Medication Assisted Treatment Guide

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Medication Assisted Treatment

Medication-assisted treatment (MAT) combines behavioral counseling, therapy, and medications for substance use disorders like alcoholism and opiate abuse. This treatment is an effective way to reduce cravings, withdrawal symptoms, and the chance of relapse. It is considered the gold standard of care for opioid addiction.

As more people are now using MAT voluntarily, there has been increased interest in this approach, and many myths have cropped up that may not be very clear to those considering it. We want you to know all the facts before deciding about MAT treatment.

MAT Effectiveness

MAT has proved to be clinically effective and cost-effective. In one study by the National Institute on Drug Abuse, methadone users had a 2% mortality rate compared to 15% for non-methadone users.

How do you know if medication-assisted treatment is right for you? If you or a loved one is unable to cut down or quit using alcohol or drugs despite the negative life consequences that they cause, it may be time to get help with MAT. If family and friends have told you that your behavior is noticeably different when you are under the influence. Some people also know that it’s time to start MAT because the quest for drugs or alcohol has taken over their lives. Some people neglect their responsibilities while engaging in destructive behavior such as poor school performance and unsafe sexual practices.

This treatment approach has proved to:
• Improve client survival
• Increase retention in treatment
• Decrease illicit opiate use and other criminal activity among people with substance use disorders
• Increase clients’ ability to gain and maintain employment
• Improve birth outcomes among women who have substance use disorders and are pregnant

MAT Models

The Food and Drug Administration (FDA) has approved several medications for treating addiction to alcohol, opiates, and stimulants. There are two main types of medications used in MAT treatment. Agonists bind to opioid receptors in the brain and prevent withdrawal symptoms while antagonists attach to the receptors but do not produce a high.

Clients with opioid use disorder can require several different medications in their treatment plan. When a client first starts using MAT, there is usually not yet a medication that exactly fits the individual’s needs. The counselor will help the client learn about their addiction and determine the best treatment plan. This stage of MAT treatment aims to get the person to “tolerate” taking therapy and medications as part of their recovery process.

Alcohol Use Disorder Medications

These medications are typically taken in pill form, or they can be given to the clients by their doctor as a liquid. Acamprosate, disulfiram, and naltrexone are the most common drugs used to treat people with alcohol use disorders and reduce craving for alcohol.

Acamprosate

Acamprosate is for people in recovery who no longer consume alcohol and want to stop the habit. It works by preventing the urge to drink alcohol. The use of acamprosate typically begins on the fifth day of recovery. It is recommended that clients take acamprosate for at least three weeks before discontinuing treatment.

Disulfiram

Disulfiram works to prevent the effects of alcohol by keeping it from reaching the brain and central nervous system. It helps prevent nausea, vomiting, and other physical symptoms experienced when drinking. It begins to show effectiveness after two weeks of use.

This medication is taken daily for a recommended time of three months. Doctors can then determine its effectiveness in reducing or eliminating alcohol cravings after this period.

Naltrexone

Naltrexone is combined with counseling and other therapies to help people who are not in recovery. It is taken as a pill or in injection form. If clients have any physical symptoms related to alcohol withdrawal, they should stop taking naltrexone and contact their doctor immediately.

Clients on this medication must continue to take it for the entire established period even if they do not have cravings for alcohol or have not increased their consumption of alcohol during that time.

Medications for Opioid Use Disorder

Three medications have been approved by the FDA to treat opioid dependency: methadone, buprenorphine, and naltrexone. These medications are all taken as pills or in liquid form and work in the brain to reduce cravings for opiates, mitigate withdrawal symptoms and craving for opiates, and help reduce the physical dependence on opiates.

These medications come in two primary forms: immediate-release (IR) tablets or IR capsules that must be taken with food every eight hours for eight to 12 weeks. In this stage of treatment, it is essential to monitor clients’ intake closely and determine if they can comfortably tolerate the medication by watching their weight, blood pressure, liver function tests, and moods.

Methadone

Methadone has been used since the 1960s to treat opioid use disorders by reducing cravings and preventing withdrawal symptoms. It is generally taken once daily before eating. Methadone is mainly prescribed for at least three months. Doctors can, however, monitor progress to increase the time if necessary.

Buprenorphine

Buprenorphine allows for reducing and eliminating withdrawal symptoms that clients might experience after stopping opioid use. It is a partial opioid agonist, which can help reduce physical and psychological dependence on drugs. It is typically taken once daily in the morning before eating.

It comes in two forms: a pill that must be swallowed whole and a liquid that you can mix with orange juice or a smoothie. Buprenorphine treatment usually begins at step one in the treatment plan. It is generally continued for four to six weeks, after which time the individual may start to wean off the medication.

