Everyone knows that the United States has a big problem with substance use disorder. Drug overdoses claimed almost 70,000 American lives in 2018. Luckily, treatment options are evolving quickly and becoming ever more effective. Thanks to an emphasis on evidence-based treatment, the U.S. is making big strides in overcoming the problem of substance use disorders.
A major part of this success has been medication-assisted treatment, which is among the safest options available for serious dependencies. It can be a game-changer for people who are ready to kick harmful addiction habits but afraid of cutting off substances too fast. MAT has been studied extensively, is supported by government organizations like SAMHSA and most importantly, has helped thousands of people improve their lives.
At Green Mountain Treatment Center, MAT is one very valuable arrow in our quiver. We treat each client individually. Everyone’s program is customized. That’s why we offer medication-assisted treatment selectively for people who will most benefit from it.
The Basics of Medication-Assisted Treatment
According to the Substance Abuse and Mental Health Services Administration, MAT involves FDA-approved medications, in combination with counseling and behavioral therapies, to provide a holistic approach to the treatment of substance misuse disorders. It’s most commonly associated with treating opioid and alcohol use disorder. Medication-assisted treatment doesn’t mean just giving pills to patients and then walking away. MAT was conceived as a holistic strategy to help more people stay in treatment and recover completely. This method adds a medication regimen to more traditional types of treatment, which may be therapy or spiritually based. It shouldn’t be viewed as subtracting anything. Since there’s lots of peer-reviewed and anecdotal evidence showing that medication-assisted treatment can be effective, patients should not shy away from considering this option.
There are two major types of medications used in MAT. The first category of medications replace the illegal substances that people use to get their euphoric high. Typically, these medications work the same way as the problem substance. For example, they may bind to the same receptors. Using a properly dosed replacement medication can reduce cravings and problematic behavior for people who struggle with substance use disorder. Furthermore, replacement medicines can prevent withdrawals. The second category of medications does not reproduce any of the effects of substance use. Instead, they work on the causes. By making the use of substances like opioids or alcohol less fun, these medicines help move people away from cravings.
Having been used in the United States for about 40 years, replacement therapies are a great strategy to help people who struggle with substance use disorder. Patients get a regular dose of a safe, unadulterated medication when they enter replacement therapy. During the process, they are supervised by medical professionals while it’s administered. Most importantly, they don’t need to do anything illegal to get a dose of something that will end their painful withdrawal symptoms.
Methadone is one of the most well-known ways to treat opioid use disorder. It is a synthetic opioid and a full agonist. Essentially, methadone is a long-acting drug that binds to the same receptors in the brain that opioids like heroin attach to. When people are using methadone, they’re less likely to have cravings for opioids. Methadone can be administered orally or via injection. While it may be life-saving, patents can still overdose on methadone. It’s important not to take additional doses of this drug.
Methadone is known as maintenance therapy. It replaces opioids like heroin, but it doesn’t involve detoxing. The value of maintenance therapy is that it helps the patient stay in treatment as they decrease their use of opioids. Only specially certified doctors can administer methadone. At first, patients must receive their treatment in a supervised setting. If they show success with this approach, they may eventually be able to take some methadone doses at home in between office visits. Typically, methadone treatment lasts at least one year.
As another FDA-approved MAT drug, Suboxone contains an opioid called buprenorphine. Unlike methadone, buprenorphine is only a partial agonist. Like methadone, it attaches to opioid receptors in the brain. But it doesn’t stimulate them in the same way a full agonist like methadone does. Suboxone also contains a drug called naloxone, which is effective at blocking other opioids from binding to receptors. This drug can even be used to reverse overdoses. Because of this, it’s not possible to overdose on Suboxone. Also because of this, some doctors and organizations don’t see Suboxone as a true replacement therapy. They would rather place it in a category of its own. However, most providers see Suboxone as very effective for people battling opioid use disorder. Other brand names for this medication include Zubsolv.
There are three ways Suboxone can be administered. The first is via a tablet that’s placed under the tongue. Suboxone is also available as a film that’s placed under the tongue or in the cheek. These formats dissolve easily, and that’s the only way they’re really meant to be used. If they’re swallowed, for example, they won’t be completely effective. Suboxone must be taken daily. It works on the central nervous system to prevent withdrawals in people who’ve become physically dependent on opioids. This drug is only available with a prescription.
