How Long Does Someone Stay on Medication-Assisted Treatment?
People may remain on Medication-Assisted Treatment for months or years, depending on their specific needs.
When determining how long a person should stay on Medication-Assisted Treatment (MAT), doctors will consider the degree of the physical and psychological dependence on alcohol or opioids, what MAT drugs are being prescribed and their doses, how the person reacts to them, and whether the person can develop a reliable support system in aftercare.
Drugs Used in Medication-Assisted Treatment
There are many different types of medications that have been approved by the Food and Drug Administration for the purposes of Medication-Assisted Treatment — specifically, for the treatment of alcohol use disorder and opioid use disorder. The drugs are intended to assist the detoxification process by alleviating withdrawal symptoms and cravings for more alcohol or opioids, and preparing them for psychological counseling and therapy to help them with their long-term rehabilitation.
For alcohol use disorder, acamprosate, disulfiram, and naltrexone are used.
For opioid use disorder, buprenorphine, methadone, and naltrexone are used. They are best used to treat a dependence on short-acting full opioid agonists, like heroin, codeine, and fentanyl, as well as prescription semi-synthetic opioids like hydrocodone and oxycodone. Depending on the degree of dependence, these medications are safe to use for months to an entire lifetime. Their use must be supervised by a doctor because they can become sources of addiction in and of themselves.
How Long Should Medication-Assisted Treatment Last?
In general terms, the longer someone stays on their Medication-Assisted Treatment program, the better their outcome. For methadone, for example, doctors recommend a 12-month program to maximize its benefits.
Medication-Assisted Treatment comes to an end when alcohol or opioids have not been consumed for an extended, significant time; the person reports substantially diminished cravings for alcohol or opioids; and doctors are satisfied that the person has enough community support to help them once they are discharged from formal treatment.
How can the progress and effectiveness of MAT be tracked? Doctors look for signs that the person’s health and quality of life have improved since the program began. As cravings for alcohol or opioids subside, and the person has the energy and wherewithal to pursue healthier interests, this kind of behavior will provide valuable benchmarks to determine that MAT is working and can potentially be discontinued if progress is maintained.
Doctors will also note that the person’s overall health improves. They may become physically fitter, display less anxiety and agitation, and get better and healthier sleep. Relationships might get restored, hobbies might develop, and there may be other signs that the person is no longer psychologically dependent on alcohol or opioids for validation and comfort.
Other milestones to indicate the progression (or lack thereof) of MAT include whether the person is able to hold down a steady job or resume their academic ventures.
Is It Safe to Stop MAT?
Some people may feel they have a handle on their rehabilitation and want to discontinue their Medication-Assisted Treatment. However, stopping MAT without a proper plan is very dangerous. It is safest to discuss a program for winding down MAT treatment with a doctor. Cutting off the medications suddenly can cause intense withdrawal symptoms, which might precipitate a relapse.
If a doctor concurs that MAT can be discontinued, the treatment will be gradually tapered off, with the patient being carefully monitored for any signs of withdrawal or signs that they are struggling to maintain their sobriety without Medication-Assisted Treatment.
The key to stopping MAT is to let the body gradually adjust to the medication’s lower doses, without overpowering side effects. How long that might take will depend on the medication, the dosage, the degree of psychological dependence that is being treated, and if that patient has a good support system to help them through the transition. Some people might adjust quite naturally, which indicates that their MAT time is drawing to a close. Others will have a harder time dealing with the discontinuation of their medication, which could mean they are not yet ready to stop MAT.
How MAT Can Work With 12-Step Programs
Medication-Assisted Treatment (buprenorphine, methadone) is an accepted and medically established form of treatment for opioid use disorder. However, some schools of thought in the recovery community disagree and feel that participation in 12-step programs like Narcotics Anonymous is off-limits while a person is on any kind of opioid therapy.
Most 12-step programs require total abstinence as a condition for membership. This has caused some conflict with treatment and rehabilitation centers that use MAT and also encourage participants to connect with 12-step groups for ongoing aftercare.
A 2015 study published in the Journal of Substance Abuse Treatment found that “referring patients in buprenorphine treatment to attend Narcotics Anonymous or other 12-step meetings does not have a detrimental impact on treatment outcomes.” In fact, it greatly increases the likelihood that people exiting formal treatment and re-entering normal life will have a much better chance of maintaining their long-term sobriety than those who do not follow that path.
This has led some people in the medical community to call on the moderators of 12-step programs to allow MAT patients to join, opining that most of the skepticism about MAT is based in the myth that such treatments merely swap out one drug for another.
However, since most 12-step programs are not regulated and autonomous, there is no consensus among the wider NA (or Alcoholics Anonymous) community that being on Medication-Assisted Treatment is not a barrier for entry. While some programs may have no objection to MAT patients joining, others may place restrictions on their participation.
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Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. Substance Abuse and Mental Health Services Administration.
Medication-Assisted Treatment of Opioid Use Disorder. (March/April 2015). Harvard Review of Psychiatry.
Methadone Maintenance Treatment. (2009). World Health Organization.
Withdrawal From Methadone Maintenance Treatment. (2002). European Addiction Research.
Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes. (October 2015). Journal of Substance Abuse Treatment.
By Shunning Medication-Assisted Therapy, 12-step Meetings Are Making the Opioid Crisis Worse. (October 2017). STAT.