MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.
The effective use of medication is a necessary and routine part of substance abuse treatment. Most typical treatment regiments involve “dual diagnosis” treatment, meaning they address the co-occurrence of mental health or psychological illness as well as substance abuse. The frequency of this co-occurrence is seen because individuals with mental health disorders may use substances to self-medicate and because mental health symptoms are typically exacerbated as a result of substance use.
Dr. Jawad Daud, Medical Director at Transformations explains that people seeking treatment often suffer from both substance use disorders and psychiatric illness, and he explains that “Treating both diseases is essential for complete recovery.” A well-equipped treatment center identifies and treats the psychological, psychiatric, medical and substance abuse issues, to address all contributing factors. In addition to psychotropic drugs, substance abuse treatment often includes other medications; when someone becomes physically dependent on a substance, a multitude of drugs are utilized to support a medically safe detox process and minimize complications.
For example, it is a regular practice to utilize a benzodiazepine (valium, Xanax, etc.) during the detox process to prevent seizures, even though this class of medications can be abused if used incorrectly. Additionally, finding effective, non-narcotic medications for pain management may be paramount for addressing substance abuse in those with chronic pain. In none of these cases are the individuals considered to be following a non-abstinence-based treatment protocol, it is understood that these medications support treatment and recovery.
While it may seem counter-intuitive to use substances to stop using other substances, the human body, while resilient, does not respond well to abrupt changes. When even the most conditioned athletes prepare to climb Mount Everest, they must spend time at different elevations and let their bodies slowly adjust to have a chance at reaching the summit. Although treatment without prolonged medication assistance may provide removal of the substance within days or weeks in a medically safe manner, this is not necessarily the most effective process for all individuals.
Particularly with opiate addicts, a quick detox process can result in the individual dealing with very uncomfortable withdrawal symptoms including chills, sweats, nausea, gastrointestinal issues, tremors, difficulty with attention and focus and others. These symptoms can in turn lead to cravings or compulsions to go back to using the dependent substance. The idea behind MAT is that minimizing the uncomfortable symptoms of withdrawal and cravings supports both cessation of the drug and sustained recovery. Additionally, minimizing these withdrawal symptoms allows for an individual to be a more active and engaged participant in their psychological treatment practice.
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While many different medications are utilized as part of an effective treatment plan, Medication Assisted Treatment typically refers to those medications that directly support the cessation or prevent relapse of a dependent drug; this is done by either minimizing withdrawal symptoms and cravings associated with detox or preventing or blocking the effect of the drug if used again. These medications are most often used in opioid addicts but can also be supportive for alcohol and other addictions.
There are three commonly used drugs for MAT approved by the FDA for this purpose. Methadone is a full agonist, acting on the receptors that other opioids use, and is used essentially to maintain the individual on a controlled level of an opiate, and tapered down when used effectively. Buprenorphine, is a partial agonist, which acts on the opioid receptor in a reduced capacity but is not an opiate. The individual has fewer withdrawal symptoms after stopping use of an opiate but does not experience the euphoria of opiates when the drug is used properly. Buprenorphine is available in two forms. The first, Subutex, is Buprenorphine alone and is typically used for pregnant women. The second, Suboxone, combines buprenorphine with naloxone, which prevents the abuse of this form. Finally, naltrexone is known as an antagonist and helps reduce cravings while blocking the effect of opiates or alcohol.
MAT is not intended to be a cure or quick fix but is intended to be a piece of a comprehensive treatment program to promote long-term abstinence. These supplemental medications can support a treatment program by helping to normalize brain chemistry, relieve physiological cravings, stabilize withdrawal symptoms and block the euphoric effects of opioids.
When asked to give an overview on medication-assisted treatment at Transformations Treatment Center, Dr. Daud provided the following insights, “When we are talking about MAT at Transformations, we are referring to naltrexone, and in buprenorphine (in our case Suboxone). If someone were to use on this medication, the pleasurable effect is greatly reduced.
“This may prevent the addictive behavior of seeking a reward or desired effect and reduce the chances of going back to opioid use. Prescribing a blocker, such as naltrexone, along with educating the patient can reduce the actual addictive behavior. Prescribing Suboxone on the other hand is actually treating the withdrawal symptoms of a chronic opioid use disorder, which would otherwise prevent the person from focusing 100 percent on their treatment.”
These medications are not designed to be the treatment, but rather to assist with a comprehensive treatment program that addresses all aspects of the individual. Jamie Salsberg, Assistant Clinical Director at Transformations Treatment Center explains, “If we are truly providing individualized treatment, it is necessary to consider every option that may support sustained recovery, better quality of life, and more productive members of society. While supplementing treatment with medications is not necessary for everyone, there is certainly a portion of the addicted population that is not seeing improvement with psychotherapy alone. Addressing this epidemic requires us to truly identify what is best for each client, and design treatment specific to their needs.”
Transformations Drug and Alcohol Treatment Center offers treatment programs based on the individualized needs of each person seeking help. Our intensive outpatient treatment program, with psychiatric support, includes a combination of therapy, mental health, and medication support including a medication-assisted treatment program.
Salsberg mentions that ultimately, the goal at Transformations is to help more people recover from drug and alcohol addiction. “We are a treatment center that addresses the underlying issues that lead to drug use and alcoholism. Our goal for our clients is sustained recovery, but how we get them there will not always look the same. While some individuals may do best with immediate abstinence, others are better supported by the temporary adjunct of medication to improve engagement in their treatment program.”
