The way that drug and alcohol abuse are treated in South Florida is rapidly changing. For many years, the conventional model of treatment — which promotes strict abstinence while people learn the skills that help keep them sober — was the only one available to people looking for help with substance abuse.
However, over the last two decades, many rehab centers have been able to incorporate helpful medications into treatment drug and alcohol addiction successfully. These medicine-assisted treatment options are now becoming increasingly utilized, and more importantly, increasingly effective at keeping people in treatment longer, preventing overdose deaths and reducing the damaging consequences of drug and alcohol abuse.
What Is Medication-Assisted Treatment?
It’s important to understand the medication-assisted treatment definition. Medication-assisted treatment, or MAT, is the supervised administration of prescribed medications which help reduce physical symptoms of addiction, decrease cravings or prevent withdrawal symptoms.
Most often, MAT is used to aid people who are in treatment for alcohol addiction or opioid addiction.
However, MAT is not meant to take the place of the critically important role of 12-step based programs, psychotherapy and relapse prevention work. As the name suggests, MAT is meant to support the primary psychological treatment and counseling work, rather than replace it. Without counseling support, MAT cannot be fully effective.
Medication-Assisted Treatment for Drug Abuse
The United States Food and Drug Administration (FDA) has approved medications for the treatment of opioid use disorders. These medications can help decrease the intrusive, overwhelming cravings that can affect a person in recovery and redirect their behaviors.
Some of the medications used in MAT are also used to address physical withdrawal symptoms during medical detox. The medications methadone, naltrexone and buprenorphine (including combination buprenorphine and naloxone products like Suboxone) are all approved as medication-assisted treatment for opioid abuse.
Under the guidance of an experienced medical team, taking these medications while attending 12-step groups, therapy sessions, process groups and other treatments can enhance a person’s stability during a vulnerable time as they begin recovery.
Medication-Assisted Treatment for Alcohol Abuse
The FDA has also approved medications to assist in the treatment of alcohol use disorders. The medications disulfiram, acamprosate and naltrexone (including the injectable naltrexone product Vivitrol) are all approved as MAT measures for alcohol use disorders.
Unlike the medication-assisted treatment for opioid abuse, FDA-approved medication-assisted treatment for alcohol use disorders is different than the medications used to treat physical withdrawal symptoms. However, medications used in MAT for both alcohol and opioid use disorders serve the same purpose: to help people in recovery achieve enough stability that their treatment and recovery efforts last longer, are more efficient and are more effective.
Medications Used in Medication-Assisted Treatment
Popularly known by its brand name Antabuse, this medication is approved to treat alcohol use disorders. Disulfiram works by blocking an enzyme in the body to create negative side effects from drinking alcohol. Though it is effective when taken, it must be taken daily, and thus treatment adherence can be a problem.
Naltrexone is approved to treat both alcohol use disorders and opioid use disorders. It works by directly opposing the effects of opioids at the primary opioid receptor in the body. Although it is not an opioid, alcohol also acts on the body’s opioid receptors.
Naltrexone is currently the only medication approved to treat opioid use disorders that is not an opioid. Naltrexone can reduce cravings and has been shown to reduce days of heavy drinking or opioid abuse. The major drawbacks with this medication are treatment adherence and the required seven day period of abstinence from opioids. The abstinence period is required so that the medication does not induce opioid withdrawal.
Vivitrol is a brand-name, injectable form of naltrexone that is effective for about one month before a new injection is required. It is also approved by the FDA to treat alcohol use disorders and opioid use disorders.
Vivitrol is a long-acting injection and addresses the drawback with naltrexone in treatment adherence, but it still requires a seven-day period of abstinence from all opioids to avoid inducing withdrawal.
Along with probuphine, Vivitrol is among the more expensive options for MAT. Vivitrol does not need an abstinence period from alcohol to be effective.
