Are You Really Sober if You’re on Medication-Assisted Treatment?

Rehab Helps Thousands of Addicts Quit. It Can Help You, Too.

As much as we’d like to think that treating an addiction is as simple as pulling-yourself-up-by-the-bootstraps, it is not.

Some people tell themselves that they can stop using their drug of choice at any time. When they can’t, they don’t immediately think that they may need the very best care for their chronic brain disease with stealth medical intervention, top physicians and mental health professionals.

No. Most people, when faced with their own addiction, feel utterly weak and ashamed. They tell themselves that today will be different. TODAY, they will not drink or drug. At the very least, they will limit their use. But as sure as it will be “5 o’clock somewhere,” the cravings become overwhelming and “just one” can slip the brain into desiring more, more, more.

The very nature of addiction makes that phrase, ‘just say no,’ or moderating, almost impossible.-Polly Drew

The very nature of addiction makes that phrase, “just say no,” or moderating, almost impossible. When ad hoc attempts to change behavior fail, most people feel hopeless and helpless against their addiction. In the privacy of their own hell, they deem themselves weak, moral failures.

But nothing can be further from the truth. Science proves that addiction is a chronic disease that is just like heart disease, diabetes or high blood pressure.

Sure, there are mild cases of these illnesses that can be managed with diet and exercise. But in many cases, a combination of medicine, education, and support from community and family is needed to fully treat these conditions.

MAT: What is Medication-Assisted Treatment?

The term, Medication-Assisted Treatment (MAT) has traditionally been associated with treatment for opioid addiction. But in recent years, MAT has been broadened to mean any treatment for substance use that combines medicine with a treatment plan for addiction.

Why would we treat addiction any other way?

Why wouldn’t we use everything we have to treat the epidemic of addiction to regain and maintain a healthy lifestyle?

When the brain changes and becomes addicted to a substance, the cravings create an overwhelming impulse that results in loss of control.-Polly Drew

When the brain changes and becomes addicted to a substance, the cravings create an overwhelming impulse that results in loss of control. The ability to moderate becomes almost impossible. And in the worst cases, compulsive abuse becomes so impulsive that severe harm or death can result.

Even if you choose to taper off of an addiction, it can be very difficult. And in some cases, the attempted taper can be life threatening. To be protected, we need our full arsenal of treatment tools to help people detox safely. And once safely detoxified, we should use the multi-treatments available to help people regain their lives.

Or should we? For decades, the bedrock of Alcohol Anonymous has been abstinence from all drugs and alcohol.

“I used to be vocal (in my disapproval) of MAT,” says Dr. Julie Dostal, executive director of LEAF Council on Alcoholism and Addictions in Oneonta, NY. Dostal is in long-term recovery and once believed that using medication to recover from addiction was transferring from one addiction to another.

…I’ve seen up close that medications used to treat addictions are NOT mood-altering, they are mood-correcting or stabilizing…-Dr. Julie Dostal

“But, over the years, I’ve seen up close that medications used to treat addictions are NOT mood-altering, they are mood-correcting or stabilizing,” she said underscoring her change of heart. “It’s just so clear to me that people suffering with addiction need full, systemic treatment for the disease of addiction.”

Addiction is not a second-class illness.

“People with addiction are patients, not inmates,” Dostal said. “I think that sometimes these old-timers ‘in the rooms’ (a term used to describe those in AA) feel threatened that there is more than one road to recovery.”

But Dostal said that the science can’t be ignored.

“More and more science is coming out every year,” she said. “Every year when I prep for teaching an addiction class at Suny Oneonta, it’s undeniable.”

Dostal, who moderates a Twitter chat called #addictionchat Wednesday nights at 9 p.m. ET, has a few other thoughts using 140 characters or less:

  • We need to redefine what we consider mood-altering drugs. Appropriately prescribed medications can help heal.
  • Just because it’s not my path, MAT is not the wrong path for others.
  • Parts of the body go bad. Parts of the brain can break, too.
  • Think about all the new meds that heal. AIDS was once a death sentence. It’s now it’s a chronic illness. There is HOPE for addiction.

When we use all we have to combat addiction, the outcomes are promising. Survival is improved. People stay in treatment. Illicit drug use is decreased. Criminal activity goes down. Employment goes up. Quality of life improves. And most importantly, individuals heal.

And healing along with them are their families – and all of society.

What Are Your Thoughts on this Topic?

  • AddictionMyth

    Old-timers are the one who insist that you will surely die from your disease, even if they themselves caught it in the early stages before becoming a ‘low bottom drunk’ thank GoD. I don’t think we need worry so much about what they think. NIDA and Volkow are a different story, but I think we’re making good progress on that front. Decriminalization will put the lie to their false doctrines masquerading as ‘science’.

  • judy j

    What is with the”old timers” bashing. This article is intriguing and educational. Yet they allow this comment in to color the feel about those in long term recovery in 12 step. Might it be that people with long term recovery are just concerned that they have seen a lot of bad science come along and damage good people? Could it be that because what 12 step programs Have done for them is free them from their personal addiction prison and it is scary to think that doing it some other way might kill people? Yes, I am hopeful we are finding better and more paths to helping people stop their disease. And yes, I Have 22 years clean in Narcotics Anonymous. And yes, I too am unsure of the safety of MAT.

    • AddictionMyth

      Old-timers are the ones that claim that their way is the only way and beware others who will try to lead you astray causing you permanent damage. And if you don’t believe it then your fate is ‘jails, institutions and death’ and anyone who challenges them is surely killing the still suffering alcoholic/addict. And that’s ‘How it Works’, thanks for the demonstration!

