Medication-Assisted Treatment | An Alternative to Detox?

Medication-assisted treatment (MAT) is an approach to treating substance use disorders with a combination of medications and other therapies. When you go through an addiction treatment program, you may take a variety of medications to manage uncomfortable symptoms and medical issues that occur alongside addiction. You may take medications for nausea, insomnia, anxiety, depression, and other issues. But the medications used in MAT are specifically approved to treat drug dependence and addiction, not just their symptoms.

For the most part, psychotherapy is the gold standard of treating substance use problems. Since chronic addiction is a disease that affects the brain, it manifests itself as a behavioral disorder. Cravings and compulsions make it difficult to resist using drugs, even despite consequences. Psychotherapy is used to address underlying issues and develop coping strategies that can lead to long-term recovery. 

However, traditional addiction treatment usually begins with a detox phase. You stop using the drug and go through a period of uncomfortable withdrawal. During withdrawal, some drugs cause uncomfortable psychological symptoms like stimulants, opioids make you feel like you’re very sick, and depressants can cause some life-threatening physical symptoms. In many cases, withdrawal requires medical treatment to ensure safety. However, even with treatment, withdrawal can be difficult to get through for some people. Some people experience chronic relapse, which is attempting treatment and relapsing during withdrawal or after reaching sobriety many times. 

It’s important to note that chronic relapse can be frustrating for people with substance use disorder, but even people that relapse many times can achieve lasting sobriety. MAT is one of the ways chronic relapse is addressed. 

But is MAT a viable alternative to the standard model of detox and treatment? Learn more about medication-assisted treatment options. 

How Does Medication-Assisted Treatment Work?

Medication-assisted treatment works by using a drug that can treat uncomfortable withdrawal symptoms. For instance, someone with a chemical dependence on heroin will experience severe flu-like withdrawal symptoms when they try to quit. Along with cravings, these symptoms can make it difficult to get through withdrawal without relapse. In MAT, they would be treated with an opioid medication that can allow them to stop using heroin without experiencing a relapse. Opioid medications that are approved for MAT can activate the same receptors that heroin and other opioids do, which helps prevent uncomfortable withdrawal. 

While illicit heroin is unpredictable and dangerous, MAT medications are safer and easier to manage. The first goal of MAT is to break the cycle of active addiction. Someone caught in a pattern of heroin misuse spends the majority of their time seeking, using, and recovering from a heroin high. Using illicit heroin and other illicit drugs can also be dangerous. MAT allows a person with a substance use disorder to spend more time pursuing life goals, taking care of themselves, and managing other responsibilities. It should also help them avoid the medical, legal, and financial consequences that are associated with addiction and dependence. 

In MAT, medications are used in conjunction with psychotherapy and traditional treatment models. The medications allow a person to skip the uncomfortable detox period and start attending to other aspects of addiction treatment. While the medication takes care of physical dependence, you can start to address the underlying causes and consequences of addiction and develop strategies to safeguard your sobriety for the long term. Many people that have experienced chronic relapse struggle to get to or complete psychotherapies because of powerful drug cravings and uncomfortable symptoms. 

MAT also allows you to remove yourself from a lifestyle of drug use. If you spend a year in MAT, when you complete treatment, you will have a year of separation from the people, places, things that you associated with drug use and addiction. This can allow you to have the impression that you’ve started a new life in sobriety.  

What Causes Withdrawal?

Withdrawal is a consequence of chemical dependence, which is when your brain adapts to the presence of a drug. After a period of regular or excessive use of a drug, your brain will adjust your brain chemistry to compensate for the foreign chemical. Depressants may cause your brain to adjust by producing more excitatory chemicals and less of its own inhibitory chemicals. Stimulants can cause the opposite effect. When you stop using the drug, you’ll experience the effects of chemical imbalance in your brain. Your brain is adaptable, and it can return to normal after becoming chemically dependent. But it can take time to adjust to life without the drug. During that time, you may feel uncomfortable and even dangerous withdrawal symptoms, depending on the drug. 

In some cases, you don’t need to take the same drug to avoid going into withdrawal. A similar drug that’s in the same category as the substance you’re dependent on can help to avoid withdrawal symptoms. For instance, sometimes benzodiazepines are used to treat alcohol withdrawal because both are depressants. In MAT, particularly for opioids, medications bind to the same receptors that misused drugs interact with. For instance, buprenorphine activates the same opioid receptors that heroin activates. But the medications are more manageable and don’t cause severe intoxication. That’s why MAT medications can prevent withdrawal while being less dangerous to use than illicit drugs. 

What is Medication-Assisted Treatment Used For?

Currently, MAT is primarily used to treat opioid use disorders. There are some medications that are approved to treat alcohol and depressant addiction, but MAT usually refers to the treatment of opioid use disorders with opioid medications. Opioids are notoriously addictive. While opioid withdrawal isn’t usually life-threatening, it can be extremely uncomfortable, causing vomiting, nausea, sweating, diarrhea, and other symptoms. Opioid withdrawal can also cause some powerful cravings and compulsions to use your drug of choice again. Opioid medications that are used in MAT can help you avoid these uncomfortable symptoms and cravings while you begin addiction therapies. 

