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Alcohol abuse and opioid addiction are two of the most prevalent health problems in the United States. As awareness of the opioid crisis increases, it becomes impossible to ignore the startling and frightening consequences of nonmedical opioid use. Nearly 2 million people were addicted to prescription opioid painkillers in 2015, while in the same year, around 33,000 Americans died due to opioid overdose—which includes overdose due to drugs like heroin and illicitly manufactured fentanyl, as well as prescription opioids.1

Statistics regarding alcohol abuse are equally troubling. In 2015, an estimated 15.1 million American adults over 18 years of age had an alcohol use disorder, the clinical term used to describe alcohol addiction.2 Further complicating the issue is the fact that people who abuse opioids also commonly abuse alcohol or other substances.3

MAT, or medication-assisted treatment, is one approach to treating opioid or alcohol addiction that has shown a high degree of success.


What Is Medication-Assisted Treatment?

Doctor giving woman medicationMedication-assisted treatment is an individualized approach to treating people with substance use disorders that involves a combination of FDA-approved medications, behavioral techniques, and counseling. Rather than relying entirely on pharmaceutical interventions for addiction treatment, the combination of behavioral interventions and medication help address physical, psychological, social, and emotional issues that can trigger as well as result from substance abuse. MAT is mainly used to treat people suffering from addiction to opioids such as heroin or prescription painkillers, but it is also often used to treat alcohol addiction.4

Chronic opioid use results in a number of changes to brain chemistry that underlie the development of both physiological dependence and addiction. Addiction is a chronic disease characterized by continuing drug use despite knowledge of the negative consequences. Physical dependence, which commonly coincides with addiction, means that you need to continue using the drug in order to feel normal and to avoid serious and potentially debilitating withdrawal symptoms.5

Like opioid users, people who abuse alcohol can also suffer from dependence and addiction. And while acute opioid withdrawal is often extremely uncomfortable, alcohol withdrawal can actually be quite severe, as it is sometimes accompanied by dangerous health complications such as seizures and delirium tremens.6 Quitting alcohol is a process that requires special care, so individuals who have come out on the other side of the process are often highly motivated to maintain recovery. However, severe cravings and social pressure may make staying sober exceedingly difficult. MAT drugs can help to alleviate these cravings and increase the chances of long-term success in recovery.

Various MAT interventions may help to: 4

  • Prevent relapse.
  • Block the euphoric properties of certain substances.
  • Alleviate withdrawal symptoms.
  • Prevent or reduce cravings.
  • Help facilitate behavioral therapy.
  • Allow patients to focus on activities of daily living, such as work or home responsibilities.

Behavioral therapy and counseling help people make positive life changes, enable them to examine and overcome issues that led to substance abuse, and assist them with learning new and improved coping skills that can help prevent relapse. MAT drugs help to facilitate therapy by restoring some of the physical and psychological stability needed to fully participate.

Is It Effective?

MAT has been shown to be a useful and beneficial form of treatment for helping people overcome substance abuse disorders.4

MAT is an evidence-based form of treatment, which means that it has been backed up by research proving its effectiveness. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT has “proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for [people suffering from opioid use disorders].”4

Unfortunately, MAT has been underutilized; fewer than 1 million of the 2.5 million Americans with an opioid abuse problem in 2012 utilized MAT.7 Despite this, MAT has shown to be effective in a number of clinical studies. For opioid abuse, specifically, there are many studies that demonstrate its benefits.

MAT has been shown to be a useful and beneficial form of treatment for helping people overcome substance abuse disordersA report from The New England Journal of Medicine cites a study of heroin overdose deaths in Baltimore between 1995 and 2009, in which an association was made between the increasing availability of methadone and buprenorphine (commonly used MAT drugs) and an approximate 50% decrease in the number of fatal overdoses. The same report showed that MAT often results in an increase in the number of patients who remain in treatment, helps to improve a patient’s social functioning, and reduces the risk of drug-related infectious disease contraction and criminal behaviors.7

The first long-term follow-up evidence for MAT’s effectiveness was published in 2015. Researchers followed participants in the Prescription Opioid Addiction Treatment Study. The study, which was a collaborative effort between the National Institute on Drug Abuse Clinical Trials Network and researchers at the School of Medicine at the University of Texas Health Science Center at San Antonio, examined the abstinence rates among people who had participated in MAT. The study found that half of the participants reported being abstinent from drugs for 18 months following MAT therapy, while after 3.5 years, the number rose to 61%, with fewer than 10% meeting the criteria for a diagnosis of drug dependence.8

Additional studies of MATs in high-income countries (such as the US) have backed up these numbers, with numerous studies demonstrating an average 50% rate of retention in MAT treatment.9

What Medications Are Used?