Drugs That Stop Cravings
As mentioned earlier, not all medication-assisted therapy involves replacement drugs. The medications that are designed to block cravings are just as important. The idea is that by eliminating the desire for the substance, it’s possible to eliminate excessive use, too.
Naltrexone can be used to treat both alcohol use disorder and opioid addiction. This medication doesn’t replace a drug. Instead, it’s used to reduce the desire for a drug. It does this by binding to receptors for endorphins. It blocks the feel-good effects of substances like alcohol and opioids.
Naltrexone is not an opioid and is not habit-forming. Before starting on a naltrexone regimen, patients need to be fully off opioids and alcohol. If not, they may suffer serious side effects. Naltrexone can be administered by any health care provider with prescribing privileges. Ideally, this drug is used as part of a more holistic treatment program in combination with other tools like counseling. Naltrexone, which can be administered by injection or orally, is usually only prescribed for adults over 18.
Disulfiram uses a different strategy. Used to treat alcohol use disorder, this drug is designed to discourage drinking. It does this by producing very undesirable effects when users drink alcohol. Disulfiram makes people flush and can cause nausea if they drink after taking a dose. Chemically, it stops alcohol from breaking down in the body. It’s sometimes known by the brand name Antabuse. People should wait at least 12 hours after their last use of alcohol before taking disulfiram. This drug is available in a tablet form.
Acamprosate is sometimes known by the brand name Campral. While first used in Europe in the late 1980s, this drug was approved in the U.S. in 2004. No one fully understands why acamprosate works. It seems to decrease cravings for alcohol, and to make its use less pleasant. This medication has a solid track record for safety and effectiveness, as demonstrated in many studies over the years. It’s administered orally as a tablet.
How Effective Is Medication-Assisted Treatment?
Research shows that MAT can be an important and effective component of treatment for substance use disorders. In fact, MAT is more effective than counseling approaches alone. That said, MAT isn’t just about drugs. It is meant to incorporate strategies like behavioral therapy as well. Medication is only part of the treatment. Understanding mindset and how to cope with any cravings that do arise are also important components of treatment.
Treating substance use disorders isn’t just about ending the consumption of drugs. Often, there are underlying problems that led a user to seek relief via drugs. Effective treatments have to be comprehensive. Counseling that touches on issues like employment, repairing interpersonal relationships and learning healthier coping strategies is crucial. Finding new, less self-destructive ways to deal with stress helps prevent relapse or a simple shift from one disordered behavior to another.
Busting Myths About Medication-Assisted Treatment
Some people are skeptical of MAT. They may even see medication-assisted treatment — specifically the idea of using drugs to curb a drug addiction — as cheating. Some think that only total abstinence can be considered a full recovery from a substance use disorder. However, even organizations like Narcotics Anonymous are starting to modify their stance on MAT. The organization released a statement clarifying that using prescribed medications is not the same as use. They take no official stance on MAT options like methadone treatment and encourage all their members to define their own abstinence from substance use in a way that makes sense to them as individuals. Now that even abstinence-based programs can recognize the value of MAT, there shouldn’t be any stigma around them any longer.
Another rumor that clings to MAT is that it’s not covered by health insurance. This is not true. Medicaid, Medicare and many private insurance agencies cover medication-assisted treatment. The Mental Health Parity and Addiction Equity Act, or MHPAEA, offers protections to Americans who struggle with mental health and substance use disorders. While there can still be limits on coverage, people should know that they have rights, including the right to appeal any denials of claims.
Finally, there are individuals who have unrealistic views on the MAT process. Some people want to believe that medication-assisted treatment will be a quick solution. That’s not true either. For example, methadone treatment is designed to take at least a full calendar year. Even medications like naltrexone work slowly. They help people step down their use, but the full behavioral change takes time. Medication-assisted treatment is one key piece of a full recovery program, but it’s not a magic solution. The recovery process still requires a big investment of time and energy.
Find the Right Treatment to Curb Your Addiction
At Green Mountain Treatment Center in New Hampshire, we offer a full range of services for people with substance use disorder. We provide medical detox to get the ball rolling. From there, our traditional inpatient program helps people rebuild their lives from the ground up. These programs incorporate 12-step strategies and other therapies. Evidence-based treatment is a huge part of what we do. We also provide the supportive environment that patients need to truly succeed. A healthy diet, exercise options, including yoga, and a focus on mindfulness can also be incredibly helpful in helping our clients leave their dependencies behind.