing a patient from the addiction lifestyle.
Decrease The Risk Of Disease
Like crime, addiction is closely related to the contraction of infectious disease, especially when injectable drugs are involved. Approximately 1 in 10 new cases of HIV involve injection drug use. Other diseases that are associated with illicit drug use include hepatitis, tuberculosis, and other STDs. Beginning MAT treatment can dramatically lower your risk of contracting an infectious disease.
Other Proven Benefits
The use of MAT to remove clients from a lifestyle of drug use and remain in a treatment program can help people avoid other dangerous outcomes of drug use like birth and pregnancy complications. The opioid epidemic has led to an increase in a phenomenon called neonatal abstinence syndrome, which occurs when babies are born to addicted mothers with withdrawal symptoms of their own. Illicit drug use during pregnancy comes with clear risks and infants can be born addicted to drugs or suffer other serious complications. Pregnant mothers who attempt to quit and withdrawal risk compilations like premature birth and early contractions. Methadone that is maintained during pregnancy has been closely studied and has shown to lead to seeking pregnancy care earlier and improved birth outcomes.
MAT has also shown to improve a person’s employability and their ability to maintain employment. Addiction and relapse make it difficult to keep a job. Drug seeking behavior and intoxication often lead to poor job performance, absences, and eventual job loss. MAT can help you gain and keep employment.
Again, MAT is a combination of mediation and clinical therapies. Medical interventions alone may not be enough to facilitate a meaningful recovery. It’s important to address all issues that are related to your addiction and explore any potential underlying causes. If you suffer from depression, trauma, anxiety, or other unresolved issues, medication will only be a temporary fix.
The Chemistry of Addiction
Addiction is much more than a bad habit or a moral failing. When you relapse over and over despite a legitimate desire to stop using, it’s not because you simply lack willpower. Addiction is a complicated disease that dramatically changes brain chemistry and has a variety of causes and underlying issues.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the clinical diagnosis for someone who has a problem with an addictive drug or alcohol is a substance use disorder. But substance use disorders can be separated into three categories, including:
This refers to the use of a drug that goes beyond recommended, prescribed, or safe dosage. For instance, teens that go to parties and drink to the point of blacking out abuse alcohol. However, substance abuse doesn’t necessarily mean that a person is addicted or even dependent, though that is an inherent risk. Teen and college-aged drinking is a serious problem and can lead to alcohol poisoning, auto accidents, sexual assault, and risky sexual behavior but many people who binge drink during their teen years never develop a chemical dependence on alcohol or addiction.
Addictive drugs and alcohol achieve their effects by altering chemical processes in the brain’s method of communication. Your brain normally communicates essential functions by passing messages from neuron to neuron. Nerve cells pass messages in the form or neurotransmitters to each other across a space between them called the synapse. The neurotransmitters bind to receptors and interact with them for the desired result. Drugs often work by inserting themselves somewhere into this process. Opioids bind to opioid receptors to create a feeling of euphoria and pain relief that’s more potent than your naturally-occurring endorphins. Stimulants like cocaine and meth block the recycling (reuptake) of dopamine, causing intense feelings of excitement and energy.
After a while, your brain will start to get used to the chemicals introduced by the drug you are using and start to rely on them to maintain normal brain functions. In some cases, your body may even work against the drug to achieve balance. As you feel a tolerance building, it will take more of the drug to achieve the same effects. If you stop using, your brain will experience a sudden loss of the chemical it can to depend on and neurochemistry will become unbalanced. You will start to feel withdrawal symptoms that range from uncomfortable to deadly, depending on the drug.
Where chemical dependence affects your brain’s messaging system, addiction primarily takes place in a different part of the brain. The limbic system, which has close ties to the reward system, is designed to identify specific activities that are good for you and trigger a reward response that passes the message to your brain’s learning center. The limbic system essentially teaches your brain which activities and experiences you should repeat and which ones you should avoid.
Your brain carefully modulates your feelings, motivations, and thinking to facilitate normal, productive behavior and the limbic system responds to those functions. Drugs disrupt that balance and give you artificial pleasure, relaxation, contentment, and euphoria even during harmful or unproductive activities. When your positive feelings lose touch with the reality of their causes, the limbic system struggles to tell the difference. Even if your drug use is causing detrimental effects to your health and well-being, your limbic system will continue to associate it with positive feelings and trigger cravings and impulses to keep using.
To a person that is addicted to a chemical substance, this phenomenon will present itself as an inability to stop despite consequences. Here is where drug use goes beyond a mere bad habit. Many people who are caught in a pattern of addiction know there is a problem and desperately want to stop using, but addiction continues to drive them back to the drug. Dependence causes uncomfortable symptoms and cravings when you stop using but addiction can cause a relapse even after you detox.
Ultimately, abuse, dependence, and addiction are all intertwined and many people have experienced struggles with all three.
Medication-Assisted Treatment and the Brain
Medication-Assisted Treatment is intended to help rebalance the brain chemistry changes that occur in withdrawal and addiction. Different medication affects different points in the brain’s processing of drugs and alcohol. Currently, the only MAT medications that are approved by the FDA are for opioid and alcohol addiction. Some prevent withdrawal symptoms by replacing harmful drugs with more easily manageable medications to wean people off of the addictive substance. Others attempt to rewire the way the limbic system processes drugs after you have already gone through detox. However, each medication is most effective in conjunction with evidence-based behavioral therapies and a full continuum of treatment.
