Medication Assisted Treatment

Medication-assisted treatment (MAT) is one of the many pathways individuals can take to recover from addiction. Because addiction is a complex disease that begins in the brain, some individuals need medication to help re-stabilize the brain in order to fully recover from addiction challenges. Medication-assisted treatment can help provide the medication they need to start rehabilitating their life.

As research continues to prove the effectiveness of medication-assisted treatment, an increasing number of people have become interested in this pathway to recovery and more professional treatment centers have started including MAT as a viable recovery option. As you learn more about medication-assisted treatment, you can decide if this type of treatment might be the right fit for you or a loved one looking to maintain long-term recovery from addiction challenges.

What Is Medication-Assisted Treatment?

Medication-assisted treatment is an addiction recovery process that combines medication, counseling, and behavioral therapy to help treat alcohol and opioid use disorders. Despite its name, medication-assisted therapy seeks to provide a “whole-person” approach to treating substance use disorders that doesn’t rely solely on pharmaceutical drugs. Since addiction can interfere with every aspect of life, effective treatment needs to address the entirety of a person's needs, not just their drug use. Typically, this includes an individual’s medical, psychological, social, and vocational needs.

As a whole-person approach to recovery, medication-assisted treatment focuses on treating the:

• Mind through FDA-approved medications that help stabilize the brain and therapy to change behavior. The medication portion of MAT is designed to normalize brain chemistry and reduce cravings. The behavioral therapy component of MAT works to help individuals determine what led them to use substances in the first place.
• Body. As medications help stabilize the brain’s reward system, individuals can focus on restoring their physical health.
• Spirit. Counseling works to help individuals rebuild their spirit by improving their communication and interpersonal skills. Working with a counselor can also help individuals better manage their emotions and find relief from depression, anxiety, and other mental health challenges, which in turn can help improve their self-acceptance and boost their self-esteem.

Because of this “whole-person” approach, medication-assisted treatment can help individuals not only overcome addiction but sustain long-term recovery as well.

The History of Medication-Assisted Treatment

Even though medication-assisted treatment has recently gained popularity, the concept of using medication to help prevent relapse isn’t new.

Unfortunately, early attempts did not meet our modern medical standards. In 1929, the US Congress appropriated funds to establish treatment facilities called “narcotic farms” in Fort Worth, Texas, and Lexington, Kentucky. Later, the Lexington facility was renamed the U.S. Public Health Service Narcotics Hospital. These institutions detoxified individuals who were addicted to opioids. After they were free of opioids, the individuals stayed at the facility for about 6 months. During that time, these hospitals offered social, medical, psychological, and psychiatric services to individuals in recovery. Unfortunately, these hospital-like farms were prison-like and punitive.

After World War II, rates of heroin addiction rose. In 1952, the Riverside Hospital for adolescents with addiction disorders opened its doors in New York City. The hospital used the medicines and psychological treatment popular at the time to help cure addiction. Unfortunately, an estimated 86 percent of the individuals admitted in 1955 relapsed and the facility closed in 1961. Despite well-intentioned leadership, the hospital hadn’t been able to design effective treatment programs for addiction.

Almost a decade later, hospitals started to dispense drugs in a controlled manner to help patients addicted to illicit opioids. The Kennedy Administration’s Advisory Commission on Narcotic and Drug Abuse recommended research to determine the effectiveness of this method. The research discovered that methadone was effective when administered orally. Most of the individuals treated with methadone were able to overcome illicit opioid use.

In the early 1980s, the National Institute on Drug Abuse (NIDA) tested naltrexone as a treatment for opioid addiction. Four years later, the Food and Drug Administration (FDA) approved the drug as an effective treatment for opioid use disorder. In 1995, the FDA approved naltrexone as a way to prevent relapse for individuals addicted to alcohol. Two years later, a National Institute of Health panel called for an expansion of medical treatment for substance use disorders. Since then, methadone and other treatments have grown in popularity. Today, medication-assisted treatment has become one of the most effective ways to treat opioid and alcohol use disorders. Despite the medical community’s acceptance of MAT as the gold standard of care for opioid use disorders, there remains much misunderstanding surrounding medication-assisted treatment.

Myths and Facts About Medication-Assisted Treatment

Research consistently shows that medication-assisted treatment can help reduce drug and alcohol use and cravings. Despite evidence of the benefits of MAT, some people continue to make negative assumptions about this method of treatment. Luckily, addressing these myths can help individuals understand the truth behind MAT.

