Benefits of Medication-Assisted Treatment in Recovery
When someone first hears about the use of medication in recovery, they may ask: Why use a drug to treat addiction?
Dr. Nicole Labor, an addictionologist and Medical Director at OneEighty, addresses this quickly.
“We’re not using a drug to treat addiction,” says Dr. Labor. “We use medication as a tool in the treatment realm of drug addiction.”
Medication-assisted treatment (MAT) is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as “the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.” Dr. Labor explains this using a hypothetical situation: If you break a bone in your leg, and you want your leg to heal, you need to take pressure off of it for a period of time. The goal is to eventually be able to put pressure back on the leg, regain your strength, and walk again—and most people will—but in the meantime you use crutches.
How Medication Impacts the Brain in Recovery
“If you are using drugs, drugs are your solution to everything,” says Dr. Labor. “The brain wires itself to say, when I take this drug, I instantly feel better.”
To better understand this, you need to know about two parts of the brain involved in recovery:
- The frontal cortex, responsible for things like decision making, social appropriateness, and other cognitive behaviors
- The midbrain, a part of the limbic system, responsible for reward, pleasure seeking, satiety and survival
The goal of treatment is to restore the frontal cortex and help people learn to cope with life without needing the substance: One way to achieve this is by using medication.
“Medication takes some pressure off of the midbrain, the part of the brain that’s craving and really wants to use,” says Dr. Labor. “This gives the person the capacity to use other parts of the brain to develop some skills—like coping skills and stress relief—or to attend out- or in-patient therapy without the obstacle of constantly being triggered or thinking about using a substance.”
Common Medications Used in MAT
For the treatment of Alcohol Use Disorder:
|Disulfiram (Antabuse)||Makes you ill if you come in contact with alcohol|
|Acamprosate (Campral)||Reduces cravings for alcohol|
|Oral Naltrexone (ReVia)||Reduces cravings for alcohol|
|Injectable Naltrexone (Vivitrol)||Reduces cravings for alcohol|
For the treatment of Opioid Use Disorder:
|Oral Naltrexone (ReVia)||Blocks the euphoric effects of opiates|
|Injectable Naltrexone (Vivitrol)||Blocks the euphoric effects of opiates|
|Methadone||Full opiate agonist that fills opiate receptors and reduces withdrawal and cravings|
|Buprenorphine (Suboxone, Zubsolv, Subutex)||Partial opiate agonist that fills opiate receptors and reduces withdrawals and cravings, also blocks other opiates from working at the receptors|
|Injectable Buprenorphine (Sublocade)||Partial opiate that reduces withdrawal and cravings; monthly injection reduces need for daily dosing|
Using Oral Naltrexone (ReVia) and Disulfiram (Antabuse)
In MAT, there are medications for two different substance abuse disorders: alcohol use disorder (AUD) and opioid use disorder (OUD).
“The way medications work in individuals for those specific disorders is different,” says Dr. Labor. “It varies both by medication and the substance we’re treating.”
Oral naltrexone (ReVia) is a medication approved by the Food and Drug Administration to treat both AUD and OUD. According to SAMHSA, naltrexone is not an opioid and is not addictive. It binds and blocks opioid receptors, which reduces and suppresses cravings.
“If someone with opioid use disorder takes naltrexone, it completely blocks the opioid receptors in the brain,” says Dr. Labor. “If someone tries to use an opiate, they will get no response—no euphoria—because those receptors are blocked.”
The way that naltrexone works for those with AUD is different. “Naltrexone slightly decreases the overall effect of alcohol and reduces cravings,” says Dr. Labor.
There are other medications that focus on decreasing cravings for alcohol. For example, disulfiram, known by the brand name Antabuse, is used in the treatment of AUD. Disulfiram is a negative reinforcer, meaning it makes you violently ill if your body comes in contact with alcohol.
“This doesn’t quite have the impact that we want,” says Dr. Labor. “It is human nature to avoid negative consequences, and sometimes the medication is associated with the negative consequence—not the opioid or alcohol use.” As a result, some people will simply stop taking the medication and continue using the substance.
Still, Dr. Labor notes, disulfiram can be used for someone in recovery who wants to attend a social event, like a wedding or large family gathering, without fear of relapse. And there are other medications for those with AUD that reduce cravings for alcohol, including acamprosate (Campral) and injectable naltrexone (Vivitrol).
Using Methadone, a Long-Acting Opioid
A lot of the drive to use for people addicted to opiates is that they are short-acting: The person uses, experiences euphoria, and within a few hours, they are already getting restless, irritable, sick, and feeling physical withdrawal.
“Replacing the opiate in the receptor with methadone, which is really long acting, can help reduce that seeking behavior,” says Dr. Labor. “This puts the person in a position where they can start seeking skills, not drugs.”
Many people have heard of methadone, a long-acting opioid agonist, as a treatment for pain. Chronic pain patients can be prescribed methadone out of a doctor’s office like a regular pain medication. However, if you have OUD and you need methadone, you must go through a federally qualified methadone clinic with federal and state regulations.
“Typically the individual starts by going every day, dosing at the clinic, and continuing to dose daily at the clinic until they meet certain qualifications and can get take-home doses,” says Dr. Labor. “However, if they actively use another substance, or their urine isn’t clean, they must go back to daily dosing.”
The availability of Sublocade, an injection of buprenorphine extended-release, has given people with OUD an alternative to daily or weekly methadone dosing. Because of its extended release, the need to take something every day is eliminated.
“When we treat addiction, we want to treat every aspect, including the idea of ‘I’m sick, I need to take something,” says Dr. Labor. “Transitioning the individual to an injectable form of medication eliminates that behavior.”
The person comes in once a month to get an injection—never waking up sick and never having to worry about withdrawal or about losing their prescription.
Achieving Long-Term Recovery: 12-Step Programs
Medication-assisted treatment is only part of an individual’s recovery: It is used alongside ancillary services like group therapy, peer coaching, and 12-step programs.
Dr. Labor is able to relate with her patients from her own experience in recovery. She has been in recovery since 2005 and has continued to work a 12-step program for 18 years.
The 12-step model, as defined by American Addiction Centers, is based on the basic premise that “people can help one another achieve and maintain abstinence from the substances or behaviors to which they are addicted.” Contrary to popular belief, while a 12-step program does incorporate a spiritual component, the program is not based on any specific religious doctrine.
“A 12-step program isn’t the only way,” says Dr. Labor. “But there has to be a conversation about your long-term goal. There has to be a conversation about sacrifice. For me, [recovery] is about creating a life that you like and enjoy; a life that you don’t have to escape from.”
She continues: “When an opportunity to use a substance comes up again—and it always will—it’s a lot easier to sacrifice that moment in order to preserve what you have in the rest of your world.”
OneEighty’s Medical Services for addiction and substance abuse were formed in 2010 and continue to offer medication-assisted treatment. OneEighty follows the chronic care model, using the 6 dimensions of ASAM (American Society of Addiction Medicine) to assess clients and form treatment plans. In addition to MAT, OneEighty offers counseling programs, intensive addiction treatment programs, group addiction treatment, residential services, recovery housing, and peer recovery.