Medication-Assisted Treatment (MAT) for Addiction Recovery and Aftercare

According to the Substance Abuse and Mental Health Services Administration, there are multiple pathways to addiction recovery. One of these pathways is medication-assisted treatment.

Medication-assisted treatment, or MAT, uses a combination of medication and counseling to treat a substance use disorder. It’s particularly suited to treating opioid use disorders, including addictions to prescription painkillers and heroin. It’s also commonly used to treat alcohol use disorders.

Myths and misconceptions about MAT abound, but research continues to find that it’s highly effective for treating addiction. Here’s an in-depth look at medication-assisted treatment to help you decide if this pathway to recovery is right for you.

Addiction, Dependence and MAT

Addiction Dependence and MAT

To understand how and why medication-assisted treatment works, it’s important to understand how addiction and dependence develop. While these terms are often used interchangeably, there is a difference between addiction and dependence.

Addiction

Addiction is a chronic disease resulting from brain changes that occur with heavy substance abuse. It’s characterized by compulsive drug abuse despite the negative consequences it causes.

Drugs and alcohol are psychoactive substances, which means they act on brain chemicals or neurotransmitters. Different substances act on different neurotransmitters. For example, some increase the activity of GABA, a neurotransmitter responsible for feelings of calm and well-being. Others increase the activity of glutamate, which is responsible for feelings of excitability. While there are a number of neurotransmitters affected by drugs, all psychoactive substances act on the neurotransmitter dopamine. Dopamine is the primary neurotransmitter responsible for feelings of pleasure. It plays a key role in the brain’s memory, reward, and learning systems.

Dopamine

Dopamine is what produces the euphoric feelings you get from pleasurable activities like eating when you’re hungry, doing a good deed, or exercising. When you engage in these activities, your brain creates a memory of the activity and the pleasure it produces. It also records the environmental cues present, such as the people who are there or an emotion you’re feeling at the time. When an addiction develops, these environmental cues become triggers for relapse.

Under normal circumstances, the brain carefully regulates the amount of dopamine it produces. But when you use drugs or alcohol, dopamine activity increases beyond what’s natural. This jolts the brain with pleasure far greater than what you can feel by doing normal, everyday activities.

Brain Rewiring

Heavy substance abuse can lead the brain’s reward circuit to become re-wired. Repeated use leads to the brain’s pleasure and planning centers to communicate in a way that causes an association between pleasure and drug use. Your brain associates liking the drug with wanting it. The result is powerful cravings, a conditioned response that leads to compulsive drug-seeking and drug-taking behaviors.

People who are addicted may want or try to quit using, but most find that they can’t sustain recovery for very long. The National Institute on Drug Abuse stresses that for those who become addicted, recovery requires more than willpower and good intentions.

Risk Factors for Addiction

The number of people who develop an addiction is actually very small. Some of the risk factors that increase the chances of developing an addiction include:

Addiction as a Chronic Disease

Addiction is progressive, chronic, and relapsing. Progressive means that without adequate treatment, an addiction will grow worse over time. Chronic means that it can’t be cured, but it can be sent into remission with proper treatment. Relapsing means that if someone uses again after a period of recovery, the addiction can relapse, once again causing brain changes that lead to compulsive use despite negative consequences.

A large body of research points to addiction as a medical disorder rather than a moral failing or a character weakness. Many researchers compare addiction to other chronic, relapsing diseases like diabetes and heart disease. These, like addiction, have a range of underlying factors and causes, including:

  • Genetic predisposition.
  • Unhealthy lifestyle choices.
  • Environmental factors.
  • Biological factors.
Diabetes and heart disease are treated with a combination of medication and behavioral and lifestyle changes that lead to a successful remission or management of the disease. Medication-assisted treatment regards addiction as a disease that can also be treated with medications and behavioral and lifestyle changes. Medication-assisted treatment offers better rehab outcomes, particularly for opioid addiction, than counseling only.

