Addiction is a chronic disease that can cause long-lasting health problems. Achieving sustained recovery from addiction requires a multi-pronged, whole-patient approach, including detoxification, counseling and behavioral therapies, medication assisted treatment (MAT), and aftercare to prevent relapse. Please continue reading to learn more about the role that medication assisted treatment (MAT) plays in overcoming addiction.
What is medication-assisted treatment?
Medication-assisted treatment (MAT) in addiction recovery refers to the use of medications approved by the U.S. Food and Drug Administration (FDA) to treat substance use disorders. These medications help in controlling craving and withdrawal symptoms, sustain recovery, and prevent relapse and overdose. MAT is used to treat alcohol use disorder (AUD) and opioid use disorder (OUD) and is considered the gold standard of care for opioid use disorder.
What are the benefits of MAT?
Research has shown that combining medication-assisted treatment (MAT) with behavioral health measures such as counseling results in higher success rates in people undergoing recovery from addiction. Some of the key benefits of MAT include:
- Decreased use of substances during recovery;
- Reduced incidence of criminal activities among people with substance use disorders;
- Lowered risk of contracting sexually transmitted diseases such as HIV or hepatitis C;
- Increased ability of patients to stay in treatment;
- Improved ability to obtain and retain jobs;
- Reduced rate of relapse;
- Greater success in achieving and sustaining recovery and leading a life free of substances;
- Fewer overdoses and improved survival.
What are the phases of medication-assisted treatment?
Medication-assisted treatment is typically divided into three main phases:
Induction Phase
The induction phase of MAT typically lasts for 1-3 days. Before the induction, you will be instructed to stop using opioids for 12-48 hours, either at home or at an inpatient location. It is vital that you honestly report the timing of your last substance use to your healthcare providers because this will determine the timing of the first dose of your MAT medication.
The induction phase of MAT includes discussions about treatment options with your healthcare providers. The pros and cons of medication-assisted treatment will be explained to you at this stage and treatment expectations will be outlined. You will also be asked to sign a consent form during the decision-making process.
The next step in the MAT induction phase is a thorough pre-treatment assessment. During this overview appointment, the MAT team will obtain a detailed health history and substance use history. You will undergo a physical examination and laboratory tests. You may be asked to provide urine, blood, mouth swab, and/or hair samples.
Following this, the healthcare team will review instructions for medication induction and develop a follow-up plan for the other phases of MAT.
You should arrive for your induction appointment after being substance-free for 12-48 hours, in a moderate state of withdrawal. Your healthcare team will assess your withdrawal symptoms and prescribe the appropriate medications.
You should start to feel better after your first dose of medication-assisted treatment. You will receive additional medications, if needed, and the dose of your MAT medication will be adjusted over the following days and weeks.
You can complete the induction phase of medication-assisted treatment at home or at an inpatient facility. In either case, it’s important to communicate regularly with your MAT team and tell them how you are feeling at every stage of the treatment.
If you are completing the induction phase at home, you will likely receive prescriptions to last you until your next appointment. Refills will be made available at follow-up visits. Keeping all your appointments during this phase of medication-assisted treatment is vital as your healthcare team needs to evaluate the safety and efficacy of the treatment. You may also be asked to provide samples for drug testing during this time. Failure to bring in your remaining medication or refusal to participate in drug testing may result in your dismissal from the MAT program.
Stabilization Phase
The second phase of medication-assisted treatment can last several weeks and consists of stabilizing your recovery. During this phase, your healthcare team will find a dose of MAT medication that works best for you. You will be asked to notify your healthcare providers if you experience any triggers or cravings, so that the dose can be adjusted.
The MAT stabilization phase is also the time when you will start working on your long-term treatment goals. Additional supplementary treatments, such as counseling and behavioral therapies, will be instituted to help you build resilience and remain substance-free.
If you continue to progress as expected, your dose of MAT medications may be reduced to prepare you for the next phase of your recovery.
Maintenance Phase
The final phase of medication assisted treatment is the maintenance phase, during which your healthcare team will monitor your progress. There is no fixed timeline for this phase of MAT, but most experts recommend 12-18 months of continuing treatment to prevent relapse. Some people may need to take MAT medications for longer to stay drug- or alcohol-free. When your healthcare team deems it appropriate, you will be slowly tapered off from your MAT medications to minimize withdrawal symptoms. Your MAT team will advise you to contact them right away if you experience triggers or cravings in the future so that they can reinstitute MAT, if necessary.
How long does someone stay on medication-assisted treatment?
The induction phase of medication assisted treatment typically lasts for 1-3 days. The stabilization phase lasts for several weeks. The maintenance phase can last anywhere from 12-18 months or longer. Medications used during MAT are safe to use for several months, years, or even lifelong.
