Medication Assisted Treatment (MAT) for Addiction
Ending an addiction is no easy task, but the benefits of recovery are worth the hard work you put into quitting. Recovery brings greater mental clarity and purpose to your life. It fosters healthy relationships and healthy habits that increase your quality of life and sense of wellbeing.
The Substance Abuse and Mental Health Services Administration (SAMHSA) stresses that there are multiple pathways to recovery. What works for one individual may not work for another, and finding the pathway that works for you is central to successful recovery.
Medication-assisted treatment, or MAT, is one pathway to recovery for people who are addicted to alcohol or opioids, such as heroin or prescription painkillers. MAT involves a combination of medication and therapy that promotes whole-person healing.
Misconceptions about MAT are common, but the truth is, medication-assisted treatment works, and is, in fact, the gold standard for treating an opioid addiction according to SAMHSA.
In examining addiction and dependence, medication-assisted treatment helps numerous people recover from even a severe addiction once and for all.
Addiction vs Dependence and MAT in Recovery
Medication-assisted treatment treats both addiction and dependence, which are not the same thing, although they commonly occur together.
Addiction is characterized by compulsive drug-using behaviors despite the negative consequences the substance abuse causes. People who are addicted may want to quit or try to stop, but they often find that they can’t.
Once an addiction develops, willpower and good intentions are not enough to stop using drugs or alcohol, according to the National Institute on Drug Abuse. Professional help is almost always needed. This is because addiction:
- Is the result of changes in the brain’s chemical functions and physical structures that affect thought and behavior patterns, and recovery requires re-learning healthier ways of thinking and behaving.
- Almost always has underlying causes that must be addressed for a successful recovery.
- Usually causes a range of problems in life, including relationship, financial, legal or physical or mental health problems that need to be addressedin order to recover for the long-term.
Addiction occurs when heavy substance abuse results in a re-wiring of the brain’s reward circuit. The brain’s reward center begins communicating with the planning and execution center in a way that produces a very strong connection between the act of using drugs or alcohol and the pleasure it produces. The brain begins to associate liking the drug with wanting it. The result is powerful cravings that drive compulsive drug-seeking and -using behaviors.
Risk Factors for Addiction
Not everyone who uses drugs or alcohol will develop an addiction. According to the Institute of Medicine of the National Academy of Science, 23 percent of people who try heroin and 15 percent of those who try alcohol will develop an addiction.
Whether someone develops an addiction depends on a number of factors. Some common risk factors for addiction include:
- A family history of addiction.
- A history of trauma, such as physical or sexual abuse or being the victim or witness of violence.
- Chronic stress.
- Co-occurring mental illnesses like anxiety or depression.
- Dysfunction in the family.
- Missing coping skills.
Addiction is considered to be a progressive, chronic and relapsing disease of the brain. Progressive means that without proper treatment, the addiction will get worse. Chronic means that it can’t be cured, but it can be sent into remission through treatment. Relapsing means that using again after a period of recovery can cause a relapse of the addiction, once again characterized by brain changes that lead to compulsive use.
Similar to other chronic diseases like diabetes and heart disease, addiction has underlying factors and causes related to genetics, biology, environment and lifestyle. And just as medications and lifestyle changes are essential for treating diabetes and heart disease, both can effectively treat addiction as well.
Dependence is also the result of changes in brain function. Dependence is characterized by withdrawal symptoms that occur when you stop using drugs or alcohol.
Heavy substance abuse causes the brain to attempt to compensate by increasing or reducing the activity of certain brain chemicals known as neurotransmitters. For example, alcohol increases the activity of the neurotransmitter GABA, which produces feelings of calm and wellbeing. At the same time, it reduces the activity of the neurotransmitter glutamate, which is responsible for feelings of excitability.
Tolerance and Withdrawal
With chronic alcohol abuse, the brain will attempt to maintain normal functioning by increasing GABA and reducing glutamate. As a result, tolerance develops. This means that you need to drink more and more to get the desired effects. At some point, brain function may shift so that the brain now operates more comfortably when alcohol is present. Then, when you stop using, normal brain function rebounds Neurotransmitters that were suppressed now flood the brain and those that were increased now slow down. This causes physical withdrawal symptoms to occur.
Medication-assisted treatment addresses both dependence and addiction for a better chance at long-term recovery.
Medication-Assisted Treatment for Opioid Addiction
More than 2.5 million Americans are addicted to heroin or prescription opioid painkillers. Every day, 115 people lose their lives to opioid overdose. Countless others suffer from addiction and dependence, which wrecks their health, their relationships and their finances. Legal problems may add up as a result of opioid abuse, and many people who are addicted have a low quality of life and lack a sense of safety and wellbeing.