Dependence

Dependence is also the result of changes in brain function. Dependence is characterized by withdrawal symptoms that set in when you stop using.

Heavy, chronic drug and alcohol abuse causes the brain to change its chemical operation in an attempt to maintain normal function. For example, alcohol stimulates the activity of GABA, the calmness neurotransmitter, and suppresses the activity of glutamate, the excitability chemical. Heavy, prolonged alcohol use causes the brain to reduce GABA activity and increase glutamate activity to compensate.

These changes in chemical function lead to tolerance. This means that you need increasingly larger amounts of alcohol to get the desired effects. But as you continue to drink more, the brain continues to change its chemical function to compensate. At some point, the brain may begin to operate more comfortably when alcohol is present. Then, when you suddenly stop using, normal neurotransmitter function rebounds, and this causes physical withdrawal symptoms.

Treating Dependence

Traditionally, dependence is treated with medical detox. During medical detox, the substance of abuse is withheld so that all traces of drugs or alcohol leave the body and brain function can begin to return to normal.

During medical detox, a variety of medications are used as needed to treat the severity of withdrawal symptoms and reduce the time it takes to detox. Medication also helps prevent dangerous or fatal symptoms associated with withdrawal from alcohol and benzodiazepine sedatives, such as Klonopin and Valium.

Dependence and Withdrawal

While withdrawal from opioids isn’t particularly dangerous, it can be excruciating. Withdrawal symptoms include intense cravings, which don’t normally resolve along with the other symptoms of withdrawal, such as vomiting, diarrhea, muscle cramps and chills.

Partly due to long-term cravings and the intensity of brain changes associated with opioid addiction and dependence, treating opioid use disorders with medication-assisted treatment is the gold standard, according to the Substance Abuse and Mental Health Services Administration.

MAT for Opioid Addiction

MAT for Opioid Addiction

More than two million Americans are addicted to opioid painkillers like OxyContin and Vicodin, and another half-million are addicted to heroin, according to the National Institute on Drug Abuse.

With the opioid epidemic claiming more than 115 lives every day to heroin and prescription painkiller overdose, the medical and mental health professions largely agree that medication-assisted treatment is the best way to help individuals achieve sobriety once and for all.

Opioid Relapse Rates

When not treated adequately, opioid addiction has a high relapse rate. In general, the relapse rates for addiction are about the same as those for diabetes and heart disease – around 40 to 60 percent, according to the National Institute on Drug Abuse. One study found that 91 percent of addicted individuals relapsed after opioid detox when it wasn’t followed up with treatment. Participation in therapy significantly delayed relapse or prevented it altogether.

Medications Used in MAT for Opioid Addiction

Medication-assisted treatment involves medications that block the effects of opioids, reduce cravings and, in some cases, prevent the onset of withdrawal. The medications used help to restore normal brain function, which enables individuals with an opioid use disorder to focus on the cognitive and behavioral aspects of recovery without having to cope with cravings and the brain fog that can take some time to clear after detox.

Three medications are approved by the FDA for medication-assisted treatment of opioid addiction: Methadone, buprenorphine and naltrexone. These medications work in different ways.
Methadone
Methadone is a synthetic opioid. It’s an opioid agonist, which means that it activates the opioid receptors in the brain. Because it affects these receptors more gradually than other agonist opioids like heroin, its psychoactive effects -including euphoria- are weaker than those of other opioids. Since methadone attaches to the opioid receptors, it prevents other opioids from attaching, effectively blocking their euphoric effects if they’re used while on methadone.

Methadone has been used in medication-assisted treatment since it was approved for that purpose in 1971. Taking methadone prevents the onset of withdrawal symptoms and reduces cravings for opioids. Because methadone has a high abuse potential due to its effects -however mild-methadone must be administered through a government-approved clinic or doctor’s office, which requires a daily visit.