Myth #2: Addiction treatment medications prevent “true recovery.”

• Fact: Addicted individuals cannot function properly because their brains have been “re-wired” by drug use. As the brain becomes accustomed to consistent and increasing drug use, individuals focus their attention on pursuing additional euphoric highs and avoiding painful withdrawal symptoms. Because of this, they have difficulty fulfilling their responsibilities at school, work, or home. They also have trouble maintaining relationships. Recovery provides the ability to perform basic life functions and fulfill responsibilities without using illicit drugs or alcohol.

Individuals stabilized by medication-assisted treatment don’t have to worry about experiencing symptoms of withdrawal. As a result, they don’t live life in pursuit of the next high. Instead, they’re able to function properly and rebuild their lives as part of a true and lasting recovery.

Myth #3: Medication-assisted treatment should not be used long-term.

• Fact: There isn’t a one-size-fits-all duration for medication-assisted treatment. Some people only need MAT for a few months. Others may need medication-assisted treatment for years. If the medication is used as prescribed, individuals can benefit from either short-term or long-term MAT depending on their needs.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends a phased approach to medication-assisted treatment that begins with stabilizing the brain. From there, they recommend moving to medication maintenance and counseling. The third phase, also called ongoing rehabilitation, focuses on determining whether individuals can taper off medication or need long-term medication maintenance. Overall, the length of treatment should be based upon an individual’s specific recovery needs.

Myth #4: Most insurance plans don’t cover medication-assisted treatment.

• Fact: Thanks to the Affordable Care Act, many insurers now cover addiction treatment. Often, that coverage includes medication-assisted treatment. Be sure to read your policy thoroughly because your insurer may have limitations on the total amount of medication they will cover. Even partial coverage can help you purchase addiction medication with a reasonably low co-pay.

Myth #5: Pregnant women can’t receive medication-assisted addiction treatment

• Fact: The American College of Obstetricians and Gynecologists (ACOG) states that medication-assisted treatment is the most effective and recommended treatment for pregnant women with an opioid use disorder. Women can also continue to take certain addiction medications while they breastfeed. According to the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), the benefits of breastfeeding to the baby outweigh the minimal risks of the infant ingesting small amounts of medication.

Myth #6: Quitting drugs and alcohol cold turkey is better than medication-assisted treatment.

• Fact: Withdrawal from opioids and alcohol can be excruciating and life-threatening. Quitting both substances cold turkey can trigger withdrawal symptoms that range from restlessness, insomnia, nausea, and vomiting to tremors and a heightened risk of stroke. Typically, these relentless symptoms make people go to extreme lengths to obtain more drugs or consume more alcohol just to make the pain stop. This behavior, unfortunately, can lead to relapse. Sometimes, these symptoms can even result in hospitalization. For many people, withdrawal is often the first and most difficult hurdle to recovery. Quitting cold turkey can make this step even more difficult.

Quitting substances cold turkey also doesn’t address drug and alcohol cravings. One major aspect of medication-assisted treatment is the satisfaction of the brain’s temporary need for opioids and alcohol, as well as the quieting of ongoing urges to abuse substances. Regulating the brain in this way makes it significantly easier for individuals to abstain from opioids and alcohol.

Myth #7: Medication-assisted treatment was designed for individuals with severe addictions only.

• Fact: There are no addiction severity requirements for medication-assisted treatment. Whether you’ve been living with addiction for a few months or for a few decades, MAT can help you effectively recover from an addiction to opioids or alcohol.

Myth #8: Individuals receiving medication-assisted treatment aren’t sober.

• Fact: Contrary to what you might hear, individuals receiving medication-assisted treatment are still sober. Like addiction, sobriety can look different for everyone. When used correctly, these substances do not cause any of the highs associated with problematic use and compulsive drug-seeking.

Why Is Medication-Assisted Treatment Considered So Effective?

MAT is believed to be particularly effective for opioid and alcohol use disorders because this method of treatment addresses both addiction and dependence. Addiction is a pattern of behavior characterized by compulsive drug or alcohol abuse despite negative consequences. Dependence is an indication of addiction that’s characterized by withdrawal symptoms that occur when individuals quit using drugs or alcohol. Both conditions result from changes in the chemical functions and physical structure of the brain.

Addictive substances hijack the brain’s reward system, which mostly thrives off dopamine, the brain chemical responsible for feelings of pleasure. Dopamine also helps you determine your motivations, pushing you to continue doing things that make you feel good. As the brain “learns” to associate addictive substances with pleasure, the mind becomes rewired to continually seek out substances like opioids and alcohol. Ultimately, the drug-seeking behavior becomes compulsive, which triggers intense cravings.