Also known by its brand name Campral, acamprosate is approved for the treatment of alcohol use disorders. The way acamprosate works is unclear, but it likely helps to resensitize the body to the neurotransmitter gamma-Aminobutyric acid (GABA) after excessive alcohol consumption has desensitized the body to it.
Buprenorphine is a partial opioid activator that is FDA-approved to treat opioid use disorders. Its partial activator status puts a ceiling on its opioid effect. It is available under several different brand names.
Buprenorphine can be combined with naloxone, creating the medication Suboxone (among other brand names). Naloxone helps dissuade injection or inhalation of buprenorphine by neutralizing the effects of buprenorphine when it is taken in either of these two ways.
Except for probuphine (a buprenorphine skin implant), most buprenorphine medication must be taken under the tongue or in the cheek. For all forms of buprenorphine, a patient must be in at least mild withdrawal before taking it.
Methadone is a full opioid activator that has long been FDA-approved to treat opioid use disorders. Like buprenorphine, it is often used to treat opioid withdrawal symptoms, and is now considered as a potential for treatment even beyond withdrawal. Methadone, as a full opioid, has potential for overdose, and it must be prescribed for the treatment of opioid use disorders in a federally licensed treatment center.
Success Rates of Medication-Assisted Treatment
Public interest in MAT has grown sharply since the Centers for Disease Control and Prevention and other researchers published data showing that opioid-related overdoses had quadrupled between 1999 and 2010, and that an opioid crisis was emerging.
This renewed public interest coincided with the growing acceptance of vastly underutilized medications to help treat substance use disorders. Studies showed that certain medications could make a meaningful contribution to rehab treatment.
In general, medication-assisted treatment success rates are higher than those of conventional treatment; MAT also appears to decrease the chance of a fatal opioid overdose by at least 50 percent.
Medication-Assisted Treatment Statistics in America
The medication-assisted treatment statistics below highlight important features of substance use disorders. The sheer number of opioid-related overdose deaths demand that the most effective treatment be utilized, and that while the numbers of facilities offering MAT is increasing, the number is still less than 50 percent of all facilities offering substance abuse treatment.
- 70,237 people died from a drug overdose death
- 47,600 people died from an opioid overdose in 2017
- 13,492 substance abuse treatment facilities exist in America as of April 2019
- 5,940 American rehab facilities offer medication-assisted treatment as of April 2019
Medication-Assisted Treatment Program: What to Expect
When entering a MAT program, an initial evaluation is performed by a physician or other medical professional. In this assessment, a series of screening and diagnostic questions can be asked so that a substance use disorder can be identified. This evaluation also identifies co-occurring disorders that may need consideration during treatment. This information will help the clinical team know if the client will be a good candidate for MAT.
It is important to know that medication alone does not treat substance use disorder. Medical experts agree that full treatment of a substance use disorder uses evidence-based psychosocial therapy, education, development of relapse prevention strategies and medication when appropriate.
Once an MAT plan is established (if applicable), how long it continues depends on the individual client, the prescriber and the treatment team. There is no predetermined length of time for MAT, but doses are often decreased after healthy routines are established and emotional sobriety takes root.
If you have been struggling with alcohol or opioid addiction and would like to consider medication-assisted treatment, you have options for rehab. We can help guide you through the process. Call one of our representatives today to get started on your journey to recovery.
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Substance Abuse and Mental Health Administration. “Medication-Assisted Treatment (MAT).” Updated in 2019. Accessed April 25, 2019.
Centers for Disease Control and Prevention. “Opioid Overdose.” Last updated in 2018. Accessed April 25, 2019.
Volkow, N. et al. “Medication-assisted therapies–tackling the opioid-overdose epidemic.” New England Journal of Medicine, 2014. Accessed April 25, 2019.
American Society of Addiction Medicine. “The ASAM National Practice Guidelines Supplement.” Published in 2015. Accessed April 25, 2019.
The AMFAR Foundation for AIDS Research. “Opioid and Health Indicators Database.” (n.d.). Accessed April 25, 2019.