How Medication-Assisted Treatment Helps Substance Abuse Disorders

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Substance use disorder has become a public health crisis. According to the US. Department of Health and Human Services, 16.5% of the population, or over 61 million people, met the criteria for having a substance abuse disorder in 2021. 

One of the ways professionals are trying to help people recover from addiction is through medication-assisted treatment.

What Is Medication-Assisted Treatment?

A woman shakes hands with a doctor, discussing her medication-assisted treatment plan for a substance abuse disorder

Medication-assisted treatment, or MAT, is a comprehensive and evidence-based method that helps people overcome addiction and achieve recovery. MAT is primarily used for opioid and alcohol use disorders but can also be beneficial for other substances. 

Advocates of MAT view addiction not as a bad habit or personal fault but as a brain disorder that can be medically managed. The FDA-approved medicines used in MAT are designed to balance brain chemistry, block the “feel-good” effects of opioids and alcohol, ease powerful cravings, and help the body regain its normal functions.

Another key idea of MAT is that it takes care of the whole patient. In other words, it doesn't just focus on helping people overcome their addiction but also guides them in other aspects of their lives. For example, it could involve connecting people with social workers, job help, and legal assistance to support their path to recovery.

What Are the Goals of MAT?

The overarching objective of MAT is to help individuals with substance use disorders sustain recovery. This broad aim is achieved by several specific goals:

  • Reducing substance use and preventing overdose: By dampening the rewarding effects of substances and reducing cravings, MAT can help patients reduce their substance use.

  • Improving physical and mental health: MAT can also improve related health issues, such as infectious diseases or mental health disorders, by treating substance use disorders.

  • Enhancing quality of life: By promoting recovery, MAT can help individuals reintegrate into society, improve their family dynamics, and boost their overall life satisfaction.

  • Lowering criminal behavior: Research shows that MAT can reduce criminal behavior associated with substance use, making it a tool for public safety.

What Common Medications Are Used in MAT for Opioid Addiction?

The strategic use of certain medications in MAT is designed to counter the physiological effects of opioid addiction, aiding in managing withdrawal symptoms, reducing cravings, and preventing relapses. The commonly used medications in MAT include methadone, buprenorphine, and naltrexone. Each of these drugs functions uniquely, offering distinct benefits in the recovery process, and are administered under professional supervision as part of an integrated treatment program.

Methadone

Methadone, a long-lasting opioid agonist, is mainly used to help people overcome opioid addictions. A review of multiple studies on methadone maintenance treatment found that methadone was highly effective in reducing opioid use, improving treatment retention, and reducing mortality rates among individuals with opioid use disorder.

As an opioid agonist, methadone activates the same brain receptors as opioids, but it does so more slowly and lasts longer. This helps to stop withdrawal symptoms and lowers cravings, making it easier for patients to stop using opioids in an unhealthy way.

However, like any medication, methadone can have side effects such as constipation, sweating, and weight gain. Plus, it can only be given out through clinics that the federal government regulates.

Buprenorphine

Buprenorphine is a partial opioid agonist, meaning it doesn't fully activate the brain's opioid receptors. This characteristic lowers the risk of misuse, dependency, and side effects.

Buprenorphine's effectiveness lies in its ability to reduce opioid withdrawal symptoms and cravings without providing the “high” associated with opioid misuse. 

Potential side effects of buprenorphine can include nausea, vomiting, constipation, and headaches. Unlike methadone, buprenorphine can be prescribed in various settings, including doctors' offices.

Naltrexone

Naltrexone stands apart from methadone and buprenorphine because it’s an opioid antagonist. This means it blocks the activation of opioid receptors, effectively nullifying the euphoric and sedative effects of opioids. Naltrexone is used in the treatment of both opioid and alcohol use disorders.

Naltrexone can help to maintain abstinence after detoxification from opioids or reduce heavy drinking. However, it is only effective once opioids are completely detoxified from the system. 

Side effects of naltrexone can include nausea, headache, dizziness, and fatigue. Naltrexone can be administered in a monthly injection under the brand name Vivitrol, which is convenient for people who struggle with taking medication daily. 

Is Medication-Assisted Treatment Effective for Alcohol Use Disorders?

A doctor writes a prescription for substance abuse treatment medication, while a pill bottle comes into focus in the foreground

Alcohol use disorder, often called AUD, is a recurring brain disease where someone compulsively uses alcohol, can't control their drinking, and feels negative when they're not drinking. It can cause serious health issues and problems in society.

Medication-assisted treatment for AUD has been proven to help lower alcohol use, prevent a return to drinking, and assist in maintaining an alcohol-free lifestyle. It's most effective when combined with counseling and psychological support. 

Each medication works differently, and how well they work will change from person to person. Factors such as the seriousness of the alcohol use disorder, adherence to the medication schedule, and participation in behavioral treatments can influence how well the medication works.

Disulfiram

Disulfiram works by causing unpleasant physical reactions when someone drinks alcohol while taking the medication. Side effects include nausea, vomiting, flushing, rapid heartbeat, and headaches. These symptoms can occur within 10 minutes of consuming alcohol and last several hours. This discourages people from drinking alcohol because they want to avoid the uncomfortable side effects.

Acamprosate

Acamprosate works by restoring the balance of certain chemicals in the brain that are disrupted by long-term alcohol consumption. Drinking heavily over a prolonged period can lead to changes in brain chemistry, causing imbalances that contribute to alcohol dependence.

Unlike other medications used for AUD treatment, acamprosate does not cause unpleasant physical reactions if alcohol is consumed. Instead, it helps reduce the cravings and uncomfortable withdrawal symptoms that individuals with AUDs may experience when they stop drinking or try to cut back. Its purpose is to support long-term abstinence and aid in maintaining sobriety by reducing the desire to drink. 

Naltrexone

Unlike disulfiram and acamprosate, naltrexone targets the brain's reward system. When someone consumes alcohol, it triggers the release of chemicals that create pleasurable feelings. However, naltrexone acts as a barrier, preventing these chemicals from producing their desired effects. 

As a result, the individual taking naltrexone experiences reduced cravings for alcohol and diminished pleasure when drinking. This can help them control their alcohol intake and support their journey toward recovery.

Mental Health Conditions and Their Impact on MAT for AUD

Often, people with AUD may also have mental health conditions, such as depression, anxiety, or post-traumatic stress disorder. These conditions can make the treatment process for AUD more complex.

For example, some medications used to treat mental health conditions can interact negatively with AUD medications, requiring careful management by the healthcare provider. 

Also, untreated mental health conditions can make it harder for people to stick to AUD treatment, possibly leading to worse outcomes. Therefore, a combined treatment approach that addresses AUD and any mental health conditions simultaneously is important for a successful recovery.

Medically-Assisted Treatment Can Change Lives

A young latino family smiles at the camera, thankful for medication-assisted treatment for their family member's substance abuse disorder

Medically-assisted treatment has been proven effective in managing substance use disorders, particularly opioid and alcohol addictions. By combining medication with counseling and behavioral therapies, MAT can help people get better treatment outcomes, reduce cravings and withdrawal symptoms, and prevent a return to substance use.

Despite the substantial evidence supporting the efficacy of MAT, it is essential to recognize that no single treatment approach is suitable for everyone. Individualized treatment plans that consider each person's unique circumstances, needs, and preferences are key to achieving successful outcomes in addiction recovery.

With continuing research and innovation in this field, the future of MAT holds a lot of promise for even more improvements in treating substance use disorders.