What is medication assisted treatment for a use disorder?
A use disorder is an addiction. There are different types of use disorders, such as opioid use disorder, alcohol use disorder, tobacco use disorder, methamphetamine use disorder, and more.
Medication Assisted Treatment MAT simply means for a doctor to prescribe one or more medications that are part of an evidence-based treatment plan to treat an addiction. Typically, medication treatment is only one part of the plan, which may also include individual psychotherapy and group therapy.
Currently, there is no single medication that is proven to be effective in treating all addictions. There are specific medications which are proven to work for certain types of addiction.
For example, Suboxone works very well in treating opioid use disorder. It is one of several medications for opioid use disorder (MOUD). Suboxone is a brand name for a combination drug that includes buprenorphine.
Buprenorphine is the one of the safest and most effective medications for opioid use disorder. Other drugs used for opioid addiction include methadone and naltrexone.
Is opioid addiction the only substance use disorder that can be treated with a medication assisted treatment program?
For many years, medication assisted treatment has been closely associated with opiate addiction treatment. MAT for opiate and opioid addiction treatment goes back to the 1960s and the beginning of the methadone maintenance program.
In fact, MAT for opioid use disorder goes back much further. The use of a safe supply of opioids to treat opioid addiction has a long history.
Methadone and buprenorphine are both opioids, but they are uniquely suited to be used for addiction treatment. Buprenorphine, a mixed opioid receptor partial agonist and antagonist, is the best medication for medication assisted treatment for opioid addiction.
In recent years, mostly during the past decade, we are learning more about the possibility of effective MAT for other types of addiction. For example, there is now proven medication assisted treatment for alcohol dependence.
There is also medication assisted treatment for tobacco use disorder. This is important because tobacco contains nicotine, the most addictive drug on the planet, and one of the most destructive drugs.
Why would a specialist in addiction medicine not follow medication assisted treatment best practices?
There are general practitioners, family doctors, and internists who take an eight-hour course to get a medication assisted treatment certification. And, there are also doctors who specialize in addictionology.
A board-certified addictionologist is a doctor who has completed additional training to become an expert in diagnosing and treating addiction-related health conditions, such as substance use disorders.
Yet, many of these board-certified addiction specialists do not embrace medication-assisted recovery services. Why would an expert in treating opioid dependence have a problem with an opioid treatment program using therapy such as Suboxone medication-assisted treatment?
Unfortunately, the abstinence-based philosophy of the 12-step program of Alcoholics Anonymous has infiltrated every level of addiction treatment in the US, and other parts of the world. Even addiction residencies and fellowships that train and certify doctors as specialists embrace AA dogma.
Slowing down the opioid epidemic has been hampered by the influence of Abstinence-based and spiritually-based programs, such as AA. We are at a point in history where a doctor who has medication-assisted treatment training rather than board certification in addiction treatment may have a far better success rate with treating patients addicted to opioids.
When it comes to medication-assisted treatment vs abstinence, MAT is dramatically more effective in the case of opioid use disorder treatment. Alcohol addiction also responds well to MAT services for alcohol, using medications such as naltrexone, topiramate, gabapentin, ondansetron, baclofen, and acamprosate.
Medications for opioid use disorder (MOUD) and medications for alcohol use disorder (MAUD) have changed the way we treat addiction. Medication-assisted treatment programs (MATP) and the overall medication-assisted pathway (MAP) are the way of the future in how we address addiction.
Of course, ideally, the best situation would be to have doctors able to get the best possible training in addiction medicine and also fully embrace evidence-based medication-assisted recovery. Medication-assisted treatment effectiveness is well established.
Is there such a thing as medication-assisted treatment for benzodiazepines?
Unlike opioid and alcohol addiction, benzodiazepine addiction does not occur nearly as often. There are people who are prescribed benzos for medical purposes, and they become physically dependent on them over time.
Physical dependence is different from addiction. A person who has a physical dependence will become physically sick when they discontinue the medication the abruptly.
Addiction and physical dependence can go together, such is often the case with alcohol and opioid addiction, but it is possible to have a physical dependence on a drug without necessarily being addicted to it.
Still, benzodiazepine addiction is possible. Often, a person with an addiction to another drug will find the effects of drugs such as Xanax, Ativan, or Valium to be pleasant. They transfer their addiction to this new drug that is so effective at relieving anxiety and inducing sleep.
