The use of medication-assisted treatment (MAT) for substance abuse can occur in many contexts. It can be used to:
- Address symptoms of withdrawal from alcohol or drugs
- Help the individual deal with cravings for alcohol or drugs
- Reduce the amount of a substance an individual consumes
- Reverse overdoses
- Treat co-occurring conditions that may foster relapse
Are There Recognized Success Rates for MAT?
Defining success rates for specific medications in the treatment of addiction is not a straightforward process. There are no set success rates for any particular medication.
Different research studies will provide different results depending on the sample of individuals used in this study, the way the medication is used, how success is defined in the study (the term success is rarely used in research studies on addiction treatment outcomes), and the use of any other interventions along with the medication.
Often, more than one medication is used, and they are combined with therapy and other interventions, even in research studies. For instance, a recent study found that abstinence rates for clients with different levels of abuse, who were in aftercare using a combination of four MATs and intensive treatment, declined over time.
The primary factor that contributed to higher abstinence rates was the length of time that the person was in treatment and not the medications used.
There is no best MAT for everyone in every situation. The administration of any medication to treat any mental health disorder is based on an assessment of the individual and the person’s response to the medication. It is not unusual for treatment providers to change medications or adjust the dose numerous times during treatment.
Small sample research studies can provide an overall picture of the potential effectiveness of a particular MAT; however, they never provide an established success rate. Individual results in the real world will be much more variable.
The Most Common Forms of Medication-Assisted Treatment in 2019
Many different medically assisted treatments can be applied to individuals who have substance use disorders at certain levels of recovery.
Methadone has long been used for the treatment of opiate withdrawal, most often for heroin. Relapse rates for heroin addiction are high with all forms of treatment. Methadone maintenance treatment (MMT) is commonly used to help individuals with opiate use disorders decrease their use of opiate drugs and reduce rates of criminal activities.
MMT programs are ongoing. Individuals continue to use methadone in place of their opiate drug of abuse.
Recent reviews of research indicate that MMT demonstrates improved outcomes for individuals in regard to decreasing their heroin use, their participation in criminal activities, and their likelihood of contracting blood-borne diseases such as HIV as a result of needle sharing.
The research studies investigating the effectiveness of MMT are quite variable in their quality. More research needs to be done to determine the effectiveness of this approach. Moreover, methadone is a drug that is associated with numerous overdose deaths across different states.
Buprenorphine is a partial opioid agonist, meaning that it acts like other opioid drugs but does not have the full effect of opioid drugs. It is used in medications like Suboxone for treating the withdrawal symptoms associated with recovering from an opiate use disorder.
Large-scale review studies like the one presented by the prestigious Cochrane Review have compared the effects of buprenorphine for the treatment of withdrawal symptoms to methadone, clonidine, and lofexidine. Those on buprenorphine were more likely to remain in treatment longer, had less severe withdrawal symptoms, and experienced fewer side effects. The use of methadone was generally equivalent to buprenorphine over the studies in the review.
Lucemyra (lofexidine) is the first non-opiate medication approved by the FDA for the treatment of withdrawal symptoms from opiate drugs. Clinical trials have shown that it is safe and effective to help individuals manage withdrawal symptoms in the early stages of recovery.
The drug should only be used for limited durations, such as 14 days. It may carry the risk of serious side effects in some individuals.
Benzodiazepines represent a large class of drugs that are primarily designed for the treatment of clinically significant anxiety and seizure disorders, but they are also sometimes used as withdrawal management medications. Benzodiazepines are considered to be the first-line treatment for alcohol withdrawal and benzodiazepine withdrawal, and they are often used to control the withdrawal syndrome associated with other drugs of abuse.
They generally are administered on a tapering schedule. They are recognized to be an effective approach to treating withdrawal from many different substances.
Antabuse (disulfiram) has long been used to help people diagnosed with chronic alcohol use disorders to stop drinking alcohol and recently to control cocaine use. The medication produces severe ill effects when one drinks alcohol and can be effective in reducing alcohol consumption.
Research studies consistently find that compliance is an issue with this medication. If someone just stops taking the medication between 12 to 24 hours before they intend to drink alcohol, they will not receive the full effects of the drug. Research findings investigating the use of Antabuse are mixed and often not encouraging.
Naltrexone (ReVia or Vivitrol) is a medication that has been used to reduce cravings for opiate drugs and alcohol. The research findings suggest that it is more effective at reducing alcohol consumption than it is in reducing cravings for opiates, but it is used for both purposes. The drug is generally most effective in reducing cravings when it is combined with relapse prevention therapy.
Campral (acamprosate) is one of three FDA-approved medications to treat alcohol abuse; the other two are Antabuse and naltrexone. Campral does not completely stop alcohol consumption nor does it affect the withdrawal symptoms associated with stopping alcohol use.
It appears to be effective in reducing stress in those who have already been abstinent from alcohol for a significant amount of time (typically five days to a week). When combined with counseling or psychotherapy, it can reduce cravings to drink alcohol in these cases.
Narcan (naloxone) has received publicity regarding its utility in addressing opiate overdose. The drug is an opiate antagonist that can immediately reverse the effects of an opiate overdose by attaching itself to the receptors in the brain that are specialized for opiates and removing any opiates that are there.
Naloxone has no utility in treating a substance use disorder, but it can be lifesaving for an opiate overdose if it is administered quickly enough.
Other Forms of MAT With Mixed Research Findings
Many drugs may be used in the treatment of a substance use disorder, most often to control cravings or withdrawal symptoms. These drugs include certain antidepressants such as Zoloft (sertraline); anticonvulsants like Neurontin (gabapentin) or Topamax (topiramate); the antiemetic Zofran (ondansetron); and medications that are generally used to treat hypertension such as clonidine (brand name: Catapres).
These medications are often used in an off-label fashion to treat substance use disorders. While they may be useful in addressing issues with substance abuse at certain stages in recovery, the research evidence for their use is inconsistent.
In some cases, a medication may be administered to address a side effect of the primary medication or to control a symptom that has not been addressed by standard treatment approaches. For instance, individuals may experience lethargy, insomnia, or jitteriness when they are in the early stages of abstinence from many different substances of abuse. Physicians may prescribe or recommend a medication to treat these types of symptoms. The chosen medication depends on the needs of the client and any other medications that person may be taking.
Overall Success With Medication-Assisted Treatment
According to the clinical manual, A Guide to Treatments That Work, MAT in the treatment of substance abuse issues should always be accompanied by behavioral interventions such as psychotherapy, support group attendance, and adjunctive interventions to produce maximum effectiveness. The use of MAT alone for the treatment of any substance use disorder is never recommended.
For instance, simply using Suboxone for the treatment of prescription opiate abuse will only be effective to reduce withdrawal symptoms in the early stages of recovery. If the person does not become involved in therapy and other forms of behavioral interventions, the potential for relapse is extremely high once they complete the medical detox program.
While there aren’t publicized success rates for specific forms of MAT in 2019, those in recovery often achieve success with these medications. If used as part of a comprehensive treatment program that includes therapy, MAT can be a vital part of the recovery process for some.