Once dependent on addictive substances, the brain operates more comfortably when drugs or alcohol are present. Often this causes people to consume more substances in order to feel “normal.” When individuals quit these substances, normal neurotransmitter levels return, temporarily shocking the brain and triggering physical withdrawal symptoms and cravings. Medication helps ease the brain’s temporary shock, allowing individuals time to:

• Relearn healthy ways of thinking and behavior
• Develop healthy coping skills
• Make lifestyle changes that support long-term recovery

Without medications to help ease the recovery process, dependence can linger long after an individual has quit their preferred substance.

What Addictions Does MAT Help Treat?

Even though medication-assisted treatment is primarily used to treat opioid use disorder, this method of treatment can also help individuals recover from alcohol use disorder. The type of medications differs for each disorder, but ultimately, this integrated form of treatment works to:

• Normalize brain chemistry
• Reduce physical cravings
• Block the effects of alcohol and opioids
• Treat withdrawal symptoms

“One way of understanding addiction to opioids is thinking of it as riding a chemical highway, driving a Porsche,” Dr. Josh Hersh, Suboxone Certified Physician Staff Psychiatrist at Miami University Student Counseling Service, said in a Partnership for Drug-Free Kids ebook. “You’re driving erratically miles and miles down this chemical highway, and while you’re driving down the chemical highway you’re making a lot of changes to the brain,” he says. “Your brain, after you’ve traveled months or years down this chemical highway, is very different. Your brain is reliant on opioids and has…lots of changes that are involved in this disease of addiction.”

In order to recover, individuals have to learn to travel the other way. Dr. Hersh then compared medication-assisted treatment to a minivan. “You’re driving safely back, and that takes time. You’ve got to head back slowly and it could take months or even years to get back where you started.”

Medication-Assisted Treatment For Opioid Addiction

Approximately 128 Americans die every day from an opioid overdose. According to the National Survey on Drug Use and Health, 1.6 million Americans had an addiction to opioids and another 438,000 Americans had a heroin use disorder in 2019. Overcoming an addiction to opioids can be difficult, but medication-assisted treatment can help improve the recovery process and increase individuals’ chances of long-term sobriety.

In order to fully understand how medication can help benefit opioid addiction, you need to understand how opioids affect the brain. When consumed, opioids such as oxycodone, heroin, Percocet, and Vicodin attach to opioid receptors in the brain. Opioids then send signals that block pain and promote a feeling of tranquility and calmness.

When misused, opioids flood the brain with dopamine, the “feel-good” chemical that creates a short-lived feeling of euphoria. The brain, which is naturally wired to repeat behaviors associated with pleasure, then craves more opioids. Continued misuse leads to addiction. When addicted individuals stop using opioids, they usually start to feel extremely sick, which is known as withdrawal. The medications used in MAT help to reduce symptoms of withdrawal and cravings for more opioids.

Typically, there are two categories of medication doctors use to help individuals overcome opioid addiction. They are:

• Long-acting opioids. Medications that fall into this category are opioid-based, but unlike fast-acting opioids, they are absorbed into the bloodstream over a long period of time. Because of this, individuals don’t experience as many withdrawal symptoms when recovering from opioid use. Long-acting opioids also help break the brain’s association between taking an opioid and experiencing an immediate high. Without feeling a euphoric high and having to fight against withdrawal symptoms, the brain gradually stops associating opioids with pleasure, which in time, lessens an individual’s desire for the substance.
• Opioid antagonists. An opioid antagonist reverses the effects of opioids by blocking opioid receptors. This type of medication does not produce a euphoric effect or alleviate pain. Because opioid antagonists block the effects of opioids, individuals who relapse and take opioids will not experience a euphoric high or any pain relief. Without being able to experience the high, eventually, the brain’s desire for opioids decreases.

Medication-Assisted Treatment For Alcohol Use Disorder

More than 14 million Americans had an addiction to alcohol in 2019. The World Health Organization estimates that approximately 3 million people around the world die from harmful alcohol use every year. An addiction to alcohol can weaken nearly every organ in the body. In addition, being addicted to alcohol can cause memory loss, seizures, epilepsy, mood changes, heart attacks, high blood pressure, fatty liver disease, and cancer. Nevertheless, because of the overwhelming social acceptance of alcohol, millions of individuals drink recklessly only to later find themselves battling alcohol addiction.

