The Benefits of Medication Assisted Therapy for Addiction TreatmentAddiction Treatment
Addiction is a serious problem that affects 40 million Americans, according to a recent study. Although societies have struggled with addictions for more than a century, in recent decades, medical science has helped us to understand the problem and find various ways of treating it.
There was a time when addicts were considered lost souls. It was believed they had some sort of character flaw that made them react to drugs and alcohol differently from most people. Once an addiction was recognized, there was nothing that could be done other than to try to restrict access to the drug of choice.
Addiction treatment is a lot more advanced now. Brain science research has identified the specific areas of the brain related to addiction and has shown how drugs manipulate brain chemicals to create dependence. The genetic component of addiction is understood, along with other factors that can mitigate the risk.
Brain chemistry alters behavior, which is how addiction is created and perpetuated. Modern addiction treatment requires a combination of behavior modification and detoxification. The difficulty often lies in the interaction between altered brain chemistry and addiction-driven behaviors. Addiction works against your recovery.
The Current Addiction Epidemic
The basic concepts of addiction have not changed. We just know more about the process than ever before. Alcohol, nicotine and opium are still the major culprits when it comes to addictive substances. The fastest growing addiction in the US is opioids — medications derived from or that mimic the chemical profile of opium.
The face of addiction has changed in recent decades, though. The typical addict is no longer just a rich superstar who succumbed to the fast lifestyle of cocaine, or the poor inner-city teenager trading dope on the corner as his only career option. Today, addiction is reaching all neighborhoods and all ages because it is not a profile or a stereotype. Addiction is a deadly disease that does not discriminate.
One of the greatest contributing factors to addiction is access. Anyone who has access to addictive substances has the potential to develop an addiction. No longer just a problem associated with illicit drugs, addiction is happening with over-the-counter medications and prescription drugs, too. These substances are available to children tall enough to reach the medicine cabinet at home, grandmothers recovering from hip replacement surgery and weekend athletes who suffer ankle strains.
The addiction crisis in this country is growing in part due to the fact that more medications are being produced and are available to the public. No one wants to become an addict, but sometimes using medication for legitimate medical purposes leads to addiction before anyone realizes it. Once addiction takes hold, treatment is required to keep the situation from worsening.
Advances in the pharmaceutical industry have brought us a means of relieving pain for many chronic pain sufferers. These medications also speed healing and alleviate discomfort for thousands of surgery patients each year. It only makes sense that the industry could come up with something to help mitigate the addiction dangers of these potent medications.
Medication for Those Addicted to Medication
It may seem counterintuitive to rely on medication to help end an addiction, especially one that started innocently with a medical need. A deeper understanding of the brain chemistry involved in addiction, however, shows the value of this approach.
Drugs, whether they are over-the-counter, regulated by prescription or obtained illegally on the street, alter your brain chemistry. When addiction is concerned, those drugs have an effect on the pleasure centers of the brain. They either block the brain from receiving certain natural chemicals or they mimic those brain chemicals.
The brain uses chemicals, neurotransmitters, to send messages throughout the central nervous system. They communicate everything from sensory perceptions — for instance, seeing that the sky is blue — to complex emotions — such as sadness. When drugs interfere with the messaging system, you may see things that are not really there or not understand that stepping off the edge of the balcony would result in serious injury.
In the same way, drugs can interfere with the pleasure centers in your brain, and this is where addiction is created. Your brain is naturally designed to create healthy habits to improve your quality and longevity of life. Sexual arousal is the most obvious example of how this system is supposed to work. The pleasure you feel feeds back certain chemicals to your brain that make you want to repeat those actions that gave you pleasure, thus forming a habit that is meant to promote procreation and the continued survival of the species.
This habit-forming system also releases feel-good chemicals in your brain when you exercise, so it promotes this healthy habit. The system has many positive uses.
Unfortunately, this habit-forming system gets distorted and used to develop addiction — dangerous patterns of behavior. Drugs stimulate the pleasure centers in the brain to produce euphoria. The drug-taking behavior becomes a habit because your brain is driving you to reach that euphoric state again. Each time you do so, it takes a little more of that substance and reinforces your pleasure-seeking habit.
If Chemicals Create Addiction, How Can They Help?
In a very simple sense, drugs get into the brain and cause addiction. Taking the drugs out of the brain, which happens naturally during detox, should be the solution. The problem is that drugs cause an entire transformation of brain chemistry which takes time to reverse — keep in mind that this brain chemistry also regulates your vital organs.
The first key to addiction recovery is detox. It is important to get the drugs out of your system, so they can stop creating more damage. Those drugs, however, are running your pleasure centers. If they are removed too quickly, your brain will not be able to create enough feel-good chemicals on its own to support you. Cravings for the drugs will be too great to ignore, and you will probably go right back to using again. If you don’t, you run the risk of lapsing into a major depression.