Benzo withdrawal is particularly unpleasant. It is as if all of the anxiety that the person avoided over a period of months or years suddenly rushes in all at once.
Opioid withdrawal is, of course very unpleasant, as is alcohol withdrawal, and even Suboxone withdrawal. Yet, many people have described benzodiazepine withdrawal as being worse than any of those other withdrawals, even heroin withdrawal.
While there is no medication-assisted recovery services that are known to be effective for benzodiazepines, there are protocols for helping a patient to discontinue benzos. For example, there is the Ashton Method. The Ashton Method is a protocol for gradually tapering medication over a period of months.
In some cases, where it is considered to be dangerous to continue a benzodiazepine for long periods, because the patient is severely abusing the drug, some doctors may start the patient on anti-seizure medication to prevent seizures that can occur during benzodiazepine withdrawal.
What is the most effective form of MAT for alcohol use disorder?
MAT for alcohol addiction, as stated earlier, utilizes one or more of several drugs that have been demonstrated to be effective. Traditionally, MAT for sobriety was the standard, with patients being told to stop drinking altogether.
More recently, MAT treatment for alcoholism includes The Sinclair Method (TSM), which is a harm-reduction method involving a patient taking naltrexone while they continue to consume alcohol. Surprisingly, TSM is more effective than abstinence-based methods in many cases.
How does TSM work? In order to follow The Sinclair Method protocol, a patient takes a naltrexone 50 mg tablet, waits an hour, and then consumes a measured single alcoholic beverage. That is essentially the entire implementation of the program, summarized in one short sentence.
Yet, the practical implementation is much more involved, because there are many variations and individualized applications for individual patients.
Some patients take naltrexone daily. Others only take it occasionally, on days that they drink, and not on alcohol-free days (AF). Of course, even with this effective form of MAT alcohol abuse is still possible.
However, while not all patients have a smooth path early on with TSM, this form of alcohol medication-assisted treatment is highly effective for several reasons. First of all, it is based on solid neuroscience.
Taking naltrexone in combination with controlled alcohol consumption effectively erases the alcohol habit from the brain, gradually over time. Proponents of TSM call this process pharmacological extinction.
In addition to naltrexone, there are other medication-assisted alcohol treatment drugs that are also effective. An experienced concierge addiction physician will be able to use alternate medications or combinations of medications for alcohol use disorder when appropriate.
How did the government ever allow treatment of opioid addiction with opioids?
Some people get very upset about the idea that treatment drugs, such as buprenorphine and methadone, are approved by the government as medication-assisted treatment medications. Yet, the government has not only allowed legal use of these drugs, they have provided guidelines for medication-assisted treatment in the form of treatment improvement protocols.
For example, treatment improvement protocol 42 from SAMHSA, the Substance Abuse and Mental Health Service Administration, is about substance use treatment for patients who have co-occurring disorders. Co-occurring disorders are mental health conditions that occur with a substance use disorder.
A person who has a severe social anxiety disorder and then uses opioids or drinks alcohol to overcome their anxiety would be considered to have a dual diagnosis or co-occurring disorder. TIP 42 is important to provide guidance to mental health services in providing treatment for multiple mental health conditions.
SAMHSA tip 43 is specifically about medication-assisted treatment with Suboxone and similar buprenorphine-based medications. It is specific guidance from a federal agency to help doctors better implement a medication-assisted treatment program using MAT medication combined with appropriate therapy.
With tip 43 SAMHSA is providing treatment facilities with the information they need to develop a treatment program around MAT detox and MAT maintenance. MAT is highly effective in addressing opioid craving and opioid withdrawal to help patients achieve opioid recovery.
Whether a person is addicted to heroin, fentanyl, or opioid medication, such as oxycodone or hydromorphone, opioid use puts a person at high risk for opioid overdose. Fentanyl analogs on the streets are among the most addictive drugs, and they are very potent and deadly.
Medication-Assisted Treatment drugs to make it possible to help people to stay alive and out of harm’s way. When using medications to treat addiction, it is important to see the treatment with the perspective of providing harm reduction.
The immediate goal is not perfect complete abstinence from all addiction treatment drugs. The goal is to help the patient to get off of the streets and out of danger, and to help them to begin thinking clearly, so they are able to follow a path of recovery.
What is the cost of medication-assisted treatment?