Buprenorphine
Buprenorphine was approved by the FDA for MAT in 2002. A partial opioid agonist, buprenorphine activates the opioid receptors, but its effects are far weaker than other opioids, including methadone.

Like methadone, buprenorphine prevents the onset of withdrawal symptoms when you stop using opioids, and it effectively blocks cravings. Unlike methadone, buprenorphine has a ceiling effect so that taking more of it won’t produce more pronounced effects. This reduces the risk of abuse, which means that buprenorphine can be prescribed by a physician and taken at home, increasing the chances that someone taking it will stay on it until they’re ready to successfully recover without it.

In 2016, an implantable form of buprenorphine was developed by Braeburn Pharmaceuticals and Titan Pharmaceuticals. Known as Probuphine, this matchstick-sized device is implanted beneath the skin and delivers buprenorphine for around six months. Since one of the roadblocks to successful recovery with MAT is the ease with which patients can go off their medication and return to using, researchers hope that this new implant will reduce the risk of opioid relapse even further.

Naltrexone
Naltrexone, widely known under one of its trade names, Suboxone, is a combination of buprenorphine and naloxone that was approved by the FDA for MAT in 1994. Naloxone is known as the overdose reversal drug because it knocks opioids out of their receptors to restores breathing after an overdose.

Naltrexone is an opioid antagonist, which means it attaches to the opioid receptors but has no psychoactive effects. It also blocks all effects of other opioids used while on the medication, and it effectively reduces cravings for opioids.

The combination of naloxone and buprenorphine reduces the risk of abuse of naltrexone. However, naltrexone makes you more sensitive to the effects of opioids -including respiratory depression- and increases the risk of overdose if you relapse while taking it.

Naltrexone is a little different from methadone and buprenorphine, which can be started at any time in the recovery process. For those who are still actively using opioids, methadone and buprenorphine will prevent withdrawal from occurring when opioid use ends.

Naltrexone, however, can only be taken once all traces of opioids are out of the system. This means that MAT with naltrexone will require medical detox before starting on the medication. Naltrexone is available by prescription as a daily pill or a once-monthly injection.

The medications used in MAT for opioid addiction help to correct chemical imbalances in the brain that produce withdrawal symptoms and contribute to intense cravings. It helps reduce the cognitive effects of opioid addiction, including mood swings, problems with decision-making and an inability to concentrate.

MAT for Alcohol Addiction

MAT for Alcohol Addiction

Six percent of Americans over the age of 18 -nearly 15 million people- have an alcohol use disorder. Medication-assisted treatment can help people overcome an alcohol addiction in several ways, depending on the medication used.

The protocol for MAT is the same for both opioid addiction and alcohol addiction: It involves both medication and counseling. Three medications have been approved by the FDA for alcohol addiction: disulfiram, acamprosate, and naltrexone.

Medications for Alcohol Treatment

Naltrexone
Naltrexone, the combination of buprenorphine and naloxone that’s used to treat opioid addiction, is also effective for treating alcohol addiction. Naltrexone works to reduce cravings, lessen the effects of alcohol if it’s consumed while on naltrexone and reduce the urge to drink more. Naltrexone is ineffective in people who are still drinking when treatment starts.
Acamprosate
Approved by the FDA in 2004 to treat alcohol addiction, acamprosate promotes a balance between glutamate (excitability) and GABA (calmness) to reduce alcohol cravings. Acamprosate is taken three times a day. It’s started around five days after detox and reaches its full therapeutic effectiveness in five to eight days. It should be continued even if a slip-up occurs and you drink alcohol.
Disulfiram
Disulfiram has been used to treat alcohol addiction since it was approved for that purpose in 1951. Drinking alcohol while on disulfiram leads to unpleasant side effects.

When alcohol enters the body, it’s first converted into acetaldehyde, which is toxic, and then to acetic acid. Disulfiram prevents the acetaldehyde from converting to acetic acid, and the result is a buildup of acetaldehyde that causes nausea and vomiting, headache, weakness and tachycardia, or an abnormal heartbeat.

