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What is Medication Assisted Treatment (MAT)? How does it Work?
An individual’s willingness to get clean can vary from day to day, but one of the most common reasons people leave treatment is their urge to use again. The purpose of medication-assisted-treatment (MAT) is to help ease these drug cravings so individuals can focus on their therapy. The longer people stay in treatment, the better their chances of long-term success so MAT is just one of the many tools we utilize to help our clients get their life back.
On entering treatment here at Coalition Recovery, you’ll be medically assessed by our doctors to establish a medical history and background. From there, our psychologist will prescribe medications to help alleviate withdrawal symptoms and at times additional medications to help mitigate cravings. Of course, these medications are non-addictive and are extremely difficult to abuse. We understand MAT may not be for everyone, but we offer the service to anyone who believes it may better their treatment experience.
The primary use for Medication Assisted Treatment is for treatment of opioid addictions such as heroin and pain relievers, alcohol use disorders and sometimes dependence to benzodiazepines like Xanax and Valium. To understand how MAT works, it is easier to understand how these drugs work first. Opiates, alcohol and benzos function by crossing the blood-brain barrier and attaching to brain receptors, which then trigger a multitude of neurotransmitters producing highs and euphoric feelings. Addictions form when the user seeks these feelings of euphoria despite adverse consequences – causing dependence and a substance use disorder.
Medication Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to treat substance use disorders. These medications come in two forms: one (called an antagonist) blocks the opiates from attaching to the brain receptors in the first place – disabling the user from feeling the opiate effects. The other (called an agonist) extends the effects over time allowing the feelings of withdrawal to be neutralized longer – counteracting the need to use constantly. Agonists are generally more effective, but abusable. When combining both antagonist and agonists, such as Suboxone, the effectiveness is far greater.
Opioids, alcohol, and benzos are some of the most highly addictive drugs due to their euphoric feelings making them extremely hard to come off of safely and effectively. When an individual stops using, he or she begins to develop strong psychological feelings to use coupled with the need to ease the physical withdrawal symptoms that reside. For this reason, treatment can be a difficult time for those struggling with these addictions. The first weeks can be very difficult times due to the mental and physical strain of withdrawals. MAT is a helpful tool to ease these struggles. While MAT can be effective on its own, when used together with counseling, therapy, and aftercare, medically assisted treatment has been shown to significantly improve the chances of success.
Pros & Cons
It might seem counterintuitive to treat an opioid addiction with another opioid, but prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opiates, relieve physiological cravings, and normalize body functions without the adversarial effects of the abused drug. It is essentially replacing the substance with one less harmful and addictive – making it safer and easier to detach from the substance entirely.
According to the Substance Abuse and Mental Health Services,
“In 2013, an estimated 1.8 million people had an opioid use disorder related to prescription pain relievers, and about 517,000 had an opioid use disorder related to heroin use. MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals.”
Despite its effectiveness, MAT has had a bad reputation recently due to the misconceptions of replacing one drug for another. The proportion of heroin admissions with treatment plans that included medication-assisted opioid therapy fell from 35% in 2002 to 28% in 2010.
Is it Safe?
Combining medications used in MAT with anxiety treatment medications can be fatal. Types of anxiety treatment medications include derivatives of Benzodiazepines, such as Xanax or valium. Rest assured, if you are under the care of a board-certified psychiatrist, he/she will understand these altercations and prescribe the safest and most appropriate medications.
While the addictive and abusive properties of MAT are less than other opioids, they still carry slight addictive traits. MAT drugs are specifically designed to limit the abuse, and many do not contribute a euphoric high. These drugs can still create physical dependence, and therefore a medically administered taper should be administered to safely and effectively wean off of the medication. For this reason, the government has created systems to keep the availability constrained to only those in need. For instance, federal law requires patients who receive treatment in an opioid treatment program to undergo medical, counseling, vocational, educational, and other assessment and treatment services, in addition to the prescribed medication. This limits the amount of abuse and also gives individuals the best chance towards long term success.
Opioid Agonist Vs. Opioid Antagonist
An agonist is a drug that activates certain receptors in the brain. Full agonist opioids activate the opioid receptors in the brain fully resulting in the full opioid effect. Examples of full agonists are heroin, oxycodone, methadone, hydrocodone, morphine, and opium among others. An antagonist is a drug that blocks opioids by attaching to the opioid receptors without activating them. Antagonists cause no opioid effect and block full agonist opioids. By closing the opioid receptors, they can be used to reverse an overdose. Examples are naltrexone and naloxone. Opioid use disorder medications come in two forms: the antagonist blocks the opiates from attaching to the brain receptors in the first place – disabling the user from feeling the opiate effects. The other, agonist, extends the effects over time allowing the feelings of withdrawal to be neutralized longer – counteracting the need to use constantly. Agonists are generally more effective, but abusable. When combining both antagonist and agonists, such as Suboxone, the effectiveness is far greater.
Methadone – First Medication for Withdrawal Symptoms
Brand Names: Methadose, Diskets, Dolophine
Methadone is an opiate agonist prescribed under controlled conditions to treat the symptoms of opiate withdrawal. Methadone was the first primary drug used for narcotic replacement therapy to minimize withdrawal symptoms. It functions by tricking the user into thinking they are getting the abused drug but in reality, they are not getting high – they feel normal. Nowadays, the use of methadone is strictly used for the treatment of pregnant women as it is the only MAT medication approved to safely use in pregnancy.
