While people who struggle with several types of substances benefit from different approaches to MAT, opioid-specific programs are expanding to slow the opioid addiction epidemic. Some other substances also benefit from MAT.
Medical researchers are trying to develop new treatments to manage withdrawal from a wider range of substances.
How Does Medication-Assisted Treatment Work?
Medication-assisted treatment is a science-based holistic treatment to overcome addiction to substances like opioids, tobacco, or alcohol. This “whole-patient” approach to treatment combines prescription medications with behavioral counseling.
First, a doctor prescribes medications that relieve withdrawal symptoms, so the individual’s body is physically stabilized, allowing them to slowly detox from the substance until they are no longer dependent on it. Some medications lessen the severity of withdrawal symptoms, whereas others nearly eliminate them altogether.
Once the person is physically stable, they can enter group or individual counseling. In therapy, they can learn how to manage cravings, stress, and triggers to abuse drugs as well as how to develop a daily routine that supports abstinence.
Most approaches to treating drug and alcohol abuse involve medical detox first. Then, when the individual is no longer physically dependent on the substance, they can enter a rehabilitation program for behavioral therapy and develop an aftercare plan once they complete rehab.
But many substances like opioid drugs can lead to such extensive physical dependence that slowly tapering the body off the substance works better. Working with therapists during this process creates a support structure to understand previous behaviors and change them.
Under a 2018 federal law, people entering medication-assisted treatment programs must receive behavioral counseling in addition to medication management. Further required services include vocational, educational, and other assessment services to help the transition into abstinence in daily life.
Benefits of MAT
Medication-assisted treatment has been shown to:
- Improve long-term survival rates after rehabilitation.
- Increase treatment retention.
- Decrease illicit drug use, especially opioid abuse.
- Decrease criminal activity among people who struggle with substance abuse.
- Increase an individual’s ability to gain and maintain employment.
- Improve birth and infant safety outcomes among women who struggle with substance use disorders while pregnant.
The U.S. Food and Drug Administration (FDA) has approved several different medications to manage withdrawal symptoms and achieve physical stability. Research shows that, with the proper dose of a medication, there are no adverse effects on a person’s intelligence, employability, physical functioning, and mental capacity when they use medications to manage substance use disorders.
Prescription Drugs to Manage Withdrawal Symptoms
Opioid use disorder (OUD) is the biggest focus for MAT approaches, but other substances benefit from medication management. Addictions to these substances are most commonly treated with MAT:
- Alcohol: People who have abused alcohol for more than 10 years, who drink large amounts of alcohol every day, or both, are at risk of developing delirium tremens (DT) when they try to quit drinking. This is a life-threatening condition with symptoms that include hallucinations, body tremors, loss of mental functioning, sensitivity to light, stupor, deep sleep lasting for more than a day, and even seizures.To reduce the risk of DTs, medication-assisted treatment using benzodiazepines like Valium (diazepam) that can ease the brain off dependence on alcohol appears to work best. Clinical studies have shown that anticonvulsant prescriptions can also help.MAT for alcohol use disorder (AUD) focuses mostly on reducing the risk of relapse after the person has safely detoxed from alcohol. Medications used during this period include:
- This medication blocks the euphoric effects of alcohol, reduces cravings for alcohol in general, and improves retention in long-term rehabilitation programs. People in AUD rehabilitation programs may take naltrexone to ease cravings, but in the event that they do relapse and drink, alcohol will not lead to good feelings associated with intoxication. Instead, there will be few, if any, effects from the substance, which helps the person dissociate positive experiences from drinking.However, unlike some other approaches to MAT for AUD, naltrexone also helps to ease stress around drinking in general, which can improve outcomes more than other medications.
- This drug is prescribed to people who have safely detoxed from alcohol, who are in a recovery program and want to maintain abstinence from alcohol. It does not prevent withdrawal symptoms, so it is important for clinicians to prescribe this medication only to those who have fully ended their physical dependence on alcohol. Treatment should begin no earlier than the fifth full day of abstinence.The drug takes five to eight days to become fully effective and ease cravings. There are some side effects, which can be managed by the overseeing physician.
- This was the first medication developed to stop people from relapsing into alcohol abuse. When the person taking it relapses and drinks, disulfiram causes nausea, headaches, and vomiting.The discomfort associated with drinking alcohol while on this medication should cause the person to associate negative physical sensations with drinking, but the side effects from this reaction can be risky or harmful. It is rarely prescribed as a form of MAT, but for some people who have struggled for many years to remain abstinent from alcohol, it may be useful.
- Tobacco: Since nicotine use is associated with increased risk of cancer and other health risks, medications have been developed to taper the body off this addiction. Medications prescribed to help people quit smoking are nonaddictive. They lessen cravings for tobacco, decrease withdrawal symptoms like shaking or headaches, and reduce the risk of relapse.There are several prescription gums, lozenges, sprays, and even patches that contain specific doses of nicotine, which can help the person taking them to taper off the drug. The generic antidepressant bupropion, under the brand name Zyban, can also reduce withdrawal from tobacco use.