MAT is usually reserved for people that have already tried to go through detox and traditional addiction treatment. Sobriety and freedom from drug dependence are usually preferred, especially for people that need to achieve sobriety to address medical issues. Many MAT programs are reserved for people that have experienced a pattern of chronic relapse. MAT programs aren’t as prevalent as traditional treatment programs, so they may be reserved for people that have already tried traditional treatment. 

Is MAT an Alternative to Detox?

Detox is a barrier to treatment for many people. The severe discomfort that comes with withdrawal symptoms may cause some people to cut their treatment short, and others may avoid treatment altogether. The idea of an alternative to detox may be attractive to many. MAT is not an alternative to detox altogether, but it is an alternative to the standard model of going through detox first. Maintenance programs involve taking a replacement medication indefinitely, with no clear timeline for when you will stop taking it. Plus, drugs like methadone are said to cause withdrawal symptoms that are as bad or worse than typical opioid withdrawal. However, MAT programs usually have the goal of eventually tapering off of the medication once you’ve completed treatment. 

There are some differences between standard detox at the beginning of treatment, and tapering at the end of MAT. Tapering takes longer, but withdrawal symptoms aren’t as severe as quitting cold turkey. In standard opioid detox, you may be given medications when they’re needed, but typically involves five to ten days of treatment and uncomfortable withdrawal. In MAT, you also go through the tapering and detox process after you’ve gone through therapies to build relapse prevention and better coping strategies. Ideally, you will be better equipped to handle a life free of chemical dependence. 

What Medications are Used in MAT?

There are several medications that are used in MAT, though a few have become the most popular. In MAT for alcohol use disorders, medications include acamprosate, disulfiram, and naltrexone. Acamprosate is used to lessen lingering alcohol withdrawal symptoms and it’s thought to reduce alcohol cravings. Disulfiram can interfere with your body’s ability to break down alcohol, causing nausea and stomach aches if you take it with alcohol. The idea behind this drug is to act as a disincentive to drinking. Naltrexone can block opioid receptors, which are involved in the rewarding effects of drinking. This medication is used to make drinking less enjoyable. 

Medications that are used to treat opioid use disorders include:

  • Methadone. Methadone is a synthetic, long-acting opioid agonist that can help stave off opioid withdrawal. It’s dispensed daily to people that use it to manage opioid use disorders. It has been used in methadone maintenance programs, which is the use of methadone to stop opioid cravings indefinitely. However, research shows that methadone treatment is more effective with behavioral treatment as in MAT.
  • Buprenorphine. Buprenorphine is one of the most popular MAT drugs today. It’s a partial opioid agonist, which means that it is partly activated opioid receptors. It can help stave off withdrawal and cravings without causing intoxication. It also has a relatively low overdose potential.
  • Naltrexone. As with alcohol, naltrexone blocks opioid agonists that allow opioids to take their effects. It can be used to prevent the satisfying effects of an opioid high, which ideally takes the incentive away from misuse.  
  • Suboxone. Suboxone is a brand name for a drug that combines buprenorphine and naloxone. Naloxone is an opioid antagonist that’s used to block opioid receptors during an opioid overdose. It adds an extra layer of protection against misusing buprenorphine. While the naloxone isn’t active when the drug is taken as directed, it can cause withdrawal symptoms if you try to misuse Suboxone. 

Is Medication-Assisted Treatment Just Replacing One Opioid for Another?

One of the criticisms of MAT and drug maintenance programs is that it just replaces one opioid for another. It’s true that treatment with a drug like buprenorphine or methadone means that you will still be chemically dependent on an opioid. However, there’s a significant difference between active addiction to prescription or illicit opioids and the use of MAT medications. The first distinction is that illicit drugs like heroin are inherently dangerous. Heroin is unpredictable when it comes to its contents, purity, and strength. Each time you use illicit heroin, you risk taking other chemicals or more powerful drugs like fentanyl that can lead to an overdose. 

Another distinction is intoxication. Heroin and other opioids that are used recreationally can cause a potent high that involves sedation and other intoxicating effects. It can be difficult to function in life and go about daily responsibilities while you’re high on an opioid. Opioid addiction also causes you to spend your time and money on seeking your next high. MAT drugs like buprenorphine can treat withdrawal symptoms without causing significant impairment or intoxication. This frees you to go about your life and pursue addiction treatment without worrying about maintaining your addiction or experiencing an uncomfortable high.

Is Medication-Assisted Treatment Evidence-Based?

An evidence-based treatment option is an approach to treatment that’s backed up by scientific research. Evidence-based therapies are important in addiction treatment for many reasons. If a therapy option is evidence-based, you can reasonably assume that it will have value to many people that are seeking addiction treatment. It has proven to work for real people. Evidence-based therapies are usually useful in a variety of treatment settings, as opposed to therapies that require you to be in a specific place or setting. 

