Medication-assisted treatment (MAT) is a highly controversial topic amongst individuals in recovery as well as medical professionals. When choosing the most appropriate substance abuse treatment program, patients should remain vigilant and educate themselves. Addiction recovery is not a “one size fits all” path. One method of treating substance use disorder may be effective for one person, while ineffective for another.
Although MAT can be a useful component of a successful recovery program, stigmas have contributed to this method of treatment being underutilized. MAT should be one component of treating substance use disorder while including behavioral interventions such as therapies and support group participation. The goal of medication-assisted treatments is to control a specific set of conditions during the early stages of recovery. Once the conditions are addressed, the individual should taper off the medication as they replace negative coping skills with functional behaviors.
What is Medication-Assisted Treatment?
Medication-assisted treatment (MAT) refers to the use of medications and behavioral therapy to treat substance use disorders. This method is known to provide a “whole-patient” approach to substance use disorder treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that not only can MAT help treat addiction, but it can help sustain long-term recovery as well.
MAT is used primarily on patients with opioid use disorders, but can also benefit some people with alcohol use disorders. The medications used in this type of integrated treatment help normalize brain chemistry by blocking the effects of alcohol and opioids, reducing physical cravings, and helping treat withdrawal symptoms.
Despite the medical community’s claims that MAT is a highly effective form of substance abuse treatment, some people in recovery have another opinion. Some believe that MAT simply replaces one substance with another. On the other hand, some may begin taking these medications, complete therapy, and yet fail to continue their recovery in an aftercare program or support group. When this occurs, a person may relapse, and believe that MAT doesn’t work. However, there are very specific guidelines for the use of MAT treatment, and it is important to acknowledge that everyone’s recovery is different – what works for one person may not work for another.
The Evolution of MAT
During the 1970s, the addiction treatment system was in its developmental stages. There were no clinical guidelines directing how care should be given to patients. This cultivated a chaotic atmosphere within the treatment field. There was not much evidence on the effectiveness of MAT, just as there was no therapeutic dose range established for patients. As a direct result, a damaging series of articles came out of Broward County, Florida entitled “Methadone: The Deadly Cure”. This series of articles laid the groundwork for much of the stigma that surrounds MAT during this present time.
Prior to 2016, very few physicians were licensed to prescribe medications used in MAT. However, when the Comprehensive Addiction and Recovery Act (CARA) was passed, nurse practitioners and physician assistants were granted the ability to be prescribers.
The ability to prescribe these medications was further expanded in 2018 with the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The SUPPORT Act not only expanded the ability of physicians and other qualifying practitioners (NPs, PAs, CNSs, CRNAs, and CNMs) to treat more patients with MAT, but it defined what comprises a qualified practice setting for MAT.
Today, MAT is considered the gold standard for the treatment of opioid use disorders.
How Effective is MAT?
Medications used in MAT treatment can reduce the discomfort of withdrawal from alcohol and drugs while also helping to reprogram the brain. These specific medications can also readjust imbalances in neurotransmitters and hormones. MAT can be used in many different environments, including hospitals, residential programs, outpatient treatment programs, and even prisons. The combination of these benefits foster conditions that may increase the chances of a successful path to recovery.
The key to medically assisted treatment is the word “assisted,” meaning that medication alone isn’t an effective treatment for addiction. Instead, the medications are combined with behavioral therapies to create a comprehensive approach to treating addiction. After all, some drugs used in MAT have the potential for abuse.
For example, people can abuse methadone to obtain a high, and there is a possibility of overdose. Medications, used in MAT treatment programs, may require physician supervision and require additional costs beyond those associated with the purchase of the medication. Some individuals in recovery may assume that because they are using medication, they do not have to participate in other aspects of recovery. In some cases, medication is used as a replacement drug and people may use the medications as a crutch or an excuse not to participate in other necessary therapies and treatment. This can foster a higher potential for abuse and relapse.
How To Decide If MAT is Appropriate For You
There are no set guidelines when deciding if using medications for recovery is necessary for you. The most important thing to remember is MAT treatment must be used in conjunction with behavioral therapies and a solid treatment plan to treat the substance use disorder effectively. Here are a few things to consider before deciding if MAT is appropriate for you.
- An assessment of the type and severity of the substance use disorder are determining factors regarding MAT. For example, individuals with severe alcohol use disorders may consider using benzodiazepines early in recovery to address potentially fatal withdrawal symptoms. Medications are most often used for individuals in recovery from alcohol, opioid, and benzodiazepine addictions.
- Advice from a medical professional should weigh heavily on making the decision to use MAT. A medical professional can properly assess and guide the individual to check their motives while ensuring MAT is appropriate for him/her.
- Individuals suffering from co-occurring disorders may want to consider incorporating MAT into their program of recovery. MAT focuses on treating the individual as a whole, rather than just focusing on the addiction. According to the American Society of Addiction Medicine (ASAM), failing to address the co-occurring psychiatric disorder in an individual with a dual diagnosis results in a situation where the client is almost certainly doomed to relapse.
- Individuals who have a long history of unsuccessful attempts at recovery (periods of sobriety followed by reoccurring relapse) may benefit from MAT.
Conclusions About Medication-Assisted Treatment
People in early recovery are vulnerable and may reject the idea of using medications as part of their recovery program because they do not want to risk potentially relapsing. A substance use disorder represents a diagnosis of a serious psychological disorder, and potential underlying mental health disorders as well, that requires treatment. MAT can be an important aspect of treatment.
The goal of MAT should never be to be on medication indefinitely. MAT should assist the stabilization of individuals in the earlier stages of recovery. Over time, the utilization of these medications should be gradually tapered, and eventually, the person should be free of all substances.
MAT should never be the primary method of treatment without also including a serious treatment plan that incorporates necessary therapies and proactively educates individuals on healthy coping skills. MAT should always be supervised by a medical professional and never used as a substitute for a program of recovery. Addiction is a progressively, potentially fatal disease that is contingent upon the daily physical, mental, and spiritual maintenance of the individual. There are pros and cons to the use of any medication in recovery. It is important for any person, in early recovery, to consult with a medical professional to determine if MAT is right for them.