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The Latest on Medication-Assisted Treatment

Why it is increasingly important for treating addiction.

By now, most medical professionals in the addiction field believe that medication-assisted treatment (MAT) can help people with substance use disorders. Very few doctors or therapists question that anymore.

If anything, it’s the substance abusers themselves, and their loved ones, who often remain resistant to MAT, and still feel the stigma of it.

Which simply means we still have a ways to go on this front.

What is MAT?

MAT was originally coined as the name for medication developed and used to treat opioid use disorder. It now has taken on a broader meaning that encompasses medications that are well studied and effective for other substances including alcohol and nicotine. Research is ongoing for treatments for other substances such as cocaine, methamphetamine, and marijuana.

The fallacy of complete abstinence

For decades in this country, the gold standard end-goal for people with alcohol or drug addictions was complete abstinence from all drugs, including prescription medications that were used to help keep people off more addictive and deadly drugs. The thinking was that drug therapy was somehow cheating. Or that you weren’t truly in recovery until you took no medications whatsoever, with the exception of things like aspirin, allergy medicine, or chronic disease medications.

That mindset, although it has weakened, is still with us in 2021, and I believe it does more harm than good. Complete abstinence works well for many people, but scientific evidence has shown it is not the best path forward for everyone. Or even for most people.

The whole-person approach

Medication-assisted treatment is “the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.” This definition comes from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The operative phrase here is “in combination with,” and that part is often overlooked. Treatment approaches for substance abuse that are only one or the other—medication vs counseling/therapy—are not as effective as the combination of the two modalities. We see the evidence for this daily, in a country where the opioid crisis rages. Taken together, MAT and behavioral therapies, along with mutual support (AA, NA, or SMART meetings), have proven to be a very effective treatment approach.

The ABCs on MATs

Methadone, naltrexone, and buprenorphine are all standard options in the MAT arsenal aimed at opioid addiction. They all have their strengths and weaknesses—thus they must be prescribed with care. Naloxone, also known as Narcan, the overdose drug, is exclusively used to reverse an opioid overdose.

As for those with alcohol addiction, there are three key MAT options: Antabuse, Campral, and Naltrexone.

Antabuse is an older medication that has not been shown to be effective in controlling cravings. However, it does cause a severe adverse reaction if someone drinks alcohol while taking Antabuse, so it can have a deterrent effect. It also carries some significant risks for side effects, which need to be considered before prescribing.

Naltrexone is also well studied and has shown to reduce the euphoria associated with alcohol. It has also been shown to reduce the number of drinking days during a relapse.

Campral works to restore the balance of glutamate in the brain. Glutamate is an excitatory neurochemical that can increase anxiety levels in some people when it is out of balance. Campral has also been shown to reduce cravings for alcohol.

Interestingly, there is anecdotal evidence that Campral may work better for women, and Naltrexone may work better for men. However, more research needs to be done to substantiate these findings.

To date, there has not been an effective MAT drug for cocaine or methamphetamine, which are both classified as stimulants. That said, there may be a breakthrough in this key area—more on this exciting news in an upcoming blog post.

Nicotine MAT, which includes nicotine replacement therapies such as patches and gum as well as a medication called Chantix, is well known and has been proven to be effective. However, nicotine MAT is rarely long-lasting when used by itself. It works better when combined with behavioral changes and therapy.

The bottom line

Regarding where we are today, I’ll end with this: As part of a comprehensive treatment plan for substance use disorder, MAT has its place, and then some. My advice to substance abusers and their loved ones is to be open to the possibilities, as drug treatment could be a crucial piece of your overall recovery plan.

More from Lantie Elisabeth Jorandby M.D.
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