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Medication-assisted treatment (MAT) has assumed a greater role in substance abuse recovery programs over the years. If you or a loved one is struggling with addiction, you may have heard about this treatment option. While MAT is mostly used in cases of opioid addiction, it can also be effective for people with alcohol use disorders
When individuals are addicted to substances, they often experience strong cravings and painful withdrawal symptoms when they stop using or reduce their usage. This can make it very difficult for them to quit. Behavioral therapies can help individuals to achieve and maintain sobriety but in many cases, they need additional support.
There are Food and Drug Administration-approved medications that help to normalize brain chemistry and body functions, reduce cravings, and prevent alcohol and opioids from causing euphoria.
Studies show that these drugs can improve treatment outcomes significantly while reducing the need for inpatient detoxification. In this article, we’ll take a closer look at, alcohol, opiates, opioids, and medication assistance.
Opioid use disorder is a chronic disease caused by the repeated use of prescription opioids or illegal substances. It affects the brain’s reward system as well as the parts of the brain that affect motivation and memory. Individuals who have an opioid use disorder can go into remission but they can’t be cured.
Medication-assisted treatment combines counseling, cognitive behavioral therapy, and other non-drug therapies to treat opioid use disorder. Each of the approved drugs works in a different way to reduce symptoms of opioid withdrawal and/or prevent opioids from having a euphoric effect.
This type of treatment is supported by multiple medical and behavioral health bodies including the National Council for Behavioral Health and the American Society of Addiction Medicine.
There are three medications approved by the FDA to treat opioid use disorders: methadone, buprenorphine, and naltrexone. They can be used to help individuals transition patients off prescription opioids such as morphine, hydrocodone, and oxycodone, as well as illicit substances such as heroin and fentanyl.
Methadone is a full opioid agonist. It binds fully to the mu-opioid receptor, blocks the euphoric effects of other opioids, and relieves the symptoms of opiate withdrawal. What makes methadone different from heroin and other commonly abused opioid agonists is that it is long-acting. Methadone is one of the oldest ways to get off illegal opiates, but maintains its efficacy for many people and is preferable (by far) to active addiction and constant search for your next high. That being said, there are some drawbacks to methadone.
The effects last for 24 to 36 hours so the individual doesn’t experience the peaks and valleys that can lead to constant drug-seeking. Patients who are put on methadone maintenance treatment usually take this medication for at least 12 months.
Buprenorphine is a partial opioid agonist. This means it doesn’t completely bind to the mu-opioid receptor. Therefore, buprenorphine’s effects plateau at a certain point, and taking additional or larger doses will not produce a rush of euphoria. Buprenorphine also doesn’t cause breathing difficulties even when taken in high doses.
There’s no set time for which a person should remain on buprenorphine. The patient’s treatment team decides when to discontinue treatment depending on the individual’s progress. Once that decision is made, it can take months for the dosage to be gradually tapered off.
Buprenorphine is frequently combined with naloxone to create a medication that’s often referred to as Suboxone but it is also available in generic formulations. It comes in the form of a sublingual film.
Naloxone is a strong opioid antagonist that is added to buprenorphine to discourage people from injecting the drug. If Suboxone is used in a way that’s not intended, the naloxone can quickly cause withdrawal symptoms. These may include such as nausea and vomiting, dizziness, low blood pressure, drowsiness, profuse sweating, and memory loss.
In contrast to methadone and buprenorphine, naltrexone is an opioid antagonist. This means it blocks the mu-opioid receptor instead of activating it. In doing so, it prevents opioids from having effects if they’re used.
Opioid antagonists don’t cause euphoria so users can’t become physically dependent on them. Naltrexone is used for relapse prevention and as a part of abstinence-based treatment. It isn’t used for the management of withdrawal symptoms.
These three medications are used in different settings. Methadone is highly regulated so it can only be given out by licensed facilities. It is typically given to patients on a daily basis and a professional observed them as they use it. However, since 2020, some patients have been allowed to self-administer at home.
In contrast, buprenorphine can be prescribed by certain doctors and taken at home since it is seen as safer. Patients typically get a supply that lasts two to four weeks. Meanwhile, when naltrexone is used to treat an opioid use disorder, it is in the form of an extended-release injectable that has to be administered by a medical practitioner every four weeks.
Medication-assisted treatment offers a wide range of benefits. It s:
MAT can also:
Using MAT as a bridge to sobriety is also highly recommended because it eases the transition to regular life. People who participate in residential treatment often become accustomed to a high degree of structure and lots of professional support. When they return to society, the lingering physical and emotional changes can make it hard for them to remain sober. MAT can act as a bridge between inpatient treatment and life in the community. Since individuals don’t have an urge to use opioids, they can focus on doing what they need to do to maintain their sobriety.