- Opioids: Prescription painkillers, heroin, and fentanyl are responsible for one of the largest drug overdose epidemics in American history.While access to opioid painkillers is an important part of medical treatment, loosening prescribing practices around these substances in the late 1990s led to a wave of oversight problems, addiction, and overdose death. In 2017 alone, according to the Centers for Disease Control and Prevention (CDC), there were 47,600 opioid-specific drug overdose deaths, which was about 67 percent of all drug overdose deaths in the United States that year.There are far more people who survive opioid overdoses, which can take a huge mental, physical, and emotional toll on the individual who overdosed and their loved ones.Almost 3 million people in the U.S. struggle with addiction to or abuse of opioid drugs, so getting access to science-based treatment is more important than ever. Medication-assisted treatment is the leading method for overcoming opioid addiction and returning to a healthy, sober life.
These programs are called opioid treatment programs (OTP). They must be approved by the Substance Abuse and Mental Health Services Administration (SAMHSA), through the Division of Pharmacological Therapies (DPT), which oversees accreditation standards and certification processes. Federal law requires all OTPs to provide medication management of withdrawal symptoms, behavioral counseling, and other programs to help people overcoming opioid addiction reenter normal life. Additional programs in an OTP often include services to help with job placement, to promote physical health, and to enhance family life.
The leading medications used in opioid medication-assisted treatment are:
- This partial opioid agonist had been used throughout Europe, starting around the 1980s, to address opioid withdrawal. The medication was not approved for use in the United States until 2002, but since then, prescription buprenorphine has become the leading approach to managing opioid withdrawal.The drug can be prescribed by a licensed physician and taken on an outpatient basis rather than requiring dispensation at a specific clinic, like methadone. As with all forms of opioid MAT, a prescription for buprenorphine is part of a larger treatment plan that includes counseling.
- This long-lasting opioid agonist was the primary approach to MAT in the U.S. during the 1970s and 1980s, stemming the tide of the previous heroin abuse epidemic. Since this medication can be addictive in people who are opioid-naïve, methadone clinics were developed to dispense the substance, monitor for signs of abuse or relapse, and offer counseling and other services to people working to overcome heroin addiction.Methadone MAT is a long process, taking at least a year to manage tapering off the drug with associated counseling. While it is no longer the preferred approach to medication-assisted treatment for opioid dependence, access to the methadone clinics is still vital for many people working to overcome opioid addiction.
- As with alcohol MAT, naltrexone eases cravings for opioids, but it does not ease withdrawal symptoms. It is more often prescribed once a person has overcome their physical dependence on opioids.Naltrexone also blocks the effects of opioid drugs, so if a person taking this medication relapses, they will not experience a euphoric effect from the substance.
Medications Being Investigated for Future MAT
The FDA and research groups are investigating several medications that may treat other addictive disorders that currently have no form of MAT associated with them. For example, addiction to cocaine can involve severe withdrawal symptoms and a high risk of relapse. Finding MAT approaches for cocaine addiction could help many people.
Drugs being investigated as potential MAT prescriptions include:
- Baclofen. This is a GABA-stimulating medication that is used to treat muscle spasms, which may be useful in lessening withdrawal symptoms from alcohol and cocaine abuse. The drug reduces how much dopamine is released into the nucleus accumbens, which decreases cravings for stimulants.
- Gabapentin. This anti-seizure drug may help to manage the GABA system, reducing the risk of seizures from alcohol withdrawal and potentially managing cocaine cravings during stimulant withdrawal.
- Modafinil. Unlike other listed drugs, modafinil is prescribed to treat narcolepsy. Since the drug eases glutamate depletion in the brain, it may also treat a similar problem in people who have abused cocaine for a long time.
- Tiagabine. This selective blocker of presynaptic GABA helps to manage seizures. It may also lessen cravings for cocaine and opioids.
- Topiramate. This medication helps to manage how GABA is released and transmitted in the brain, making it a potentially excellent relapse prevention drug, pending medical trials.
- Vigabatrin. This is another anti-seizure medication that may relieve GABA management problems in the brain during alcohol or cocaine withdrawal.
Addiction & Mental Illness Can Benefit From Some Medications
People who struggle with addiction are more likely to also struggle with mental illness. The comorbidity of these conditions is high enough that it is often difficult to tell whether a pre-existing mental illness, like depression, anxiety, or bipolar disorder, leads to substance abuse, or whether abusing drugs or alcohol triggers a mental illness. Regardless, many addiction treatment programs now screen for mental health disorders, so that both addiction and mental health issues can be addressed at the same time.
To that end, one of the most potentially important forms of MAT is prescription antidepressants. Serotonin specific reuptake inhibitors (SSRIs) like citalopram and fluoxetine can manage underlying stress from a mental health condition by stabilizing serotonin and dopamine management in the brain. This, in turn, can reduce cravings and reduce reactive, negative behaviors.
SSRIs may not be appropriate for everyone. Taking these does not decrease the usefulness of other forms of medication-assisted treatment like buprenorphine or naltrexone.
Access to MAT Is Crucial for Survival
Thanks to changes in federal law, access to MAT for opioid use disorder is improving, and other medications are being investigated to alleviate withdrawal symptoms for other substances like cocaine or methamphetamines.
The combination of tapering off physical dependence with behavioral therapy helps thousands of people in the United States every year. With ongoing research and continued advancements in the field, medication-assisted treatment will be able to help a wider group of people in the future.