What you need to help ease your transition from relying on drugs to supporting your own health naturally is something to supplement your production of feel-good brain chemicals that does not produce euphoria. Over time, you can reduce the amount of this supplement until your brain has completely taken over maintaining a healthy balance of chemistry.
While you are using this substance to ease your transition out of addiction, you can work on behavior modification through various counseling techniques. Changing behaviors takes time and is extremely difficult to do while you are actively continuing your addiction or fighting strong cravings to use again.
Medication Assisted Treatment for Opiate Addiction
The opiate addiction crisis might be leading the way for medication assisted treatment (MAT) in addiction. More people die in the US from opioid overdoses (16,000 every year) than from heroin and cocaine combined. The increase in addiction rates across the country in the last ten years has everyone’s attention. Policy makers are trying to find a solution.
According to an article in the New England Journal of Medicine, MAT is a highly effective and under-utilized treatment option for addiction. In Baltimore between 1995 and 2009, the availability of MAT showed a 50% reduction in overdose deaths. MAT has also been shown to keep patients in treatment programs longer, increasing their chances of a long-term recovery.
MAT has shown the following benefits:
- Reduction in criminal activity
- Lowered risk of infectious disease
- Fewer overdose deaths
- Reduced drop-out rate in treatment programs
Addiction is a strong force that most people cannot overcome on their own. It drives them to do things they would not ordinarily do, like commit crimes to get their next fix, risk their health by sharing needles or use street drugs with unknown ingredients. MAT provides an alternative to these drug-seeking behaviors by reducing cravings until the recovering addict can manage on their own.
MAT provides a safe “placeholder” for your substance of choice. It is administered in a sterile environment and monitored by medical professionals. The medications used let your brain heal slowly instead of abruptly changing your brain chemistry. Despite the benefits, MAT is only available to 34% of people in addiction recovery programs.
Options for Medication Assisted Treatment
Addiction is an individualized condition that develops in each person a little differently. The substance of choice, or combination of substances used, has a lot to do with how the brain is affected and what it needs to heal. The goal, of course, is to protect your physical health while detoxing and to control any strong urges to use again while the emotional healing is taking place.
Habits and lifestyle are the other big component in addiction recovery. Although an addict may want to give up using substances, their habits at the beginning of the recovery process are still programmed for drug abuse. Changing those habits becomes a personal journey contingent on many individual factors.
When medication is used to assist in treatment, it has to fit into the daily routine to work properly. Patient compliance is key. That is why newer versions of the MAT medications are now available to be administered monthly instead of daily. The regular dosage is important with these medications, but if it is easier to rely on old drug habits than to travel to a clinic everyday, eventually the program will fail.
In recent years, the tools available for addiction recovery have changed to address some of these individual concerns. Here is a list of the most common MAT therapies:
- Methadone — By blocking withdrawal symptoms for people detoxing from opioids, methadone reduces cravings. It needs to be taken every day to be effective, and it carries a high potential for abuse, which is why it is strictly regulated.
- Naltrexone (Revia®, Vivitrol®) — Used for both opioid and alcohol abuse, naltrexone blocks the effects of opioids making it impossible to get high while reducing cravings. It is also effective in reducing alcohol cravings and consumption. It requires regular dosing, but there is a monthly injection (Vivitrol®) available that helps increase patient compliance.
- Disulfiram (Antabuse®) — This medication assisted treatment for alcohol has been available since the 1950s. It makes people violently sick when they consume alcohol, so it provides a deterrent from continuing the habit. It works by blocking the breakdown of alcohol in the liver and goes by the brand name, Antabuse.
- Buprenorphine (Suboxone®, Subutex®, Zubsolv®, Bunavail™, Probuphine®) — One of the newer MAT options, buprenorphine is similar to methadone, but without some of the side effects. It also presents a lower risk of abuse, making it safer and more effective than methadone. Recently, the FDA approved the first buprenorphine implant (Probuphine®) that may work up for to 6 months.
- Acamprosate (Campral®) — Known by the brand name Campral, acamprosate reduces withdrawal symptoms and cravings for alcohol by normalizing brain activity.
With MAT options available, it’s hard to believe that so many people have suffered through rehab just to relapse and possibly overdose.
MAT vs. Addiction Recovery Without Medication
When we talk about providing medication for people struggling with addiction recovery, some concerns are raised. People who are not knowledgeable in the area of addiction assume that since drugs are the problem, more drugs cannot be the solution. This is a valid position for someone who has not experienced addiction and is scared about what is happening to their loved one.