Disulfiram doesn’t reduce cravings. Rather, it acts as a deterrent to drinking. The Substance Abuse and Mental Health Services Administration stresses that disulfiram is most effective in those who are intrinsically motivated to stop drinking.

Disulfiram can be an effective short-term solution for people in recovery who expect to be in a high-risk situation, such as a family wedding or a holiday party and want an added incentive to abstain from drinking. Disulfiram is administered at least 12 hours after the last drink or after detox is complete.

The Counseling Component of MAT

The Counseling Component of MAT

Medication-assisted treatment is a two-pronged approach to addiction recovery. The first prong -medication- reduces cravings, helps to restore brain function and prevents or reduces the psychoactive effects of opioids or alcohol if you use them while on the medication.

The other prong of MAT is counseling, which is essential for long-term recovery.

Address Underlying Causes of Addiction

The underlying causes of an addiction – stress, trauma, mental illness – must be addressed for a successful recovery. The addiction itself causes a range of problems in your life, including relationship, legal, financial, and physical and mental health problems. Effectively treating an addiction requires addressing and resolving these and other problems. And since the brain changes related to addiction cause dysfunctional thought and behavior patterns, learning to think and behave in new, healthier ways is central to successful recovery.

A comprehensive drug and alcohol assessment will help addiction professionals place you in the treatment setting that’s best for you, based on your unique needs and issues.

How Long Does MAT Last?

How Long does MAT Last

Medication Timeline

The medications used in MAT can be taken as long as they’re needed. Some people will take the medication for a few months. Others may take it for a few years. For some, medication will be an important part of recovery for the rest of their lives.

How long a person stays on medication depends on a number of factors, including personal preference, the severity of their addiction and how well they’re able to cope with relapse triggers.

Counseling Timeline

The counseling component of MAT should last at least 90 days, whether it’s through an inpatient or outpatient treatment program. Anything less than that, according to the National Institute on Drug Abuse, is of limited effectiveness. That’s because just as it takes time to develop an addiction and the dysfunctional thought and behavior patterns that come with it, it takes time to re-wire the brain and learn to think and behave in healthier ways. It takes time to develop healthy lifestyle changes that stick, and it takes time to undo the damage the addiction does to many areas of your life.

If Medication-Assisted Treatment is So Effective, Why Isn’t It More Widely Available?

Despite research showing its effectiveness, medication-assisted treatment isn’t as widely available as it should be. There are far more people who need it than there are programs that offer it. Less than half of all private treatment programs offer MAT, according to Pew Charitable Trusts, and only 23 percent of publicly funded treatment programs utilize it.

Many high-quality treatment programs offer MAT, but for some people -particularly those who live in sparsely populated areas- travel is necessary to receive MAT.

A study published in the journal Evaluation and Program Planning, administrators of treatment programs cite a number of reasons why the medication-assisted treatment isn’t more widely available:

  • The prevalent misconception among the general population and some medical providers that MAT simply replaces one addiction for another.
  • A lack of medical personnel on staff who are authorized to administer MAT.
  • A lack of access to medical personnel who are trained to deliver MAT.
  • Barriers to funding for MAT.
  • Cultural barriers, including staff and clients who are reluctant to rely on medications to treat an addiction.

These barriers are increasingly being addressed by government and healthcare agencies, and it’s expected that MAT will be more widely available in the coming years.

Is MAT Right for You?

Multiple pathways to addiction recovery include medication-assisted treatment. While it’s not the only effective pathway, it’s one that shows a great deal of promise for long-term recovery, particularly from an opioid addiction.

Whether MAT is right for you depends on your personal preferences, your ability to access MAT and the recommendations of your treatment team. MAT helps numerous people live drug and alcohol free more easily while they develop the essential skills they need to sustain the recovery on their own, without medication. For many, MAT is the primary factor in successful recovery. MAT works to restore function and joy to people’s lives, and it can work for you, too.