Medication-assisted treatment for opioid addiction is the recommended treatment modality. MAT reduces the risk of relapse, which is typically high for opioid addiction. A study published in the Irish Medical Journal found that 91 percent of people addicted to opioids relapsed after detox when it wasn’t followed up with a comprehensive treatment program.
That’s because detox -the process of allowing all traces of a substance to leave the body so that brain function can return to normal- only treats dependence and does very little to address the addiction.
The medications used with MAT for opioid addiction have a variety of functions, depending on the specific medication. They can:
- Block the effects of heroin and painkillers.
- Reduce cravings.
- Prevent the onset of withdrawal.
- Help restore brain function and reduce the effects of opioid addiction and dependence on the brain, which can include problems with memory, concentration, decision-making, judgment and thinking.
Three medications are approved by the FDA for medication-assisted treatment: Methadone, buprenorphine and naltrexone.
Methadone has been used in MAT for opioid addiction since 1971. It’s an opioid agonist, which means that it activates the opioid receptors in the brain the same way opioids do. Methadone affects the receptors more gradually, so its psychoactive effects, which include euphoria and respiratory depression, are weaker than those of other opioids.
Methadone prevents other opioids from attaching to the receptors, so if someone uses heroin or prescription painkillers while on methadone, these won’t have much of an effect. Methadone also prevents the onset of withdrawal symptoms and blocks cravings for opioids.
Because of its psychoactive effects, methadone has a high potential for abuse, so it’s is only through a licensed clinic or doctor’s office and requires a daily trip. This can make methadone treatment rather inconvenient, since it may be hard for some people to make the trip each day. If a dose of methadone is skipped, withdrawal will set in, and this may lead someone back to using heroin or painkillers just to prevent symptoms from occurring.
Buprenorphine was approved by the FDA for use with MAT in 2002. Buprenorphine is a partial opioid agonist, which means that activates the opioid receptors, but its effects are far weaker than those of other opioids, including methadone.
Buprenorphine, like methadone, prevents withdrawal, and it blocks cravings. But unlike methadone, buprenorphine has a ceiling effect. Taking more of it won’t make its effects more pronounced. Since this reduces the potential for abuse, buprenorphine can be prescribed by a physician and taken at home. This improves compliance since there’s no need to make a daily trip to a clinic. Buprenorphine is also available as an implant that will deliver the drug for six months.
Naltrexone is most commonly known by the trade name Suboxone, which is a combination of buprenorphine and naloxone. Naloxone, known as the opioid overdose reversal drug, is an opioid antagonist, which means that while it attaches to the opioid receptors, it doesn’t activate them, so it doesn’t have any psychoactive effects. But it prevents other opioids from attaching to the receptors, which means that if someone takes heroin or painkillers while on Suboxone, they will have no effect. Likewise, if someone tries to abuse Suboxone, the naloxone will kick in and send the person into withdrawal.
Naltrexone can be taken daily, or it can be administered as a once-monthly injection.
Unlike buprenorphine and methadone, which can be taken at any time during the recovery process, naltrexone can only be started once all traces of opioids are out of your system. This means that medical detox will be the first step of treatment.
Research continues to show that MAT is effective for helping people end an opioid addiction for the long-term. MAT has been shown to:
- Reduce the risk of a fatal overdose.
- Increase engagement and retention in treatment.
- Improve social functioning.
- Reduce relapse risk.
- Reduce illegal opioid abuse and associated criminal activity.
- Improve the ability to find and maintain employment.
- Reduce the risk of infection with HIV and hepatitis C.
- Improve birth outcomes for opioid-addicted pregnant women.
Effectiveness of MAT for Opioid Addiction
Detox is simply the process of weaning the person off the substance of abuse so they can get clean. Many recovering people are at risk of developing potentially dangerous withdrawal symptoms that could be life-threatening or may require emergency medical assistance. For this reason, it’s always recommended that the detox process is conducted under medical supervision or within an inpatient residential rehab facility.
It’s common for many people to think that a recovering person should be somehow ‘cured’ once they’ve gotten through detox. Yet detox is just the first step on the journey to recovery.
Detox only rids the body of the effects of the substance. On its own, it does nothing to address the underlying psychological triggers behind addictive behaviors.
The medications used with MAT can be taken for as long as they’re needed. Some people will take methadone, buprenorphine or naltrexone for a few months, while others may take it for several years. Still, others will take their medication for the rest of their lives with few side effects.
MAT for Alcohol Addiction
Around 15 million American adults have an alcohol addiction. Medication-assisted treatment can help people recover from alcohol addiction in a few ways, depending on the medication used to treat it.
Three medications are used to treat alcohol addiction and dependence: Disulfiram, Acamprosate, and Naltrexone.
Used to help people stop drinking since 1951, disulfiram causes unpleasant symptoms when someone drinks alcohol while taking it.