Alternative therapies are the other option next to evidence-based options. Alternative therapies are approaches to treatment that have not been tested yet or have been tested and shown to be ineffective for a significant number of people. Alternative therapies can include things like art therapy, yoga, and acupuncture. They may be helpful for some people, especially when it comes to engaging interest in treatment. But researchers are unable to prove that they can produce reliable results in treating addiction. Still, alternative therapies may be used in treatment as supplemental to evidence-based approaches. 

On the other hand, medication-assisted treatment has been tested in scientific studies and research has shown that it can be effective. However, evidence-based therapies aren’t guaranteed to work for everyone. There is no one treatment option that’s universally effective. However, evidence-based therapies are valuable and worth trying for many people. 

Does Medication-Assisted Treatment Work?

Research into the effectiveness of MAT has revealed some promising things. First, MAT can effectively reduce your risk of addiction-related problems like infectious diseases, including HIV and hepatitis C. Because MAT can help someone with a substance use disorder break the cycle of active addiction, it may help remove them from a pattern of risky illicit drug use. 

For the same reasons, it can reduce the risk of experiencing a deadly drug overdose. 

MAT may also improve a person’s engagement with treatment and their likelihood to complete a treatment program. In many cases, cravings, withdrawal, and powerful compulsions to use cause people to leave treatment and relapse. MAT may curb cravings and withdrawal symptoms, allowing treatment participants to buy into treatment therapies and complete their treatment program. According to PEW, research has shown that MAT increases patient adherence to treatment and reduces the use of illicit opioid use compared to treatment without the use of medications. In fact, using medications in conjunction with behavioral therapies may be more effective than either approach is on its own. 

Medication-assisted treatment has also been shown to increase social functioning, which is an important factor in long-term sobriety. Making healthy social connections can help safeguard recovery, strengthen your support system, and allow you to live a more fulfilling life.

MAT is especially useful in treating people that have struggled to achieve or maintain sobriety in the past. Since medication can help you feel better as you go through behavioral therapies, it can allow people to stick with treatment that has had trouble completing programs in the past.

What are the Drawbacks of MAT?

While MAT is a proven method of addiction treatment with many strengths, there are few potential drawbacks. The biggest one is that MAT involves the use of drugs that cause chemical dependence, addiction and can be misused. MAT will mean continuing to be dependent on a chemical substance for many months. People that want to be free from drug dependence will have to wait a lot longer while going through MAT when compared to the traditional treatment model. 

Plus, since MAT uses drugs that act in the brain in a way that’s similar to drugs of abuse, it’s possible for MAT medications to be misused. There are many safeguards to prevent the misuse of MAT medications. Suboxone has its own built-in safeguards,0 and methadone is rarely dispensed in an amount larger than a single dose. Still, there are ways to misuse, like hoarding pills to take a higher dose later or taking a dose in a way that’s different from what’s directed. For that reason, MAT requires a high level of supervision.

MAT can also be expensive, though most addiction treatment options can be costly. Still, drugs like buprenorphine and methadone can cost hundreds of dollars per month and thousands over the course of a year. To offset this cost burden, insurance companies can help cover some of the costs of treatment and medications. Ultimately, addressing addiction with the right care for your needs is usually worth the cost. 

Another drawback has less to do with MAT and more to do with its availability. It may be harder to find an MAT treatment program than it is to find traditional addiction treatment.

Is Medication-Assisted Treatment Harm Reduction?

Harm reduction is a philosophy in public health policies that seek to reduce the harmful consequences of certain behaviors, whether or not they are legal. An example of harm reduction would be a program that passes out free clean needles to people that use illicit drugs intravenously to help them avoid blood-borne diseases. Harm reduction policies are sometimes controversial, and opponents point out that it doesn’t address the root problem, even though it can prevent people from harm, at least in the short term. 

While MAT does have some harm reduction aspects, its ultimate goal is to lead to lasting freedom from active addiction like traditional addiction treatment. Many people complete a MAT program by tapering off the medication. Ideally, having gone through the full continuum of addiction treatment and therapy without withdrawal symptoms can prepare them for life without drugs or MAT medications. 

Does Insurance Cover Medication-Assisted Treatment?

MAT can be costly. Not only does it involve long-term use of medications, it also involves months of therapy. However, addiction treatment ultimately allows you to address an issue that may eventually disrupt your finances, your ability to maintain employment, and your health. To help cover costs, insurance companies do provide coverage for treatment services like MAT. In order to participate in the health insurance marketplace in the U.S., insurance companies have to provide coverage for behavioral health, mental health, and substance use disorder treatment. 

Most addiction treatment centers and programs accept coverage from private insurance companies. Getting coverage from your insurance company for in-network treatment programs will be the easiest path to financial help. In-network healthcare providers are ones that your insurance company has developed a relationship with. They may offer discounts and other benefits to you. However, if you find a treatment program that you feel is right for you, you may still be able to get coverage for your care, even if the program is out-of-network.

If you have a federally funded insurance provider like Medicare or Medicaid, your options may be more limited. Many private healthcare providers don’t accept government-provided insurance plans. These plans often come with extra administrative work and provide a smaller payout. However, there are some options for treatment for people with Medicare and Medicaid, just not as many. If you have no health insurance, you may still be able to find treatment options through the Substance Abuse and Mental Health Services Administration (SAMHSA).

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