What medications are used in medication-assisted treatment?
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends three FDA-approved medications, buprenorphine, methadone, and naltrexone, for use during medication-assisted treatment in opioid treatment programs.
FDA-approved medications for the treatment of alcohol use disorder (AUD) include acamprosate, disulfiram, and naltrexone.
How does MAT improve addiction recovery outcomes?
MAT improves addiction recovery outcomes by blocking the euphoric effects of alcohol and opioid drugs, relieving cravings, and normalizing brain chemistry and body functions. Different MAT medications work in different ways.
Buprenorphine
Buprenorphine is a partial opioid agonist. It activates opioid receptors in the central nervous system and produces the same euphoric effects as full opioid agonists (heroin, morphine, codeine, hydrocodone, oxycodone), but within a certain limit. In this way, buprenorphine helps to keep withdrawal symptoms and cravings in check, allowing you to gradually reduce your dependence on opioids without feeling terrible.
Buprenorphine is safe for long-term use because its effects do not go above a certain level. This is called the ceiling effect. It means buprenorphine cannot cause profound respiratory depression like heroin and other opioids. Taking more buprenorphine will not cause more euphoria beyond a point. This prevents the temptation of taking more buprenorphine than the prescribed. This MAT medication can therefore be prescribed safely for the long-term.
The other way buprenorphine works is by blocking opioid receptors in the brain. This prevents opioid drugs like heroin from attaching to these receptors. If someone uses heroin while on buprenorphine, they won’t experience the euphoric effects of heroin.
Buprenorphine is available as a sublingual tablet (Subutex), subcutaneous injection (Brixadi), subdermal implant (Probuphine), and extended-release subcutaneous injection (Sublocade). A combination of buprenorphine and naloxone is available as a buccal film (Bunavail), sublingual film (Cassipa), tablet or sublingual film (Suboxone), and sublingual tablet (Zubsolv).
Do you have a loved one struggling with addiction?
We know how hard that can be. Give us a call to find out what options you have.
+18442884672 Methadone
Methadone is a long-acting full opioid agonist. It bends to opioid receptors in the body and reduces opioid cravings and withdrawal symptoms. By occupying opioid receptors in the brain, methadone also blocks or blunts the effects of illegal opioid drugs such as heroin and prescription opioids such as fentanyl, oxycodone, and hydrocodone. In this way, methadone helps to manage opioid addiction in a safer, more controlled manner.
Unlike buprenorphine, methadone does not have a ceiling effect. The blood levels of methadone reach a steady state in about 5 days. Methadone induction during medication-assisted treatment is therefore done slowly, starting at a low dose. The dose is individualized to every patient and daily monitoring of the response to the treatment is required. The goal during induction is to identify a dose that relieves withdrawal symptoms but prevents respiratory depression or oversedation.
Methadone is available as a tablet (Dolophine) and oral concentrate (Methadose).
Naltrexone
Naltrexone is used during medication-assisted treatment for both opioid addiction and alcohol addiction. It blocks the mu-opioid receptors and to a lesser extent the kappa and delta opioid receptors in the brain. By doing this, naltrexone blocks the effects of opioid drugs such that people with an opioid dependence don’t feel the euphoric effects of these drugs. This helps to reduce cravings and prevent relapse.
When it is used to treat alcohol use disorder, naltrexone blocks the rewarding effects of alcohol and makes it less pleasurable to drink. This prevents intoxication in people with alcohol dependence. Naltrexone therefore helps people with an alcohol addiction cut down on drinking and stop drinking altogether over time.
Naltrexone is available as an extended-release suspension for intramuscular injection (Vivitrol).
Acamprosate
Acamprosate helps to reduce alcohol cravings and maintain abstinence from drinking. It interacts with NMDA receptors in the brain. These receptors play an important role in the development of alcohol dependence. Acamprosate also helps to balance excitatory and inhibitory neurotransmitters in the brain, which reduces the distress associated with withdrawal. Alcohol use does not impact how acamprosate works, so you can take it even if you are currently still drinking. This MAT medication can be used even in people with hepatitis or liver disease because it is not metabolized by the liver.
Disulfiram
Disulfiram is an alcohol-sensitizing drug. It is used to decrease alcohol consumption in people with an alcohol addiction. Disulfiram works by blocking the effects of a liver enzyme called acetaldehyde dehydrogenase which the body uses to process alcohol. If you drink alcohol after taking disulfiram, you experience unpleasant effects such as flushing, sweating, headache, nausea, vomiting, weakness, confusion, blurred vision, and anxiety. These hangover-like effects are due to an increased concentration of acetaldehyde in your body. In this way, disulfiram prevents alcohol consumption by causing unpleasant effects.