Medications Used in MAT
There are several medications used to treat withdrawal and addiction that each work differently in the brain. Some of these medications come with inherent risks of dependency, addiction, and withdrawal. Medication-assisted treatment should be approached carefully with the direction of a qualified and experienced team of medical professions, therapists, and clinicians.
Methadone is one of the most commonly used MAT medications that is used to treat opioid addiction. It is an opioid itself that is slower acting and longer-lasting. When used therapeutically, clients are given a dose that takes away cravings and withdrawal but doesn’t cause a high and generally avoids intoxication altogether. It is the only drug approved to treat opioid-addicted pregnant or breastfeeding women. Methadone can be difficult to detox from and causes uncomfortable withdrawal. Coming off methadone should be tapered slowly with medical supervision.
Buprenorphine is a synthetic opioid that’s used to treat opioid addiction. It’s a partial agonist that binds to the same receptors as drugs like heroin. Partial agonist means that it does not fully activate the receptor as other opioids do. Instead, it stops withdrawal symptoms without causing euphoria or intoxication. It primarily addresses opioid dependence by balancing the neurochemical messaging in your brain but treating addiction will require other clinical interventions. It’s commonly prescribed in a form that is mixed with naloxone called Suboxone. Naloxone is an opioid antagonist that binds to opioid receptors to reverse an overdose. However, Naloxone abruptly stops an opioid high and can send the user into uncomfortable withdrawal immediately. The buprenorphine can help to ease you out of opioid intoxication.
Naltrexone can be used to treat alcohol and opioid dependence by removing the euphoric effects of both substances. If someone is going through treatment, there is always some level of risk that a relapse will occur. While on Naltrexone, taking an opioid or drinking alcohol will stop the positive reinforcement that comes from euphoria. It is sometimes given to people who have recently completed a treatment plan to help them avoid relapse. The intent behind this drug is to go after addiction itself. By blocking the rewarding effects of the drug, you will retrain the brain to stop perceiving it as desirable.
Disulfiram is a drug that disrupts the process of breaking down and processing alcohol. If you are on disulfiram and you drink alcohol, you will experience extremely uncomfortable symptoms like nausea, vomiting, palpitations, and flushing. This medication also primary targets addiction’s hold on your reward center. By negatively reinforcing your perception of alcohol you may be able to correct your brain’s motivation to drink.
Acamprosate is another medication designed to treat alcoholism. It works by binding to GABA receptors, the same receptors as alcohol and may be able to stop some of the symptoms of withdrawal. Like opioid medication, it can limit or stop withdrawal symptoms without causing intoxication.
The Three Philosophies of MAT
The debate over medication-assisted treatment involves three philosophies as to the appropriateness of medication. The debate often falls along two extremes:
- Medication, especially opioids, are never appropriate.
- Medications are always necessary and the indefinite use of medication is acceptable.
Here is a breakdown of each philosophy.
“Replacing One Addiction For Another”
This is a legitimate concern. Ostensibly, giving someone with an opioid addiction another opioid in treatment sounds counter-intuitive. Plus, chemical dependence on opioids won’t go away if you are regularly taking an opioid. In addiction treatment, it’s important to avoid replacing one addiction for another. For instance, many fall victim to the idea that they can quit illicit drugs like cocaine and continue to drink alcohol. This often results in alcoholism replacing cocaine use. This philosophy sees the use of medication as a violation of the goal to avoid a replacement addiction. In this camp, immediate abstinence is the only option. However, MAT is very different than the abuse of a replacement drug. Medications are monitored to maintain the health of the client and, if the end goal is abstinence, MAT might help a client make it through treatment to full recovery.
“Medication Is The Only Way To Lasting Recovery”
Some see addiction as a result of a problem with brain functioning and chemistry. With the right pharmacological approach, these imbalances can be balanced. Some people simply prescribe medications and never address the cognitive, psychological, and emotional needs beneath the surface.
On the same end of the ideological spectrum, many clients hope to receive medications without having to put in the work it takes to root out the problem of addiction at its source. Unfortunately, addiction is like a weed. If medication is used it typically answers the problems that are on the surface, but unless the problems beneath the surface are addressed, addiction will return.
According to the National Institute on Drug Abuse (NIDA), the most effective treatment programs are tailored to the client’s specific needs. Addiction can occur for a number of reasons like underlying depression, trauma, genetics, environment, and a wide range of factors that all combine and feed into one another. For that reason, addiction is a complex disease that requires a nuanced solution. Medication isn’t always the answer and it isn’t always effective without other interventions like behavioral therapies.
A Balance of Medication and Traditional Treatment
As with many debates, the best options lie somewhere in between. According to NIDA, there are 13 principles of effective addiction treatment and two of them speak to this issue. Number six addresses the use of behavioral therapies, which can help people build relapse prevention skills and maintain abstinence. Behavioral therapies like cognitive behavioral therapy, group therapy, and individual therapy are the most commonly used and recommended treatment options for addiction. However, number seven points out that medication is an important element of treatment for many clients, particularly when they are combined with these other therapies.
The most effective approach is one that meets you where you are. If your needs require medication, behavioral therapies, or a combination of the two, you should receive the best treatment program for you.