MAT cost is far less than the cost of traditional rehab. And now, with Telehealth services as a treatment option, the cost has come down even more in many areas. Online medication-assisted treatment makes reaching out to help more people than ever a possibility.
In the beginning, when methadone treatment was the only option, and then when buprenorphine treatment became available, medically assisted opiate detox was the preferred treatment option. Patients were detoxed with buprenorphine within a short time, and not offered long-term maintenance for fear that they would have difficulty with Suboxone withdrawals.
Now, we know from decades of experience, that long-term maintenance is the key to success. Patients must have time to get proper therapy and to get their lives in order. Their brains need time to heal as well.
Medication Assisted Treatment without counseling is not recommended. It is important for patients to get psychotherapy at their Suboxone clinic, or independently.
Even when putting together the cost of medication, medical visits and counseling, an entire year of MAT medication assisted treatment can be provided for less than the cost of a month of residential rehab. Medication assisted treatment in-office and medication assisted treatment online is the most cost-effective way to treat opioid use disorder.
And, it is also among the most effective treatments for opioid addiction. Maintenance treatment with buprenorphine is far more effective than abstinence-based treatment, even with months of residential rehab, followed by a partial hospitalization program (PHP), and an intensive outpatient program (IOP).
Many people mistakenly believe that the intent of MAT is to avoid withdrawal symptoms of opioid drugs. While this is a part of the treatment, the most important aspects are preventing opiate cravings and helping the patient to have clarity of thought. Eliminating the obsessions and compulsions of active addiction are essential.
What is MAT recovery and how do I find medication assisted treatment near me?
On our medication assisted treatment podcast, we have discussed options for treatment, that include programs that are free and low cost. We have also discussed the up and coming new options of virtual care, including virtual medication assisted treatment.
One of our prominent guests on the podcast, Dr. Adam Bisaga, has described recovery with MAT, in his book Overcoming Opioid Addiction, as being the “new recovery.” What he means is that we must accept that patients who are functioning well with medication assisted treatment are in recovery.
What is MAT recovery? It is when a patient only takes prescribed medication, and successfully stops acting in an addictive manner. When a person takes a buprenorphine/naloxone medication, such as Suboxone, and they function well in their life, they should be considered to be in recovery.
Medication assisted treatment and addiction recovery go hand in hand. Patients who are looking for an MAT treatment program should be encouraged to go through with it.
For patients who are pregnant and using opioids on the streets, medication assisted treatment and pregnancy are safe and effective options. Many patients have had successful pregnancies, and now have healthy babies, continuing with their medication assisted program throughout pregnancy, helping them to avoid the dangers of drug abuse.
How do I find an addictionologist near me with experience in addressing behavioral health issues by providing effective behavioral therapy?
If a person is using multiple substances and has mental health issues, it may be ideal to see a board-certified addictionologist. While there is not an established MAT for meth, there are new treatments that show promise in treating meth addiction.
For patients who use opioids and also use crack or show symptoms of meth use, it may be best to aim for a higher standard of care. Yet, it is also of the utmost importance to address the issue of opioid misuse primarily.
Opioids are far more dangerous than stimulants, including cocaine and methamphetamine. Alcohol is also one of the most dangerous addictions. For patients who are using multiple substances, it may be best to first get treatment for the most dangerous addiction, whether it be alcohol or opioid addiction.
So, while seeing a specialist in the field of addiction may be ideal in complex cases for complete disease control, if an expert is not immediately available, it is still best to attend an available treatment program for either opioid MAT or alcohol MAT.
Where can I find the best medication assisted treatment FAQs?
First of all, thank you for reading this particular MAT faq. You may also find more useful resources on this website and on the website, drleeds.com. The best way to find useful information is to use the search feature.
I also recommend following our medication assisted treatment podcast, The Rehab, for more information on the subject. If you have more questions about what is a mat program and how can it help you, we are here to answer your questions.
For example, if you have concerns about topics, such as the bad taste of Suboxone, the side effects of Suboxone, issues with Suboxone constipation, or getting started after fentanyl addiction with microdosing Suboxone (the Bernese Method), we provide information on these topics in blog post articles and podcast episodes. We even have information on transitioning from methadone to Suboxone, for people interested in the subject.
What is medically assisted treatment? It is the best way to address addiction issues and provide effective harm reduction to keep people in active addiction safe. It is also the best way to help people to get on to the path to recovery and to get started with a new life that is drug-free where they are able to become productive members of society and productive members of their own families again.