Naltrexone

Unlike methadone and buprenorphine, naltrexone is an opioid antagonist, which means it works by blocking the effects of opioids. Therefore, it prevents or reduces the withdrawal symptoms that individuals might experience when they stop using opioids. It is usually taken once daily in the morning. It can reduce withdrawal symptoms but does not eliminate them.

Substance Use Disorder Treatment Models

There are various evidence-based and promising approaches to treating substance use disorder (SUD). One can deliver SUD treatment in multiple ways in different settings with varying durations. The technique used will depend on the individual’s needs, readiness, location, and duration of treatment. Some examples include inpatient, outpatient, and continuous outpatient (CO) models with various combinations of these configurations.

Inpatient Treatment

Inpatient treatment is recommended for people who have a SUD that requires intensive care and more intensive treatment than can be provided in a community-based setting. Individuals might become unmanageable or violent when withdrawing from alcohol or other sedatives. They are typically admitted to a hospital or rehabilitation center where they can be supervised and any withdrawal symptoms promptly managed.

Outpatient Treatment

Outpatient treatment is recommended when individuals can maintain their mental and physical health while receiving comprehensive, evidence-based treatment. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are 14 principles of intensive outpatient treatment. These principles include:

• Monitor abstinence
• Utilize community-based support services
• Incorporate medications, if needed
• Educate clients about substance use disorder and skills required for recovery
• Involve family members, employers, and significant others
• Incorporate evidence-based strategies into treatment
• Improve program administration capabilities
• Make treatment easily accessible
• Remove barriers to treatment
• Utilize the client’s existing motivation
• Build trusting and positive relationships between providers and clients
• Prioritize retention in treatment
• Determine and address individual treatment needs
• Provide continuous care

Continuous Outpatient Treatment

This is an effective treatment model for opioid dependency and helps to reduce the legal risks of SUD. One can complete continuous outpatient treatment in a licensed and regulated facility or facility under contract with a regulatory agency to provide the necessary services.

Stages of Treatment

Both opioid and alcohol use MAT guidelines focus on stages of treatment.

1. Assessment

This is the first stage of treatment. It helps clinicians understand the client’s needs, assess any risks involved, and set up a stage-based treatment plan.

2. Withdrawal

This stage sees the client start to experience the repercussions of not indulging in substance abuse. The goal is to reduce or eliminate withdrawal symptoms while helping clients deal with their underlying mental health problems that can lead to the relapse of SUDs.

3. Detoxification

Detoxification is concerned with managing withdrawal symptoms during the period of opioid taper. Some clients may need additional support and care to minimize the synchronized use or risks associated with SUDs.

It can be in an inpatient facility or outpatient setting. Outpatient detoxification is more common, but the highest level of care is in an inpatient setting where nurses, physicians, and psychiatrists can assess the client’s symptoms and ensure that their body is stabilized.

4. Maintenance treatment

The maintenance stage involves medical management of SUDs with MAT drugs to help the person discontinue non-medication relief of cravings. It helps avoid relapse caused by discontinued non-medication for addiction.

The goal is to stop the use of substances. The focus should be on a client’s capacity for change through treatment. It reduces the risk of relapse and overdose while improving people’s personal, family, social and occupational functioning.

Treatment Setting

Treatment settings vary from an inpatient or district clinic to a series of primary care offices and community-based programs. In the outpatient setting, clients may choose to attend a methadone clinic, psychiatric hospital, or specialty treatment centers such as rehabilitation centers for those affected by opioid dependence.

FDA-approved Medication

The FDA approves medications for prescription use for two groups: first, people with a chronic condition as determined by their doctor and second, persons at risk of not completing medication for addiction treatment. Those in the first group may be treated with methadone or buprenorphine and the second group with naltrexone or nalmefene, except during pregnancy and breastfeeding.

Psychosocial Treatment

Psychosocial treatment focuses on psycho-education that provides information, strategies, and skills to help people recover from SUD. It also entails social support and problem-solving skills to help clients face their issues while in the recovery process.

These treatments include substance abuse counseling and involve regular family check-ins and other services that can help promote recovery.

Diversion, Drug Testing, and Compliance

Several guidelines provided recommendations for addressing diversion, testing, and compliance to ensure that SUD treatments are appropriately used. It is recommended to consult the Prescription Drug Monitoring Program before MAT medication induction and periodically afterward. This is to confirm compliance with prescribed drugs and identify unreported utilization of other medications.

MAT is a commonly used and accepted treatment for opioid and alcohol use disorders. The medicines are effective in treating SUDs and help prevent relapse. They can also reduce the mortality, morbidity, and social costs of SUDs.

MAT is one element of treatment that need to be delivered alongside counseling support services, psychosocial interventions, and community reintegration programs to ensure effective results. It is strongly recommended to get help from clinicians and institutions that provide MAT to people who need adequate treatment for opioid and alcohol use disorders.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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