Medications for Addiction Treatment
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 14.5 million people needed treatment for an alcohol use disorder and nearly 1.6 million people needed treatment for an opioid use disorder in 2019.3 The cycle of addiction is a challenge to break, especially on your own, though; and, unfortunately, only about 12% of people who needed substance abuse treatment that year received specialized recovery services.3 Fortunately, for people who can’t control their use of alcohol or opioids, medication-assisted treatment (MAT) can help break the pattern of addiction and support long-term recovery.
What is Medication-Assisted Treatment?
Medication-assisted treatment (MAT) is the use of FDA-approved medicine in combination with counseling and behavioral therapies to treat substance use disorders and other health-related conditions (such as co-occurring mental health disorders). In those with opioid use disorders (OUD), medicines may help reduce the risk of opioid overdose as well as help prevent a return to opioid use.4 Medications are also currently used in the treatment of alcohol use disorder. There is ongoing research studying pharmacological options to treat addiction to other substances, such as cocaine and methamphetamine.4,5
Medicines are most effective as part of a whole-person approach to addiction treatment, which includes 4 valuable components:4
- Prescription medicine.
- Behavioral therapy from a licensed mental health or addiction expert.
- Support, encouragement, and stability offered by family and friends.
Although many people succeed in quitting drugs or alcohol with only some of the above components, studies have shown that medicines combined with other components of addiction treatment increase the chance of positive outcomes and promote long-term recovery. Counseling and behavioral therapies help address underlying issues that led to substance use.
Medicines may be safely taken for months or years to help:4
- Relieve withdrawal symptoms caused by brain and body chemistry imbalances.
- Blunt or block the euphoric (highs) and sedation effects of drugs.
- Reduce cravings for drugs or alcohol.
How Does MAT Work?
Several MAT medicines work by mimicking certain effects caused by drugs of abuse. When someone consistently uses an opioid or alcohol, particularly at higher doses, the brain and body adapts to the regular presence of the substance by altering some of the ways the body functions in an effort to maintain balance. When a person suddenly quits or greatly reduces their intake of drugs or alcohol, withdrawal symptoms appear as a result of the body being unable to quickly revert back to the way it functioned before the chronic substance use.7
Others work by discouraging continued use through reducing cravings, decreasing or blocking the rewarding effects associated with the substance, or causing an unpleasant reaction should the substance be used again. Some medicines work through a combination of these methods. Each medicine works in unique ways with its own set of advantages.
Medications for Addiction Treatment
- Methadone helps ease opioid withdrawal symptoms and control cravings for heroin and other opioids. It can also blunt or block the effects of other opioids. Methadone is available as a pill, an oral concentrate liquid, and an orally disintegrating wafer, but it is only dispensed from sites specially certified by SAMHSA called opioid treatment programs (OTPs).
- Buprenorphine is similar to methadone in that it also eases withdrawal symptoms and controls cravings. In the drug Suboxone, buprenorphine is combined with naloxone, a medicine that blocks the effects of opioids to help prevent misuse. Buprenorphine can be prescribed by OTPs and other clinicians as regulated by SAMHSA.
- Naltrexone blocks the effects of heroin and prescription painkillers. If a person using naltrexone tries to use an opioid, they will not feel any high or other euphoric or sedation effects. Naltrexone is available as a pill or an injection (Vivitrol) that can block opioids for a month with a single dose. Naltrexone treatment is widely available and can begin when you are no longer physically dependent on opioids.
Medicines for alcohol addiction and dependence include:2,4
- Disulfiram (Antabuse) causes unpleasant effects, such as nausea, when combined with even a small amount of alcohol.
- Acamprosate (Campral) helps reduce symptoms associated with post-acute withdrawal, such as poor sleep, anxiety, and depression. Acamprosate therapy is typically started several days after your last drink.
- Naltrexone blocks the desirable effects of alcohol as well as opioids. By blocking some of the reward associated with alcohol intoxication, use of alcohol is discouraged thereby supporting extended abstinence.
As mentioned, medicines are only one part of treating addiction to opioids or alcohol. Counseling and behavioral therapies are essential components of addiction treatment and can include:2
- Cognitive-behavioral therapy (CBT): Effective in treating a variety of mental health disorders and compulsive behaviors, CBT focuses on the connection between thoughts, feelings, and behaviors while teaching effective coping skills. Once triggers and cravings are identified, a person can learn to adjust their thoughts as well as their behaviors to prevent relapse to maintain sobriety.
- Motivational interviewing (MI): This therapy style works to build a person’s desire for abstinence and a drug-free life. By building internal motivation to stay clean, the person’s thoughts and behaviors can focus on change, not continued use.
- Contingency management (CM): CM provides tangible rewards for recovery-based activities and accomplishments. If a person attends treatment or tests negative for drugs, therapists will reinforce these positive behaviors with money, prizes, or valuable tokens. These rewards work to offset the positive feelings experienced with drug use.
- Community reinforcement approach (CRA): CRA is a highly structured and intensive type of therapy that offers a combination of services over a 24-week period. The sessions will build coping skills, assertive communication, vocational abilities, and healthy social outlets to increase the person’s positive behaviors.
Since finding the support of trusted friends and family members is another aspect of effective addiction treatment, many therapy options will include loved ones in treatment. Other people in recovery can attend support group meetings as a way to extend and enhance a supportive and healthy social network.2
Effectiveness of Medication-Assisted Treatment
MAT is an effective form of substance abuse treatment with many advantages. Research has shown that a combination of medicines, behavioral therapy, education and social support can:4
- Reduce the need for inpatient detox services necessary to control dangerous withdrawal symptoms.
- Offer a comprehensive, “whole-patient” treatment approach that addresses multiple needs of the individual.
- Lower the mortality rate of chronic opioid users by reducing the risk of overdose.
- Increase the length of time people remain in treatment.
- Decrease illicit drug use and other illegal behaviors.
- Improve the person’s odds of getting and maintaining employment.
- Lower the risk of contracting and spreading infectious diseases associated with intravenous opioid use, such as HIV and hepatitis C.
Though very helpful to many with AUD and OUD, use of certain medications are controversial, largely due to misconceptions and misinformation on the issue.2,4 Many falsely believe that prescribing an opioid like methadone or buprenorphine is not treatment. Contrary to popular belief, MAT is not substituting or exchanging one addiction for another.2 Buprenorphine and methadone have unique properties that distinguish them from commonly misused opioids and are given at specific dosesto provide steady, stabilizing effects. They are offered in a controlled way with monitoring from addiction professionals to ensure safety and discourage a return to illicit opioid use or excessive alcohol use.
Incorporating medication may not be the right decision for all people in their recovery from alcohol and opioids, but for many, medication used as an adjunct to traditional drug rehab treatment can be a game changer in promoting and maintaining long-term abstinence from substances of misuse.
If you’re ready to break the control opioids or alcohol have over your life, American Addiction Centers is here to help. Our compassionate admissions navigators are ready to hear your story without judgment and talk to you about your treatment options. Call any time, day or night. Or get started online by filling out the form below.