SAMHSA defines medication-assisted treatment (“MAT”) as “the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.” MAT is used to treat both opioid-use and alcohol-use disorders. For patients presenting with opioid misuse or dependence (including heroin and various narcotic pain medications), select Footprints to Recovery locations offers buprenorphine, commonly known by the brand name Suboxone®, and naltrexone, most commonly known by the brand name Vivitrol®, an injectable form of naltrexone.
Buprenorphine (Suboxone) is an FDA-approved medication that operates as a partial opioid agonist and antagonist that effectively blocks the effects of other opioids while also reducing or eliminating withdrawal symptoms and cravings. Buprenorphine can be used for an indeterminate length of time, from a few days to over a year or longer. Whether you initiate buprenorphine treatment and how long you intend to continue to use it are determined by the patient in close collaboration with medical and treatment teams.
Typically, buprenorphine (Suboxone) is administered at the start of treatment and quickly and significantly reduces opioid withdrawal symptoms and related cravings. With withdrawal and cravings contained, patients are free to focus on meeting the goals established in her or his alcohol and drug addiction treatment plan. For some patients, buprenorphine is used simply to alleviate the initial and worst symptoms of withdrawal and craving and is discontinued within a matter of days or weeks. Other patients will opt for a longer course of buprenorphine treatment and may be maintained on a stable dose of the medication for several months. A host of factors are involved in determining whether, and for how long, buprenorphine will be part of a patient’s treatment plan. Factors include drug-use history and severity, prior treatment episodes and physical and mental health comorbidities. Above all, however, Footprints to Recovery strives to honor the patient’s choice in this, and all, matters related to treatment.
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Naltrexone (Vivitrol) is used to assist treatment for both opioid-use and alcohol-use disorders. With opioid use, Vivitrol operates as an opioid antagonist, blocking the euphoric effects of opioids, thereby reducing both the incentive and craving to use. Vivitrol® is a monthly injection that provides coverage and craving reduction for up to 30 days. Vivitrol requires patients to be free of opioids for up to 7 days, so may not be administered as the first line of defense. Vivitrol may be used as an alternative to buprenorphine or after a successful course of buprenorphine treatment. Whether and how our patients utilize Vivitrol are, again, matters decided by the individual patient in consultation with our medical experts.
Naltrexone is also effective in helping to treat alcohol-use disorders, blocking the euphoric and sedative effects of alcohol and thus reducing both the incentive and craving to drink. Clients treated for alcohol-use disorders need only wait until their blood-alcohol level is zero, typically 12-24 hours removed from their last drink, before initiating Vivitrol. A course of treatment for Vivitrol® can last several months and Footprints to Recovery will ensure patients are provided with access to Vivitrol upon discharge from our clinical programs.
Too often Medication Assisted Treatment is misunderstood, by only looking at the medications themselves. It is critical to understand that the medications offered are not treatment per se; rather, they are tools that allow for some individuals to have higher success in alcohol and drug addiction treatment programs. By offering the option of medications, Footprints to Recovery is able to retain and reach patients that otherwise may have avoided or left treatment prematurely due to debilitating alcohol and drug withdrawal symptoms. Freed from the worst of their withdrawal symptoms, patients can take advantage of all addiction treatment has to offer (as opposed to making their first days in treatment a test of how much discomfort they can endure).
The best outcome for the majority of individuals struggling with alcohol and drug addiction is abstinence or chemical “freedom.” However, how one gets there is a matter of personal choice involving a host of individual factors, including whether one wishes to utilize medication to assist their early alcohol and drug recovery efforts. Given the state of research on Medication Assisted Treatments effectiveness and Footprints to Recovery’s philosophy of providing a variety of tools for alcohol and drug addiction treatment, it would be irresponsible for us not to have MAT on our treatment “menu.”
As Dr. Nora Volkow, the director of the National Institute on Drug Abuse (“NIDA”), recently observed:
“I don’t think that there are any areas where the data is shaky. It clearly shows better outcomes with medication-assisted therapy than without it. For one, it decreases relapse – significantly. Second, MAT has also been shown to be effective in preventing infectious diseases like HIV. Third, medication-assisted therapy has been shown to be effective in preventing overdoses”
Overall, the best approach to alcohol and drug addiction treatment is to follow the evidence and offer our patients things that work, whether that’s MAT, trauma-informed care or 12-step groups. We believe in providing effective options, not forcing patients into “one-size-fits-all” programs that do not account for individual differences, research or patient choice.
Author: Dr. Stacy Lott – Footprints to Recovery – Executive Director