Medication-Assisted Treatment for Recovery from Addiction

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According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there is no single pathway to recovery that works for every individual.1 Medication-assisted treatment, or MAT, is a recovery pathway that involves a combination of medication and counseling, and offers excellent outcomes for many who choose it.

Myths and misconceptions about medication-assisted treatment abound, but this treatment method is one of the most effective, and in fact, MAT is considered the gold standard for treating opioid addiction , according to SAMHSA. 2

Understanding Addiction and Dependence

To understand how medication-assisted treatment works, it’s necessary to understand the basics of addiction and dependence.

Addiction

Addiction is characterized by compulsive drug or alcohol abuse despite the negative consequences the abuse causes. Once an addiction sets in it almost always requires professional help to overcome. That’s because addiction is a very complex disease of the brain that involves changes in the brain’s chemical functions and physical structures which causes intense and consuming cravings. Whether someone develops an addiction depends on several factors, including genetic, biological, environmental and cultural factors. According to the Institute of Medicine of the National Academy of Science, 23 percent of people who try heroin and 15 percent of those try alcohol will develop an addiction. 3 Addiction also changes thought and behavior patterns, leading to dysfunctional ways of thinking and behaving that further perpetuate the addiction. Addiction is chronic, progressive and relapsing disease, much like diabetes and heart disease. Chronic means that it can’t be cured, although it can be sent into remission indefinitely. Progressive means that without treatment, the addiction will almost always grow worse. And relapsing means that after a period of recovery, using drugs or alcohol again can lead to a recurrence of the addiction, once again characterized by brain changes that lead to compulsive use.

Dependence

Dependence is characterized by withdrawal symptoms that occur when use of drugs or alcohol is stopped suddenly. Dependence, like addiction, is the result of changes in the brain caused by heavy substance abuse, which leads the brain to change its neurotransmitter, or chemical, function in order to compensate for the presence of the drug. This leads to tolerance, which means that it takes increasingly larger amounts of drugs or alcohol to get the same effects smaller doses once produced.

As larger amounts are used, the brain continues to compensate in an attempt to keep brain function normal. Brain function may shift so that it operates more comfortably when the drug is present than when it’s not. Then, when use stops, normal neurotransmitter function rebounds, and this causes physical withdrawal symptoms, which can be excruciating.

Medication-assisted treatment addresses both addiction and dependence and improves the outlook for long-term recovery. 

Medication-Assisted Treatment for Opioid Addiction

Over 2.5 million Americans are addicted to prescription opioid painkillers or heroin, and 115 people lose their lives each day to opioid overdose. Ending an opioid addiction is extremely challenging due to the intensity of the cravings, the brain changes that come with opioid addiction, and the underlying problems that often lead to opioid abuse in the first place. Medication-assisted treatment is the recommended treatment modality for people with an opioid addiction. The medications used with MAT for opiod addiction have a few functions, depending on which medication is used. The medications can:
  • Reduce cravings
  • Block the effects of opioids if they’re used while on the medication
  • Prevent withdrawal
  • Help restore normal brain function, including memory, concentration, decision-making and thinking
Medications can be taken for as long as they’re needed. For some people, a few months will be sufficient. Others may stay on medication for several years, and a few may take medication for the rest of their lives. A considerable body of research shows that medication-assisted treatment is effective for treating opioid addiction. According to SAMHSA, MAT:
  • Reduces the risk of fatal overdose
  • Improves engagement and retention in treatment
  • Improves social functioning
  • Reduces the risk of relapse
  • Reduces illegal opioid abuse and criminal activity
  • Improves the ability to find work and maintain employment
  • Reduces the risk of HIV and hepatitis C infection
  • Improves birth outcomes for pregnant women
Three medications–methadone, buprenorphine and naltrexone–have been approved by the FDA for use with medication-assisted treatment.

Methadone

Methadone has been used since 1971 to help people end an opioid addiction. An opioid agonist, methadone activates opioid receptors the same way opioids do, but it does so more gradually. This means that while it has similar effects as opioids, the effects are weaker.

Methadone prevents other opioids from attaching to the receptors. If someone on methadone uses heroin or painkillers, they won’t produce the desired effects. Methadone also blocks opioid cravings and prevents the onset of withdrawal symptoms.

Since methadone does produce psychoactive effects, it has a high potential for abuse. Therefore, it can only be administered at a licensed clinic or doctor’s office, which requires a daily trip. This makes methadone inconvenient for those without reliable transportation. If a dose is skipped, withdrawal will quickly set in, potentially leading someone back to using heroin or painkillers to end withdrawal symptoms.

Buprenorphine

Buprenorphine has been used in medication-assisted treatment since 2002. A partial opioid agonist, buprenorphine activates the opioid receptors, but its effects are far weaker than opioid agonists, including methadone. 

Like methadone, buprenorphine reduces cravings and prevents withdrawal, but it has a ceiling effect wherein taking larger doses won’t produce more pronounced effects. This makes it less likely that someone will abuse it, so it can be prescribed by a doctor and taken in pill form at home. It’s also available as an implant that lasts six months.