For people who are struggling to control their use of alcohol, the most commonly used medications are acamprosate, disulfiram, and naltrexone.
Also known by the brand name Campral, acamprosate helps to reduce the brain’s dependence on alcohol. Like other addictive substances, alcohol changes the chemistry and functioning of the brain. The longer an individual continues to abuse alcohol, the more severe these changes become. When the person stops drinking, the brain struggles to function, and the individual experiences strong cravings and often painful withdrawal symptoms.
The way acamprosate works is not fully understood. However, it helps to normalize brain activity after a person stops drinking. It also reduces anxiety, insomnia, and restlessness. Unlike the other medications used to treat alcoholism, acamprosate is broken down in the digestive tract rather than the liver. This means it can be used to treat people suffering from liver damage caused by their alcohol use.
Acamprosate doesn’t treat or prevent withdrawal symptoms. Instead, it is used to help individuals maintain sobriety when they stop drinking. It may not be as effective in people who have not gone through detoxification or quit drinking completely. It is also unlikely to help people who abuse drugs. Acamprosate must be used in conjunction with counseling or behavioral therapy.
Disulfiram causes individuals to experience highly unpleasant side effects when they drink. It does so by blocking an enzyme that assists in metabolizing alcohol. People who drink while taking disulfiram experience palpitations, nausea and vomiting, and flushing. The knowledge that this is likely to occur acts as a deterrent.
If a person drinks a lot, the effects may be more severe. They may experience respiratory depression, arrhythmias, convulsions, myocardial infarction, unconsciousness, acute congestive heart failure, and even death. People who are prescribed disulfiram have usually completed withdrawal through medical detox, are moving to the next level of care and are committed to abstinence.
Naltrexone was originally designed to treat opioid addiction. However, the brain reacts to alcohol in much the same way as it does with opioids. Naltrexone was subsequently proven to be helpful for people who are addicted to alcohol.
No matter how it is administered, the drug prevents anyone from experiencing pleasure when they drink. Since alcohol no longer activates the reward center of the brain, people who take naltrexone are less likely to continue drinking.
It is important to note that naltrexone doesn’t reduce cravings or withdrawal symptoms. Therefore, it is most effective when used along with other medications, counseling, 12-step programs, and other interventions. Unlike disulfiram, naltrexone doesn’t interact negatively with alcohol. However, it is best suited to individuals who have stopped drinking and completed detox.
In inpatient settings, naltrexone is prescribed for short periods. However, studies show that is most effective when used for three months or more. In some cases, individuals take it indefinitely.
Regardless of which drugs are used to treat an individual’s alcohol or opioid use disorder, they also need to undergo psychosocial or behavioral therapies. These treatments can take the form of:
These interventions are designed to help patients modify thoughts and behaviors that caused them to abuse alcohol or opioids in the first place. They also help them to develop new coping mechanisms to avoid relapses. Behavioral therapies can also be used to help treat co-occurring mental health disorders.
Despite all the support medication-assisted treatment gets, there are criticisms, and critics of MAT programs say medications are given too much prominence. Some are concerned that the focus has shifted too far from traditional abstinence-based treatment with individuals staying on MAT drugs for several years. This, they say, is simply substituting one drug for another.
Meanwhile, proponents of MAT sometimes see abstinence-based treatment as being outdated. They argue that short-term studies show the effectiveness of MAT and stress that it improved the quality of life of participants. Both approaches have merit since each individual has unique needs.
Like any other treatment approach, MAT involves some risk. For example, methadone and buprenorphine can be abused and depending on how they are administered, they can get people high and lead to addiction.
Also, withdrawing from these drugs can be severe so they need to be carefully tapered off. It is also not unheard of for people to continue using heroin or other opioids while on these medications. However, research shows that their usage is typically significantly reduced.
Many experts agree that MAT improves long-term recovery chances. However, people who are struggling with opioid addiction often do not know where to turn for help. It can be difficult to know which facility is best for your needs and where you can find a program that will truly work for you.
At Rehabs Of Armerica, we aim to make it easy for individuals and their loved ones to access the care they require and deserve. We can assist you in identifying treatment centers across the country that can cater to your unique needs and preferences. We may even be able to arrange same-day admission. All you need to do is fill out the contact form or call us at 877-790-6751 any time of the day or night.
Edward lives and works in South Florida and has been a part of its recovery community for many years. With a B.A. in English Literature from the University of Massachusetts, he works to help Find Addiction Rehabs as both a writer and marketer. Edward loves to share his passion for the field through writing about addiction topics, effective treatment for addiction, and behavioral health as a whole. Alongside personal experience, Edward has deep connections to the mental health treatment industry, having worked as a medical office manager for a psychiatric consortium for many years.
