How Does Medication-Assisted Treatment Work?
Medication-assisted treatment (MAT) is the process of helping a person break their physical dependence on certain drugs or alcohol, if the person’s consumption of those drugs or alcohol was excessive to the point of harming themselves and lowering the quality of their life.
Cutting off the compulsive consumption of addictive substances, without a proper plan to wind down their use, can cause a number of physical and psychological problems. Medication-Assisted Treatment is the use of prescribed medications to give patients a better chance of reaching their goal of abstinence and sobriety while mitigating the symptoms of withdrawal.
In cases of severe alcohol use disorder, going cold turkey can be fatal, so doctors will often encourage people to sign up for a Medication-Assisted Treatment program to ensure that quitting drinking can be carried out as safely as possible.
Is Medication-Assisted Treatment Based in Research?
There is a lot of research to show that Medication-Assisted Treatment is backed by evidence. The longer the treatment (starting with a MAT program, continuing with therapy and counseling, and then maintaining the work with aftercare support), the better the chance of lasting, even lifelong, sobriety.
Experts say a combination of medication and therapy can successfully treat substance use disorders, including both alcohol and opioid use disorders. For some, those medications can help to sustain life-long recovery. Medications and therapy can also help lower a person’s risk of contracting HIV or hepatitis C.
There has occasionally been pushback from some recovery advocates about the methodology of medication-assisted treatment because of the practice of using drugs (albeit prescribed) to wean a patient off their unhealthy consumption of more dangerous substances. Advocates call for an abstinence-only approach, feeling that using drugs to get off drug/alcohol use defeats the purpose of sobriety.
What Is the Effectiveness of This Treatment?
The effectiveness of Medication-Assisted Treatment is supported by many doctors. STAT News writes that doctors would rather patients be on a drug “that allows you to go back to work […] and to live normally again,” compared to “a dangerous [drug] that will kill you.”
STAT News continues that data has shown that Medication-Assisted Treatment is effective for the general population, but each patient will need different drugs, at different doses. There is no one-size-fits-all approach.
The overwhelming message from the medical community is that “the data […] clearly shows better outcomes with medication-assisted therapy than without it,” in the words of Dr. Nora Volkow, director of the National Institute on Drug Abuse. Study after study, according to Dr. Volkow, has backed that outcomes for patients are significantly better when they transition from substance abuse to MAT. Reasons include a significantly lower risk of relapse, preventing infectious diseases like HIV, and preventing overdoses.
MAT for Opioid Use Disorder
Medication-assisted treatment is also used in the treatment of opioid use disorder. Effectively—but controversially—doctors use less potent opioids to help patients wean off their compulsive use of stronger opioids, whether prescribed ones like OxyContin, recreational ones like heroin, or even other opioids that were prescribed to wean off stronger opioids, like methadone.
The therapeutic opioids share the same chemical process as the opioids of abuse, but the therapeutic opioids have a much slower mechanism of action. They are absorbed into the bloodstream over a longer period of time, keeping withdrawal symptoms under control and disconnecting the act of consuming opioids with the immediate high that many users seek out.
This is because the opioids used in medication-assisted treatment are typically slow-acting partial opioid agonists, and not full opioid agonists. As the drugs only partially activate the regions of the brain that are stimulated, people feel a very reduced degree of pleasure from the consumption, which doctors use to gradually lower the baseline of administration until it is negligible enough to conclude treatment.
Drugs Used in MAT for Opioid Use Disorder
Buprenorphine and methadone are the primary medications used for opioid use disorder.
Methadone alleviates the worst withdrawal symptoms and reduces cravings for stronger opioids. Patients will not feel any euphoria when consuming methadone as prescribed. However, methadone is still a full opioid agonist, so those with an untreated dependence on opioids might come to experience a psychological need for methadone. If this is the case, another medication-assisted treatment drug should be used, and the patient should continue to receive therapy and counseling to help them break their psychological need for methadone. This is one reason why some treatment advocates are skeptical about the use of methadone (and other drugs) in drug recovery.
Buprenorphine is a partial opioid agonist that is sometimes administered with naloxone (an opioid antagonist, a medication that completely blocks opioids from reaching the brain). Naloxone can induce immediate withdrawal symptoms, so it is combined with buprenorphine to mitigate the effects of that immediate withdrawal.
MAT for Alcohol Use Disorder
While most people associate MAT with opioids, that’s not the only substance doctors can treat pharmaceutically. People with alcohol use disorder (AUD) may also benefit from an MAT program.
MAT therapies for AUD are varied. The following three options are FDA approved for people struggling with alcohol:
- Acamprosate: This medication works by amending brain chemistry imbalances that lead to alcohol cravings. It’s designed for people who have already been through alcohol detox.
- Naltrexone: This medication blocks receptors that make alcohol rewarding. When people drink on this medication, they feel nothing and may be less likely to do so again.
- Disulfiram: This medication causes severe unpleasant side effects when alcohol enters the body. One of these episodes can be so traumatic that people are unlikely to drink again. It’s made for people who have completed an alcohol detox program.
Researchers say MAT is effective for AUD, but it’s not used often. This therapy could be especially helpful for people with alcohol problems complicated by underlying mental illnesses.
MAT Medication Options
At the beginning of any treatment program, your doctor will determine the best medications for you and your addiction. This comparison table can help you understand the pros and cons of each choice:
|Potential Side Effects
|Designed for at-home use; available in multiple formats; eases cravings and withdrawal symptoms
|Headache, nausea, vomiting, and constipation
|Strong therapy that may benefit people who don’t get relief from buprenorphine; eases cravings and withdrawal symptoms
|Lightheadedness, dizziness, sedation, nausea, and vomiting
|OUD and AUD
|Non-addictive therapy that blocks the effect of alcohol and opioids; eases cravings
|Dizziness, aching, diarrhea, and headaches
|Eases alcohol cravings
|Dry mouth, diarrhea, insomnia, and abdominal pain
|Causes severe reactions when users drink alcohol
|Headache, confusion, nausea, and drowsiness
Backed by Data
Notwithstanding concerns that Medication-Assisted Treatment is merely “swapping one drug for another,” it is still considered the “gold standard” of drug treatment and rehabilitation by many in the scientific community. It is a careful, research-backed, and evidence-based approach to help people overcome their physical need for opioids or alcohol. MAT prepares people for psychological counseling and therapy to continue their recovery.
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