Naltrexone

Naltrexone, approved in 2010 to treat opioid addiction, is a combination of buprenorphine and the overdose reversal drug naloxone. Naloxone is an opioid antagonist, which means that it attaches to the opioid receptors but doesn’t activate them, so it has no psychoactive effects. Naltrexone reduces cravings and helps to restore brain function. If other opioids are taken while on naltrexone, they won’t be able to attach to the receptors and therefore won’t have any effect.

While methadone and buprenoprhine can be started right away after quitting opioids, those taking naltrexone must undergo detox before starting it.

Medication-Assisted Treatment for Alcohol Addiction

Alcohol addiction affects around 15 million Americans, and medication-assisted treatment can help aid recovery in a few ways. The medications used to treat alcohol addiction are disulfiram, acamprosate and naltrexone.

Disulfiram

Disulfiram has been used to treat alcohol addiction since 1951. It works by causing unpleasant symptoms like nausea and vomiting, weakness and headache when alcohol is consumed while taking it.

Disulfiram doesn’t reduce cravings, but it discourages drinking. It works best for people who have a high level of motivation to quit drinking. Some people take it daily, while others may use it for the short-term if they expect to be in a high-risk situation like a wedding or class reunion. 

Acamprosate

Approved by the FDA in 2004 to treat alcohol addiction, acamprosate helps balance the neurotransmitters GABA and glutamate, which are the main brain chemicals affected by alcohol. This balance reduces alcohol cravings and restore normal brain function. It takes about a week to reach its full effects, and it can be continued if a slip-up occurs.

Naltrexone

Naltrexone was approved in 2006 to help treat alcohol addiction. It reduces alcohol cravings and block some of the effects of alcohol if a slip-up occurs. Those who drink while on naltrexone will have a reduced urge to continue drinking.

The Counseling Component of Medication-Assisted Treatment

Medication is only one component of medication-assisted treatment. Medication alone may successfully treat alcohol or opioid dependence, but it won’t end the addiction, which is far more complex than dependence. 

The second component of MAT is counseling, which is required by law when taking MAT medications. The medications used in MAT enable people to focus on recovery without being derailed by cravings and concentration problems that are common when you stop drinking or using opioids. This improves the outcomes of therapy.

Counseling occurs through an addiction treatment program. A holistic program that utilizes both traditional and complementary therapies offers the best chances for success, according to SAMHSA. Traditional therapies include cognitive-behavioral therapy, family therapy and psychoeducational classes that help people better understand addiction and recovery. Complementary therapies include yoga, meditation and art or music therapy, which help people increase self-awareness and look at problems and issues from a variety of angles.

Used together, these therapies help people in recovery:

  • Address underlying issues that led to the addiction, which often include a history of trauma, chronic stress and co-occurring mental illnesses like anxiety or depression
  • Develop coping skills to deal with stress, cravings, negative emotions and other powerful relapse triggers.
  • Identify and change dysfunctional thought and behavior patterns and learn to manage emotions.
  • Repair damaged relationships
  • Find purpose and meaning in a life of sobriety
  • Learn to relax and have a good time without opioids or alcohol
  • Develop a healthy lifestyle and healthy hobbies that promote good health and enjoyment in life

A high-quality treatment program will also use a variety of interventions and outside services to ensure all of an individual’s needs are met. These may include legal, educational or vocational assistance, life skills classes, help finding a safe place to live and medical or mental health care for co-occurring disorders.

Why Medication-Assisted Treatment Isn't More Widely Available

According to Pew Charitable Trusts, only 23 percent of publicly funded treatment programs offer medication-assisted treatment, even though research highlights its effectiveness.4 While government agencies and the healthcare industry work to increase the understanding of MAT and increase the number of program using it, a number of barriers prevent programs from adopting MAT, according to researchers. These include:

  • Misconceptions among the public and some providers that medication-assisted treatment simply replaces one addiction with another, which is untrue
  • A lack of trained and authorized personnel who can administer the medications
  • Funding barriers that prevent MAT from being implemented
  • Staff and clients with reluctance to rely on medication to treat an addiction

As medication-assisted treatment becomes more widely available and research continues to show that it’s effective, researchers and proponents hope that MAT can help slow the opioid crisis and enable individuals struggling with addiction to restore their lives for the long-haul.

Is Medication-Assisted Treatment Right for You?

Medications used in medication-assisted treatment help improve brain function, reduce cravings, and block the effects of alcohol or opioids if they’re taken while on MAT. This enables people to focus on creating a life that supports continued sobriety.

While MAT isn’t the only pathway to recovery, it’s one of the most effective, especially for opioid addiction and severe alcohol addiction. Just as medication is an important component in the treatment of chronic diseases like diabetes and heart disease, it can be a central factor for successful recovery from addiction as well. 

If you have an alcohol or opioid addiction and are ready to restore control over your life, medication-assisted treatment can help. A high-quality treatment program that offers MAT can answer your questions and help you understand how and why it works and whether it can help you, too, recover from your addiction once and for all.