Which MAT medication is right for me?
At Discovery Recovery, we perform a thorough evaluation during the induction phase of opioid treatment programs to identify the best MAT medication for you.
Buprenorphine is very effective during MAT in harm reduction and relapse prevention. It can be initiated and maintained easily and carries a low risk for overdose. However, it needs to be started after you reach a state of moderate withdrawal.
Methadone is currently considered the gold standard in MAT for opioid dependence. It can be started at any stage of withdrawal. However, titrating the dose to an effective dose is a lengthy process. Methadone can only be administered at specialty clinics.
Naltrexone can help to lower the risk of relapse and improve the quality of life of people in recovery. However, you must be opioid-free for 7–14 days before starting this MAT medication.
Challenges in accessing medication-assisted treatment
Medication-assisted treatment has proven success during alcohol and opioid treatment programs. However, there are some challenges in accessing MAT, including:
Lack of awareness
Many people are unaware of the benefits of medication-assisted treatment or hold misconceptions about its effectiveness. Some people are leery of treating an addiction with medications and think of it as replacing one addiction with another. This lack of awareness can result in missed opportunities for people to receive effective treatment for their addiction.
Limited availability
Medication-assisted treatment is a specialized treatment protocol that can only be offered by trained healthcare providers who are authorized to prescribe and dispense medications like buprenorphine and methadone. Therefore, MAT may not be readily available everywhere, particularly in rural, remote, and underserved communities.
Transportation and logistics
Accessing MAT often requires frequent long-distance travel, particularly for people residing in rural areas with limited healthcare resources. These logistical barriers can prevent people with substance use disorders from attending appointments or obtaining their medication refills on time.
Stigma
There is a significant degree of stigma surrounding addiction and MAT. Despite the proven effectiveness of MAT in promoting addiction recovery, some people feel ashamed or judged for using medications to manage their addiction. This can sometimes prevent people from seeking addiction treatment.
Insurance coverage
Medication-assisted treatment and integrated behavioral therapies and psychosocial support can cost hundreds of dollars a month. Without insurance coverage, affording the treatment can be a barrier to seeking opioid addiction treatment for many people. Some insurance plans cover MAT while others have limited coverage or high copays for MAT medications.
Regulatory hurdles
There are regulations and restrictions on prescribing and dispensing medications such as buprenorphine and methadone that are used in MAT. Healthcare providers need to undergo special training and sign waivers to prescribe certain medications. The lack of availability of qualified prescribers can be an impediment in accessing medication-assisted treatment for some individuals.
Complex treatment process
Medication-assisted treatment is a complex treatment process that involves the use of medications in combination with counseling, behavioral therapies, and other support services. Coordinating these services and creating individualized treatment plans can be challenging for healthcare providers. Some people in addiction treatment find MAT difficult to adhere to, which prevents them from obtaining the benefits of this treatment modality.
How effective is medication assisted treatment for addiction?
Studies have shown that patients who receive medication-assisted treatment during addiction recovery use less opioids and alcohol and experience improved health, reduced disability, and reduced symptoms such as pain, depression, and anxiety. Just 6 months of medication-assisted treatment for opioid use disorder can help in improving treatment retention and health outcomes. Some studies have shown that 60% of patients receiving buprenorphine or methadone remain opioid-free compared to 20% with no treatment or placebo.
Enhancing recovery through comprehensive care: Integrating MAT with counseling and behavioral therapies
A comprehensive addiction treatment plan that integrates medication-assisted treatment (MAT) with counseling and behavioral therapies is the best approach during addiction treatment. This treatment approach collectively addresses the various complex aspects of a substance use disorder. It combines medications that reduce cravings and withdrawal symptoms with evidence-based counseling and behavioral therapies that help to build resilience. In this way, it addresses the underlying psychological factors that contribute to addiction, while keeping you as comfortable as possible while you overcome your substance use disorder. An integrated MAT and behavioral therapies approach therefore addresses both the physical and psychological factors that play a crucial role in long-term recovery success. It gives you all the support you need to develop coping strategies and build the life skills you need for a sustained recovery.
Discovery Recovery’s Approach to MAT
At Discover Recovery Treatment Center, we offer one of the most successful MAT programs in Oregon and Washington. There are three levels of care in four separate programs, including medical detoxification, residential, young adult, and aftercare programs. Our highly experienced team of healthcare professionals can induct, stabilize, and maintain you on FDA-approved medications to lower your physical and psychological dependence on drugs or alcohol. Our residential program includes a structured routine, daily therapy sessions, and the medications you need to maintain sobriety. We offer continued support through your aftercare program, including medication-assisted treatment, if needed, to reinforce abstinence as you continue your recovery and resume your normal life at home.