Buprenorphine – New & Popular for Opioid Withdrawal
Brand Names: Suboxone, Subutex, Buprenex, Butrans, Probuphine
Buprenorphine is a partial opiate agonist, meaning its maximal effects are less than those of full agonists like heroin and methadone. Buprenorphine must be prescribed due to its classification as a schedule III drug compared to methadone which is a schedule II. But this means Buprenorphine is less addictive than methadone. For this reason, Buprenorphine is seen as a safer alternative to methadone for MAT.
Naltrexone – Wide Variety of Uses
Brand Names: Vivitrol, Revia
Naltrexone is an antagonist, and unlike Buprenorphine and Methadone, Naltrexone can be used for alcohol dependence as well as opioid dependence. It has benefits over methadone and buprenorphine in that it is not a restricted medication but overall benefits have been described as “modest”. Naltrexone can also be used to reverse an overdose but Naloxone is more widely used for that purpose.
Naloxone – Overdose Medication
Brand Name: Narcan
Naloxone is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system. It can be used to deal with withdrawal symptoms but mainly used by emergency responders as a means to reverse overdoses. It can also be used to reduce respiratory or mental depression due to opioids. Naloxone is most commonly injected intravenously for fastest action, which usually causes the drug to act within a minute, and lasts up to 45 minutes. Naloxone is not used in medication-assisted treatment (alone) although naloxone works together with buprenorphine to make Suboxone.
Disulfiram – Used to Deter Alcoholism
Brand Name: Antabuse and Antabus
Disulfiram works by giving the individual an acute sensitivity to ethanol. When taken prior to drinking, the effects of alcohol give the user a sense of immediate uneasiness and nauseousness similar to the effects of a hangover.
Acamprosate – Used to Treat Alcohol Dependence
Brand Name: Campral
Not to be taken while still drinking alcohol. Used to restore natural chemical balance in the brain. Acamprosate is not effective unless used alongside therapy and counseling.
Naltrexone – Wide Variety of Uses
Brand Names: Vivitrol, Revia
Naltrexone can be used for alcohol dependence as well as opioid dependence. When used as a treatment for alcohol dependency, naltrexone blocks the euphoric effects and feelings of intoxication. This can help individuals stay motivated during treatment. Vivitrol has been shown to be especially effective. Vivitrol requires a once-a-month injection, eliminating much of the compliance issues associated with medication-assisted treatment.
Here at Coalition Recovery, we offer full dual-diagnosis treatment, meaning we treat mental health disorders alongside substance use disorders. Medications for mental health disorders can often be susceptible to abuse (for example: Xanax and Valium). For this reason, it is strongly recommended that individuals who struggle from both substance use disorders and mental health disorders attend a dual-diagnosis treatment center. This way, the psychiatrist can prescribe medication for both the substance abuse and mental health condition, limiting adverse reactions as well as prescribing non-addictive alternatives.
Klonopin can is used to help minimize the symptoms of withdrawals from short-acting benzo addictions. Klonopin is a long-acting benzodiazepine used to treat seizures as well as panic and anxiety. Klonopin is typically only used during detox due to its susceptibility to abuse.
Buspirone helps to reduce anxiety and is classified as an anxiolytic due to its influence on the neurotransmitters in the brain, especially serotonin. Busiporn can be a good alternative to benzodiazepine as it does not depress the central nervous system or cause sedation.
Phenobarbital is a very common drug used to counteract benzodiazepine withdrawals; it actually associated with the class of drugs known as barbiturates. Phenobarbital is used to treat seizures and anxiety and to counteract benzodiazepine withdrawals.
Tofranil is a tricyclic antidepressant used to treat anxiety and depression as a result of benzo abuse.
Tegretol works by calming the activity in the brain and is used to help reduce symptoms of anxiety.
Vistaril is actually an antihistamine used to treat itching caused by allergies. Interestingly enough, it reacts to some of the same receptors that can help treat anxiety as it makes the user feel relaxed and sometimes even sleepy. This medication is typically only used to help short-term anxiousness: usually the anxiety associated with withdrawals from benzodiazepines.
Strattera is used to treat attention-deficit hyperactivity disorder (ADHD). Strattera may help restore certain neurotransmitters in the brain that may help increase focus and concentration. Atomoxetine is not a stimulant unlike Adderall and Vyvanse making it an appealing choice for people with both ADHD and substance use disorders
Call us to Learn More!
Medication Assisted Treatment has been proven to interrupt the cycle of intoxication and withdrawal, greatly reducing heroin and other illicit opioid use, crime, HIV/AIDS and the risk of death through an overdose. Those struggling with opioid abuse should consider MAT, but medication alone is not sufficient. To enable the best chance for recovery, MAT needs to be used alongside behavioral therapy and counseling. Despite the negative misconceptions, MAT is one of the most effective ways to treat an opioid substance use disorder.
Coalition Recovery in Tampa, Fl strives to be ahead of the curve by constantly adapting to new and better ways to treat addiction. Medication Assisted Treatment is one of the many tools we can utilize to make the process smooth and successful. If you or a loved one is considering treatment, call (888) 707-2873 for private information. Coalition Recovery may or may not be a right fit but we are willing to educate on the best options available. Call Today.
Content Creator for Coalition Recovery
Medically Reviewed By:
Coalition Recovery’s 4x Board Certified Psychiatrist in Addiction, General, Forensic & Geriatric Psychiatry.