Alcohol triggers the release of dopamine. Known as the “feel-good” chemical, dopamine helps individuals feel happy. Dopamine also plays an important role in learning and motivation. When the brain experiences pleasure, dopamine helps “teach” the brain to repeat activities associated with pleasure. Unfortunately, this function of dopamine unintentionally encourages individuals to continue consuming alcohol.

Alcohol also triggers the brain to release excessive amounts of GABA, a neurotransmitter that calms the body. Unfortunately, GABA also increases the activity of dopamine. When this happens, the brain craves, even more, higher dopamine levels, making individuals want to continue drinking. Eventually, this pattern of behavior leads to alcohol addiction.

Fortunately, the medications used in MAT help:

• Lessen individuals’ desire to drink
• Reduce cravings for alcohol
• Ease some of the discomfort and physical distress individuals experience when they quit drinking

Medications Used to Treat Alcohol Addiction

Just as there are 3 medications used to treat opioid addiction, the FDA has also approved 3 types of medications to help treat alcohol addiction: disulfiram, acamprosate, and naltrexone. None of these medications can be prescribed to people who are still drinking alcohol. These medications can only be used for individuals who have stopped drinking and are trying to maintain their abstinence.

• Disulfiram (or Antabuse) can be administered after detox is complete or when an individual’s blood-alcohol level is zero. This medication works by causing a severe adverse reaction when an individual consumes alcohol. Normally, alcohol in the body converts to acetaldehyde and then to acetic acid. Disulfiram prevents this process and allows acetaldehyde to build up in the body, which causes a toxic reaction. Typically, most people who drink alcohol while taking disulfiram vomit, which helps to deter them from additional drinking. Other adverse reactions can include headaches, nausea, blurred vision, weakness, and a fast heart rate. Disulfiram is most effective for individuals who are highly motivated to stop drinking.
• Naltrexone works by blocking the “high” that people experience when they drink alcohol. When individuals consume naltrexone and drink, they might still experience impairments, but they won’t experience a “high.” This helps to decrease the urge to drink.
• Acamprosate is also known as Campral. This is the most recent medication approved by the FDA. Acamprosate works by normalizing alcohol-related changes in the brain. This medication also helps reduce some of the extended physical, psychological, and emotional distress that comes with alcohol withdrawal. Acamprosate should not be prescribed to individuals with kidney problems.

These medications do not and cannot cure alcohol addiction, but they can help individuals overcome withdrawal, cravings, and relapse which are some of the most common roadblocks to long-term recovery.

What Types of Counseling Are Involved In Medication-Assisted Treatment?

Even though medication can help individuals deal with cravings and withdrawal symptoms, medication alone isn’t an effective way to treat substance use disorders. The most effective way to treat addiction is multifaceted. That’s why all medication-assisted treatment programs are legally required to also include a counseling component.

Different programs offer different types of counseling, but almost all medication-assisted program curriculums include cognitive-behavioral and family therapy.

Cognitive-behavioral therapy (CBT)

CBT focuses on helping individuals understand how their thought patterns affect their emotions, habits, and behaviors. Participating in cognitive behavioral therapy can help individuals identify and change destructive, disturbing, and harmful thought patterns. As they learn how to change negative thoughts into healthier, constructive thoughts, individuals will also likely begin to see positive emotional and behavioral changes in their lives as well.

Family therapy

Family therapy is a form of counseling designed to help individuals address specific issues that have negatively affected the way their family functions. Engaging in family therapy sessions can help individuals rebuild relationships, learn new skills, communicate better, heal family wounds, and set and accomplish goals with their families. Family members are a very important aspect of a successful recovery. Family members can:

• Help individuals stay motivated throughout the recovery process
• Provide transportation to and from treatment
• Offer individuals a safe living space
• Help individuals find a job and healthy activities post-treatment
• Help individuals in recovery avoid or overcome relapse

Other popular forms of addiction treatment therapy include:

• Dialectical behavioral therapy (DBT). This is a form of CBT that teaches individuals how to live in the moment, cope with stress, regulate emotions, and improve their relationships with others. In DBT, individuals can learn how to accept the reality of their situation while continuing to pursue positive lifestyle changes.

• Rational emotive behavioral therapy (REBT). This is a short-term form of therapy that helps individuals identify self-defeating thoughts and feelings. REBT can also help individuals challenge irrational feelings and replace them with healthier, more productive thoughts and emotions. Ultimately, participating in rational emotive behavioral therapy can help individuals unconditionally accept themselves, others, and life itself.