One of the basic components of the 12-step recovery program is abstinence. When Alcoholics Anonymous was first created, there was no evidence to suggest that addiction could be cured. Addiction was understood to be an unseen genetic pre-disposition that caused some people to not be able to use drugs of any kind without developing addiction. The 12-step program was a holistic approach to supporting abstinence in those people, and it was the only treatment that worked.
The 12-step method helped many people overcome their addiction and live a healthy, substance-free life, and it’s still the basis of many addiction recovery programs today. Even for people who live the 12-step lifestyle, though, relapse remains a concern. Relapse is the biggest threat to a successful recovery.
The relapse rate for recovery programs is hard to pin-point because private programs have no reporting requirements. In general, the relapse rate for addiction recovery is believed to be quite high. Some sources put it at 40-60%.
Relapse does not necessarily indicate failure, but it’s a risky place where recovering addicts do not want to be. Relapse indicates an adjustment needs to be made to the treatment plan because something is not working. It’s a terrible feeling for people struggling with addiction recovery, and it puts them at risk for giving up.
The risk of overdose is also greater during a relapse, which is a serious concern, especially with the opioid addiction crisis. Opioids are a high-risk overdose medicine to begin with. When you add to that the abuse of these substances, and potentially the mix of opioids and alcohol, the risk becomes greater. In 2014, more than 28,000 deaths were attributed to opioid use in the US.
In recovery, a person’s tolerance for opioids that may have been built up over a period of time is reduced. This increases the overdose risk in relapse. A fraction of the amount of opioids you used to take could now be enough to induce an overdose. A recent study demonstrated a 26.6% increase in overdose risk in the month following addiction recovery treatment. Relapse during treatment is more likely to result in a fatal overdose.
Access to addiction treatment is important to reducing the opioid addiction crisis in this country. Beyond that, providing treatment options with a higher success rate is paramount to overtaking the addiction rate and reducing the rate of overdose deaths. Including MAT in a treatment program can have the following benefits:
- Shorter detox time — The faster you can get the drugs out of your system, the sooner the damage stops, and you can start healing. Many people fear the detox process because of withdrawal symptoms that can be severe. By shortening the detox time and significantly reducing withdrawal symptoms, however, MAT can make it easier for people struggling with addiction to take this first step into recovery.
- Medically supervised step-down — Patient compliance is a key component to addiction recovery. In addiction, your behavior is ultimately controlled by the addiction. People suffering from addiction do not make good choices about their health, and they find it impossible to change their behavior. If you reduced the amount of your substance of choice each day by a certain percentage, you would be able to wean yourself off of the addiction. The catch-22 here is that you cannot bring yourself to take less — in fact, you want to take more. By using MAT to replace your drug of choice, a healthcare provider can take responsibility for administering a diminishing dose, stepping you down gently off the substance.
- Reduced cravings — From the very beginning of detox, relapse becomes the biggest threat to a successful recovery. As soon as you stop taking your substance of choice, your brain tries to invoke your drug-seeking habits. The cravings that opioids and alcohol create in your brain are almost impossible to ignore. MAT helps keep the cravings under control until you are more solid in your recovery. Eventually, you will learn to change your behaviors to find healthier ways to seek the happiness your brain is craving — but that takes time, and you can’t reach that part of your recovery if you end up giving into your cravings to use drugs again.
- Infectious disease risk mitigation — Addiction is dangerous in and of itself, but it also increases other serious health risks like infectious disease. MAT serves as a safer substitute for intravenous drugs while an addict is working toward complete abstinence. According to the Center for Substance Abuse Treatment, MAT reduces the risk of contracting HIV by 50% and also reduces risk of overdose death by 50%.
- Cost savings — Although there may be greater up-front costs associated with MAT, the long-range view is more economically optimistic. Depending on your individual situation, you may face costs for medication that are greater than the costs associated with a traditional rehab program with counseling but no pharmaceuticals. Research evidence suggests, however, that MAT will shorten the length of your overall rehab program and reduce your risk of relapse, which would send you back to start detox all over again.
It is important to understand that MAT is not a magic pill to make your addiction recovery easy. Recovering from addiction is a huge step that takes time and determination to fulfill. In some cases, though, the strength of the addiction is almost super-human. Without some medical assistance, many people would never be able to stop using long enough to even enter a rehabilitation program.
Learn More About Medication Assisted Therapy in Bakersfield, California
If you want to know more about medication assisted treatment in Bakersfield, California, contact Synergy Recovery Services. We are the only rehabilitation center in the region that offers a combination of counseling and medications to help you through your addiction recovery. Our comprehensive outpatient treatment program offers the best evidence-based treatment modalities, including MAT, to make your recovery as painless as possible. If you or a loved one is struggling with addiction, contact Synergy Recovery Services today to get help.