      • loretta smith

        I am a woman in long term recovery and yes, you would probably consider me an “old timer.” I would like to see the negative commenters stop painting the 12 step programs with such a wide brush. Attitudes have changed dramatically since 1984 when I chose the path of recovery. AddictionMyth , I would like you to know that I don’t hold to any of the attitudes you claim I have as a member of Alcolics Anonymous and neither do any of my friends in recovery. Had coffee today with a group of women and we talked at length about the various paths to recovery and that AA is not for everyone and whatever works is good. I know several people using suboxone while they are rebuilding their lives and never heard a negative comment from anyone in the rooms. Two young women I know recently went through the weaning off process and were quite anxious about it but had much support from their friends in recovery. They are doing great. I SIT in meetings on a regular basis with atheists and even (gasp) pagans. A religious cult? I think not.

        • Polly Drew

          There are people who are really vocal about MAT and you’re right, not all are old-timers. Some are young-timers. The main point is that the road to recovery has many paths. It’s important, especially for the newbies, that they are supported but the fellowship. Thank you for your thoughts Loretta.

    • Polly Drew

      That quote from Dr. Dostal, herself a woman in longterm recovery and also a onetime naysayer about MAT, was making a broad statement about people in general who don’t believe in MAT. The road to recovery is unique to each person she has come to believe as do I. And WOW! Congrats on your 22 years of recovery. It’s truly inspiring Judy.

  • Judy O

    I am 55 yrs old and am a prescription drug addict, have been for 30+ yrs. The drug Suboxone helped me tremendously, The Dr. I went to had me drug tested monthly and also by surprise, also called you in randomly for a medication count. Believe me I tried everything including daily AA/NA meetings for quite a few years, but I would always screw up. I do have a Higher Power, as I understand, in my life, but I needed a little bit of extra help. Suboxone got me on the right path and saved my life. So say what you want about MAT, but I truly don’t believe I’d be here today without that extra help.

    • Polly Drew

      So happy that you are here and able to voice your story. Thank you Judy.

  • Rocky Hill

    Great article. There are as many ways to find recovery as their are those of us addicted. If we really care about spreading the hope of recovery, it helps if the person is still alive. Clearly, the treatment that I received, in 1980, is no longer “state of the art” or as so many inpatient programs like to crow “evidence based”. Evidence based is demonstrated by the 180 degree turnaround of Hazelden and BFC when they began, finally, to embrace MAT. So sad that we still have so many other programs who believe in program centered treatment rather than patient centered. We must ask ourselves, why would they ignore study after study that shows the benefits of buprenorphine over an extended period of time, while the opiate dependent patient creates a structure to support their recovery when (and if), they begin to titrate. We have used buprenorphine for over ten years with extremely good results. Our census runs between 60 and 70 and we have yet to have a former patient die of an overdose of opiates. It helps to know that we understand that gnawing anhedonia that follows the acute withdrawal for so many, many months. It, also, helps to know that, they don’t need to relapse if the discomfort becomes intolerable and that they can return to the medication without any shame. It’s not a race and those on medication are as much in recovery as those who espouse a single path for recovery. Enhancing the quality of our life in the face of a fatal disease, is the goal. Recovery is about the acquisition of humility. If you don’t know the truth about medication assisted treatment, than please don’t hold yourself out as an expert. Please read more than the bias of others. Dr. A. Thomas McClellan may be a good place to start. He’s an ASAM credentialed addictionologist, who has also gone through the loss of his own son to opiates. Do you really think that you know more than he does about the pain of this disease. I have had professionals in the field tell me that buprenorphine negates one’s spirituality. I am unaware of any instrument that measures that portion of a human. Having been on subutex for the last ten years, due to football, horse and auto injuries, I can tell you that I just celebrated my 34th year of recovery and am fully conscious of a God who loves me. I also spend my life in active pursuit of adventure scuba diving, riding those same horses and finding adventure, clean and sober, the rest of my years.

  • fattyz

    I can tell you in the old days you couldn’t mention it. “You’re chewing your booze” is all you’d get out of them and they’d probably pressure out of the group. It was very rigid in those days (85 or so) and much smaller so you had little chance of getting around this attitude. You really couldn’t mention if you were seeing a psychiatrist and being prescribed any mood altering chemicals. They would even tell you to get the listerine out of the house and no over the counter meds with alcohol and announce to any doctor or medical professional you were “alcoholic”. It was total insanity. It has changed quite a lot, watered down like most things. Since I survived (survived is a good way to put it) that period I looked back on it with nostalgia and when I went back to AA for a time I thought the “new AA” was very weak and wishy washy. I think there are still pockets of that old time AA but most of those guys have died off.

  • therealjanedoe

    In 2003 when Suboxone was a trial I was entering detox/rehab for the 5th time in 5 years. I became addicted to opiates due to a lengthy disease that lead to several surgeries. As a professional woman I was able to hide my addiction, however the doctor and pharmacy shopping was taking over my life. I’d accumulate some clean time, but always relapse because I couldn’t handle the withdrawal.
    Specifically the depression that accompanied the withdrawal. – I’d have periods of sobriety but the depression or post acute withdrawal was unbearable. On that 5th detox/rehab I literally begged to be put on Suboxone. They didn’t want to do it because I was not on heroin, however finally agreed. Fast forward to now, I’m still on Suboxone. I’ve gone through a lot of shit in the past couple years (escaped a “controlling” relationship with nothing but the clothes on my back, slept on friends couches for months, have had an awful time finding employment etc.). But I’ve never relapsed. I truly believe that without Suboxone I’d have never be able to accumulate 12 years of sobriety. For me, it was nothing short of a miracle and am so very thankful every single day. I just hope with Obama-care, it is more readily available to folks as it is pricey – even the generic form but in my opinion, it is a miracle drug. It literally gave me my life back.

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