A number of approved medications are used to treat people who participate in MAT programs.

People addicted to opioids receive MAT treatment at certified opioid treatment programs (OTPs). Some of the MAT medications used to treat opioid addiction and/or withdrawal include:4,10

  • Methadone. This medication is known as a full opioid agonist, meaning that it fully activates the opioid receptors in your brain to alleviate your cravings and withdrawal symptoms. However, as part of an OPT, methadone is carefully monitored and dispensed to those participating in the program, and the daily dose is incapable of producing the overwhelming high that promotes compulsive use. Methadone is the only MAT drug approved for use in pregnant or breastfeeding women.
  • Buprenorphine. As a partial opioid agonist, this drug produces opioid effects but not at the same level of intensity as full opioid agonist drugs like heroin or methadone. Buprenorphine also has a “ceiling effect,” so after a certain point, more doses won’t produce any additional side effects. This helps to discourage abuse. Buprenorphine is commonly combined with naloxone in the MAT medication Suboxone.
  • Naltrexone. This medication works differently than the others. It is an opioid antagonist, so it blocks the opioid effects. If you relapse while taking naltrexone, you won’t feel any of the euphoria or high associated with the abused drug.

People addicted to alcohol also receive medication at MAT programs. Some of the MAT medications used to treat alcohol addiction and withdrawal include:4,11, 14

Older male pouring prescription pills on hand

  • Naltrexone. As with opioid addiction, this medication is used to block and decrease the pleasurable feelings that occur when you drink.
  • Acamprosate. This medication helps prevent people who have already stopped drinking from relapsing on alcohol. It will not prevent withdrawal symptoms in people who have only just quit alcohol. You must wait a short period after stopping alcohol use (5-8) days before beginning treatment with acamprosate.
  • Disulfiram. This medication is used to deter problematic drinking by disrupting the body’s normal alcohol metabolic pathway, thereby creating an uncomfortable physiologic reaction to one of alcohol’s metabolite chemicals—acetaldehyde. When disulfiram is taken regularly as indicated, any drinking will result in a buildup of this chemical.You will experience a whole range of unpleasant side effects including headache, nausea, and vomiting) if you relapse back to alcohol.

Medications that are not FDA-approved for the treatment of alcoholism but that have shown promising results in this area include:

  • Topiramate and gabapentin. These are anticonvulsant medications that are sometimes used to help people who are addicted to alcohol to reduce their consumption.
  • Baclofen. This muscle relaxant acts on the GABAB receptors, and some studies have indicated that it can lessen cravings and help people to prevent relapse. This medication may be most useful in those with comorbid alcohol use disorder and anxiety.

Am I Still Sober if Use MAT?

Contrary to what you may have heard, you are still sober if you use MATs. Sobriety looks different for everyone—MAT medications can help you avoid a relapse, sustaining your sobriety. Some people think that MAT medications are just a substitute for their drug of choice or that it is “trading one addiction for another”. This is not the case—MAT programs provide medications that are safe, controlled, and effective. When used properly and under professional supervision, these medications do not normally result in significant adverse effects. Used correctly, they also do not cause any of the highs associated with problematic use and compulsive drug-seeking.4

Remember that addiction is a chronic disease. Other chronic diseases, such as diabetes, rely on medication and lifestyle change, so many experts agree that addiction should not be treated any differently.12 Medication is often essential to prevent overdose (which can be fatal) and to promote recovery for many people suffering from addiction. And as with other diseases, making lifestyle changes, such as those promoted through MAT, behavioral therapies, and counseling, can help further cement your chances for recovery.

Can I Be in AA or NA and Participate in MAT?