• Eye movement desensitization and reprocessing therapy (EMDR). This form of therapy focuses on helping individuals heal from trauma and emotional distress. Participating in EMDR therapy can help individuals improve their self-esteem, decrease stress and anxiety, relieve depression, better regulate their emotions, and let go of harmful, traumatic, circular thinking.

Complementary therapies such as art therapy, yoga, music therapy, nature therapy, equine therapy, and mindfulness meditation help individuals reduce stress, build self-confidence, increase their self-esteem, and live mindfully.

Counseling is an integral component of medication-assisted treatment and can be very helpful to individuals looking to recover from addiction. Counseling can be individual or take place in a group setting with others receiving similar treatment. Regardless of the type of counseling provided, participating in therapy can provide individuals:

• Insights into what led to or contributed to addiction challenges
• A wide range of healthy coping skills
• Strategies to prevent relapse
• New ways to handle stress
• Techniques to make healthy decisions

The Benefits of Medication-Assisted Treatment

Medication-assisted treatment can benefit individuals in a number of ways. Receiving medical treatment and participating in counseling can certainly help you overcome addiction challenges, but MAT can also:

• Reduce the risk of relapse
• Help individuals stay in treatment for an adequate amount of time
• Help individuals recovering from addiction challenges find and maintain employment
• Improve the birth outcomes of addicted and recovering pregnant women
• Help individuals identify and change harmful behavior patterns
• Help individuals develop healthy skills and strategies for coping with cravings, stress, and other relapse triggers
• Address underlying issues that may have contributed to addiction such as stress, trauma, or a co-occurring mental illness
• Help individuals learn to have fun and relax without drugs or alcohol
• Repair damaged relationships
• Help individuals learn healthy interpersonal and communication skills
• Uncover the purpose and meaning of abstinence
• Restore families and relationships
• Boost self-esteem and self-efficacy

Ultimately, the end goal of medication-assisted treatment is full recovery which means abstaining from substance abuse, living a self-directed life, finding purpose and meaning in life, and enjoying healthy relationships. Even though medication-assisted treatment alone won’t help individuals accomplish all of this, MAT can help you begin and maintain a recovery journey that can lead to this kind of fulfilling addiction-free life.

Is Medication-Assisted Treatment Appropriate For Everyone?

Because medication-assisted treatment involves the use of prescription medications, everyone who participates in this type of treatment must be under the care of a medical professional who is trained to prescribe these medications. As a result, not every individual will qualify for medication-assisted treatment. In some cases, the medications used in MAT may worsen a pre-existing condition or may impact an individual’s co-occurring mental health challenges. In other cases, physicians may recommend against including MAT for individuals who have previously struggled with an addiction to methadone or other substances. As with any medical treatment, it’s vital that individuals who participate in MAT understand that their unique circumstances will influence the way their treatment proceeds and that there is no “one size fits all” treatment program. If you have questions about your eligibility for medication-assisted treatment, you should speak to your healthcare provider.

How to Locate A Medication-Assisted Treatment Program Near You?

Finding a medication-assisted treatment program isn’t difficult. Often, all individuals need to do is make a phone call or visit a website.

To find a MAT program that administers methadone, you can search this directory of providers and programs that are organized by state.

For individuals looking for medication-assisted treatment in Massachusetts, we recommend this resource site from the Massachusetts Medical Society. This site helps explain why medication-assisted treatment is a good fit for some individuals in recovery, as well as provides treatment locators and helplines for Massachusetts residents to access care.

To search for any other type of medication-assisted programs, contact the SAMHSA Division of Pharmacologic Therapies by calling 240-276-2700. You can also send an email to otp-extranet@opioid.samhsa.gov.

Of course, if you’re interested in discussing your treatment options with someone now, give us a call at 844-909-2560. Our recovery experts are available day and night to help you find a program that’s right for you.

Providing The Knowledge You Need To Take Charge Of Your Own Recovery

Here at Meta, our mission is to help empower you to take charge of your own recovery. Addiction doesn’t have to continue to control your life. Medication-assisted treatment can help empower you to take charge of your recovery journey. Our flexible outpatient programs can work in conjunction with addiction medication. Our programs can also help you continue your recovery journey after MAT. We can also provide a listening ear ready and willing to answer your questions. Whatever you decide to do, know that we’re here to help. Contact us today if you’re ready to take the next step in your recovery journey.