Alcohol in the body is converted into acetaldehyde, a toxic substance. It’s then converted to acetic acid. Disulfiram prevents the acetaldehyde from becoming acetic acid, and the resulting buildup of acetaldehyde causes nausea and vomiting, weakness, headache and an abnormal heartbeat.
Disulfiram doesn’t affect cravings, but rather discourages drinking. Disulfiram works best for people who are motivated to quit drinking. Some people use it as a short-term solution when they expect to be in a high-risk situation, such as a wedding or a vacation, and want extra incentive to stay sober. Disulfiram can be given once all traces of alcohol are out of the system -about 12 hours after the last drink. Most people begin taking it once the entire detox process is complete.
Naltrexone works for alcohol addiction as well as for opioid use disorders. Naltrexone reduces cravings for alcohol and lessens the effects of alcohol if it’s consumed while on naltrexone. It also reduces the urge to drink in those who do slip up while on it. Naltrexone can be given once all traces of alcohol are out of the system.
Acamprosate was approved by the FDA in 2004 for treating alcohol addiction. This medication promotes a balance between the neurotransmitters GABA (calmness) and glutamate (excitability,) which are the key chemicals affected by alcohol abuse. Acamprosate helps to restore normal brain function and reduce cravings for alcohol.
It’s taken three times a day, beginning at least five days after detox. It reaches its full therapeutic effects in approximately a week. It can be continued even if a slip-up occurs.
The Counseling Component of MAT
Medication is only half of the MAT protocol. Medication alone is not effective for treating opioid or alcohol addiction. Therapy is central to successful recovery from addiction, and the medication helps individuals focus their attention on addiction recovery without cravings and other distractions.
The counseling component of MAT brings about real and meaningful change in people’s lives. It helps:
- Identify and change the dysfunctional thought and behavior patterns that developed with the addiction.
- Address the underlying issues behind the addiction, which often include a history of trauma, chronic stress or a co-occurring mental illness.
- Learn the coping skills they need to handle stress, negative emotions, discomfort, cravings and other triggers for relapse.
- Repair damaged relationships and restore function to the family system.
- Develop healthy social, relationship and communication skills.
- Make lifestyle changes that support recovery.
- Find purpose and meaning in a life without drugs or alcohol.
- Learn to relax and have fun while sober.
- Set goals for the future and work to achieve them.
- Develop healthy hobbies that fill the time with productive pursuits and bring relaxation and enjoyment to life.
A holistic approach to treatment offers the best possible outcomes. This approach addresses issues of body, mind and spirit for whole-person healing. It involves a variety of traditional and complementary therapies along with a range of other services and interventions that address the multiple needs of an individual.
Traditional therapies are psychotherapies, or “talk” therapies. The most commonly used psychotherapy in an addiction treatment setting is cognitive-behavioral therapy, which helps individuals examine their thought and behavior patterns, address a range of issues and develop essential coping skills.
Complementary therapies include horticultural therapy, equine therapy and art or music therapy. Yoga and meditation are also commonly used in treatment programs. These therapies help increase mindfulness, self-awareness, self-confidence and self-esteem. They also reduce stress and negative emotions.
Other interventions and services used in treatment depend on the unique needs of the individual. These may include psychoeducational classes that provide education on a wide range of topics; life skills classes that help people develop the skills they need to live independently; and other services like vocational, educational, housing or legal assistance.
This whole-person approach to treatment leads to successful long-term recovery by removing the need and motivation to use drugs or alcohol as self-medication, a coping mechanism or a way to avoid the unpleasantness of life.
Why Isn't MAT More Prevalent?
While medication-assisted treatment is known to be the most effective way to treat an opioid use disorder, less than half of all private treatment programs offer it, and only 23 percent of publicly funded programs use it, according to PEW Charitable Trusts. Researchers cite a number of reasons why MAT isn’t more widely available:
- Misconceptions among the public and some providers that MAT is simply replacing one addiction with another, which is not the case.
- A lack of medical personnel who are trained to deliver and authorized to administer MAT.
- Barriers to funding for MAT.
- Cultural barriers, such as staff or clients who are reluctant to rely on medication to treat addiction.
Government agencies and healthcare industries are making good headway in helping to increase interest in and understanding of medication-assisted treatment. In the coming years, it’s expected that access to MAT will increase, and more people will be able to benefit from it.
Is MAT Right for You?
Medication-assisted treatment is not the only effective pathway to recovery, but it’s one of the most effective. People who engage in MAT are more likely than those who don’t to enjoy successful long-term recovery, particularly from an opioid addiction.
For many people, MAT is the driving force behind successful recovery, since it enables them to focus on restoring all areas of their lives and develop new, healthier lifestyles, relationships and thought and behavior patterns.
Choosing medication-assisted treatment is a personal decision, but it’s best made with the input of medical and mental health professionals who can help you understand how exactly it works, why it works, and whether it can work for you, too.