Admittedly, some 12-step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) tend to be strict about MAT usage while participating in the group. Sometimes, people in AA or NA might say that you’re not fully sober if you’re taking MAT drugs. Yet these well-meaning people may be providing misleading and, in fact, false information. According to an article by Dr. Louis Baxter for the American Society of Addiction Medicine, “this so-called ‘advice’ from well-intended but misinformed members is not founded in scientific or 12-step philosophy and violates a long held 12-step policy [that] AA members should not give medical advice to each other."12

Additionally, according to a presentation by Misti Storie, the former Director of Training for NAADAC, the Association for Addiction Professionals, “neither Alcoholics Anonymous (AA) literature nor either of its founding members spoke against using medications as a component of a recovery plan for alcohol dependence.” She also states that “Alcoholics Anonymous does not endorse encouraging AA participants to not use prescribed medications or to discontinue taking prescribed medications for the treatment of alcohol dependence or related disorders.”13

Still, if groups like AA or NA don’t fit with your personal recovery path, you might consider joining a non-12-step group that also offers a similar level of support. Such groups might include SMART Recovery, Secular Organizations for Sobriety (SOS), or LifeRing. You can always find a group that is more accepting and supportive of your treatment choices if traditional 12-step groups don’t feel like a good match.

How Do I Start?

Finding an MAT program is easier than you might expect and can often be accomplished through a simple phone call or visit to a website. To locate a buprenorphine program, you can contact the SAMHSA Center for Substance Abuse Treatment (CSAT) at 866-BUP-CSAT (866-287-2728). You can also send an email to infobuprenorphine@samhsa.hhs.gov.

To find a methadone program, SAMHSA has a list of providers and programs organized by state.

To find another type of MAT program, you can contact the SAMHSA Division of Pharmacologic Therapies at 240-276-2700 or send an email to otp-extranet@opioid.samhsa.gov.

Additionally, you can find more information about MAT treatment on the website of the National Alliance for Medication Assisted Recovery. Furthermore, SAMHSA has a motivational compilation of essays written by patients who have benefited from MAT in long-term recovery that can be useful for learning how MAT can also help you succeed in your own journey of recovery from addiction.

If you’re interested in discussing your treatment options with someone now, give us a call. We are available any time, day or night, to help you find a program that is right for you.


References

  1. National Institute on Drug Abuse. (2018). Opioid Overdose Crisis.
  2. National Institute on Alcohol Abuse and Alcoholism. (2017). Alcohol Facts and Statistics.
  3. Center for Substance Abuse Treatment. (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs: Treatment Improvement Protocol (TIP) Series, No. 43. Chapter 11. Treatment of Multiple Substance Use.  Rockville, MD: Substance Abuse and Mental Health Services Administration.
  4. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
  5. Kosten, T. R., & George, T. P. (2002). The Neurobiology of Opioid Dependence: Implications for TreatmentScience & Practice Perspectives1(1), 13–20.
  6. Trevisan, Louis A., Boutros, Nashaat, Petrakis Ismene L., Krystal, John H. Complications of Alcohol Withdrawal: Pathological Insights. Alcohol Health and Research World, 22(1), 61–66.
  7. Volkow, N.D., Frieden, T.R., Hyde, P.S., & Cha, S.S. (2014). Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. The New England Journal of Medicine, 370(22), 2063­­–6.
  8. National Institute on Drug Abuse. (2015). Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”.
  9. Feelemyer, J., Jarlais, D. D., Arasteh, K., Abdul-Quader, A. S., & Hagan, H. (2014). Retention of Participants in Medication-Assisted Programs in Low- and Middle-Income Countries: An International Systematic ReviewAddiction109(1), 20–32.
  10.  Substance Abuse and Mental Health Services Administration. Pocket Guide: Medication-Assisted Treatment of Opioid Use Disorder.
  11. Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. (2015). Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  12. Baxter, L. (2014). Twelve Step Recovery and Medication Assisted Therapies.
  13. Storie, M. (N.D.) Medication-Assisted Treatment for Alcohol Dependence.
  14. Minozzi S, Saulle R, Rösner S. Baclofen for alcohol use disorder (Protocol)Cochrane Database of Systematic Reviews2017, Issue 2. Art. No.: CD012557. DOI: 10.1002/14651858.CD012557.
Last updated on March 29, 2018
2018-03-29T09:44:33+00:00
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