Medication Assisted Treatment: Choosing a Side & How the Opioid Epidemic Led Us Here

The future of drug and alcohol treatment is here, and its name is MAT. MAT (Medication Assisted Treatment) is exactly what it sounds like. While being an old form of treatment it is most recently hitting headlines and beginning to be used nationwide. So what is it? It is treatment assisted with use of medications. These medications are used as maintenance, to dull the effects of illicit drug use, and to help with the cravings associated with addiction. Which in all reality, sounds like it should pretty effective. And it is, for keeping those addicted alive and for maintaining a quality of life that is better than the one most people suffering from addiction and alcoholism are accustomed to. However, there are those who believe that medication assisted treatment is merely a change in addiction and isn’t treating the core issues. That an effective treatment works because it supports total abstinence rather than replacing one substance with another.

These two mindsets, while they are not entirely exclusive, have had a polarizing effect on the treatment community. There are those who are rallying behind the idea of MAT, and those speaking out against it. The differences, if you must, truly are in the way the two treatment modalities define recovery and rehabilitation. One as you will see, defines patient survival and a decrease in illicit use as successful, the other, patient survival, as well as total abstinence.

For Medication Assisted Treatment

MAT has proven by all scientific standards to be clinically effective and to significantly reduce the need for inpatient detoxification services for those addicted to opioids. It considered the gold standard among doctors and clinicians nationwide whose goal is to improve the lives of those addicted while also keeping them alive.

The MAT approach has been shown to:

• Improve patient survival
• Increase retention in treatment
• Decrease illicit opiate use and other criminal activity among people with substance use disorders
• Increase patients’ ability to gain and maintain employment
• Improve birth outcomes among women who have substance use disorders and are pregnant

Despite these positive outcomes and the science to back them up, MAT is very rarely used. The proportion of heroin admissions with treatment plans that included receiving medication-assisted opioid therapy fell from 35% in 2002 to 28% in 2010. The reason for the slow adoption of MAT is due to the fact that many believe that it is substituting one addiction for another. Discrimination against MAT patients is also a factor, despite state and federal laws clearly prohibiting it. Other factors include lack of training for physicians and negative opinions toward MAT in communities and among health care professionals. However, we are all seeing an increase in the use of MAT and many who were strictly abstinence based are opening up to the idea. And it may be more necessary than ever with the rate of overdose deaths continuing to rise. The focus of treating addiction has changed from helping individuals find abstinence-based recovery to simply keeping them alive. And MAT is a great tool.

For Abstinence Based Treatment

Abstinence based treatment is defined as the complete cessation of drug or alcohol use. Abstinence has long been heralded as the best and most effective way to defeat addiction. Even dating back centuries, before addictions were treated as medical conditions, the traditional way to break drug or alcohol dependencies was abstinence. Now known as the Minnesota Model, abstinence addiction treatment which was originally created for alcoholism is now used to treat all addictions and is the most widely used basis for treatment in the country. Abstinence based treatment is successful in helping the patient stay 100% abstinent from all mind and mood altering substances.

Abstinence Based Treatment has been shown to:

• Improve patient survival
• Increase retention in treatment
• Decrease illicit opiate use and other criminal activity among people with substance use disorders
• Increase patients’ ability to gain and maintain employment
• Improve birth outcomes among women who have substance use disorders and are pregnant

Just like MAT. Abstinence based treatment does the same thing. Those who argue for abstinence-based treatment may even say that it improves the quality of life significantly more than MAT. Due to the fact that the individual does not need a medication to live day to day. Another piece of the argument is that MAT doesn’t actually treat the disease of addiction, it merely treats its symptoms and reduces the harm it causes. So are we truly treating the patient or just covering up symptoms? Abstinence based treatment also argues that it isn’t the lack of medication that has kept the overdose rates where they are, it is the lack of available treatment all together. And this very well could be true. Getting and finding addiction treatment is difficult and expensive.

The abstinence-based approach has been used since the 1940’s and it will continue to be a standard. However, with the opioid epidemic taking over 70,000 lives a year, and insurance companies asking for MAT to be put in place at most centers—it is looking like we may see more abstinence-based centers shift towards providing MAT with an abstinence-based foundation.

The Changing Tides of Addiction Treatment and The Opioid Epidemic

We have already seen the gold standards in addiction treatment begin to offer MAT. Hazelden Betty Ford being one of the biggest and most well-known. Hazelden’s move to start offering MAT sent a shockwave through the larger treatment community. Is this the death of abstinence-based treatment? Is this going to end up hurting more than helping? The commentary regarding the change went on, and on, and on.

With this new shift in treatment modalities only recently underway we have yet to see. We do know however, that at this point in time, helping those suffering with addiction and alcoholism is more paramount than ever. People are playing a dangerous roulette every time they use these days. Due to this fact, the goals of treatment may have to change. It may have to mean the use of MAT. Or it may mean we need to start looking at this epidemic of one as addiction and starting treating causes and conditions.

So, what do you think? Is MAT going to help save lives? Or are we all going down a dark path that is going to lead us into our next drug epidemic?