Medication-Assisted Treatment in Recovery
What is medication-assisted treatment? What role does MAT play in recovery? And, what about MAT in sober living homes like A Fresh Start Sober living that focuses on healing the whole individual?
Most sober living homes require residents to be 100% substance-free. Due to this requirement, many individuals leaving inpatient treatment have to return to unhealthy living environments. Those who require medication-assisted treatment to enhance their recovery will still need to be in a MAT program after inpatient treatment. The drugs used to treat addiction typically are a long-term solution in living sober.
What is MAT?
MAT is medication-assisted treatment. This type of treatment is a combination of medication and therapy to treat substance use disorders. Individuals with opioid use disorder (OUD) or alcohol use disorder (AUD) can benefit from medication-assisted treatment. MAT is, in fact, the most effective way for some individuals to achieve long-term recovery.
In 2017, the CDC reported startling statistics about addiction, including 72,000 fatal drug overdoses and 88,000 deaths due to excessive alcohol use. So in 2018, the American Medical Association (AMA) called on policymakers to help those addicted to opioids in an unconventional manner.
The AMA recommended the use of Medication-Assisted Treatment, and in 2017 and 2018, 15,000 physicians became certified to treat people with opioid addiction with MAT. According to the Substance Abuse and Mental Health Services Administration, MAT has shown to:
- Improve survival rates
- Decreases criminal activity
- Increase treatment retention
- Increases employment retention
- Decrease the chance of relapse
- Decreases use of drugs and alcohol
Drugs Used to Treat Addiction
Medication-assisted treatment is the use of FDA-approved medications along with individual and behavioral therapies. MAT provides a “whole-person” approach to treating addiction. There are several medications approved by the FDA to treat opioid addiction and alcohol dependence.
A common misconception regarding MAT is that it just substitutes one drug use problem for another. Those who do not understand addiction, especially opioid and alcohol addictions, do not understand the benefits of these medications. These medications relieve withdrawal symptoms and psychological cravings caused by a chemical imbalance. MAT programs provide a safe and controlled level of medicine to overcome addiction.
Medications used for opioid use disorder must be dispensed by a SAMHSA-certified opioid treatment program (OTP). Some of the medicines used in MAT can be classified as controlled substances due to their risk of abuse. The Drug Enforcement Administration (DEA) classifies substances into five distinct categories or schedules based on acceptable medical use and the potential for abuse.
Opioid Dependency Medications
Methadone, Naltrexone, and Buprenorphine treat opioid dependence to heroin, morphine, codeine, oxycodone, and hydrocodone. These medications can be safely taken for years. Individuals should not stop taking these medications without first making a plan with their physician.
Methadone tricks the brain into thinking you are still abusing opioids. This drug, when used as prescribed, does not produce a euphoric effect allowing you to be active in life without going through withdrawals.
Methadone is taken by mouth once a day and is most often used in severe opioid addiction cases. Even though methadone has an excellent success record, it requires you to go to a methadone clinic every day to receive your medications.
Side effects of methadone include:
- Chest pain
- Irregular heartbeat
- Difficulty breathing
- Lightheadedness or fainting
- Hallucinations or confusion
- Allergic reactions – rash, hives, swelling in the face, lips, tongue, or throat
Naltrexone works differently than methadone and buprenorphine. It does so by blocking the euphoric and sedative effects of opioids if you relapse. Naltrexone can be taken once a day by mouth or once a month by injection. You must be free of opioids for 7 to 10 days before starting Naltrexone.
Naltrexone blocks the opioid receptors and reduces craving and has no know risks of abuse. While taking naltrexone, you should not drink alcohol, take sedatives, or use any other opioids are illicit drugs. If you relapse after discontinuing the use of naltrexone, you can be more sensitive to opioids. A “normal” pre-treatment dose could have life-threatening consequences, including respiratory arrest and circulatory collapse.
Side effects of Naltrexone include:
- Sleep issues
- Liver disease
- Allergic pneumonia
- Joint or muscle pain
- Vomiting and stomach issues
Like methadone, buprenorphine reduces and suppresses cravings for drugs. Buprenorphine is the first medication approved by the FDA to be prescribed or dispensed in the doctor’s office. This ruling makes it more accessible to obtain than methadone.
The FDA has approved the following buprenorphine products:
- Bunavail – buprenorphine and naloxone – buccal film
- Suboxone – buprenorphine and naloxone – film
- Zubsolv – buprenorphine and naloxone – sublingual tablets
- Buprenorphine – containing transmucosal products for opioid dependence
Buprenorphine has side effects similar to opioids and include:
- Muscle aches and pains
- Nausea and vomiting
Alcohol Use Disorder Medications
Disulfiram, acamprosate, and naltrexone are FDA approved drugs prescribed to treat alcohol use disorder. The medications are not used for individuals who are still actively drinking alcohol. These medications are prescribed to individuals who have stopped drinking and trying to maintain abstinence.
Disulfiram is the first medication to be approved for the treatment of alcohol dependency. This drug works by causing adverse reactions if you drink alcohol while on this medication. Most people will start vomiting after just one drink. Disulfiram is used as a deterrent to drinking.
If you take disulfiram and consume alcohol, you may feel:
- Flushed skin
- High blood pressure
- Nausea and vomiting
Disulfiram has been successfully used for over 65 years, but must be administered in small doses. Side effects of this drug usually fade away after a few weeks. Some side effects can be serious and even fatal, so it is vital to only take a directed and be aware of any ill feelings.
Serious side effects of disulfiram include:
- Optic neuritis
- Liver disease
- Hypersensitivity to disulfiram
Acamprosate is the most common medication used to treat alcohol use disorder. Unlike the other medicines used to treat alcohol use disorder, acamprosate reduces the brain’s dependence on alcohol. When you stop drinking alcohol, the brain can not function correctly.
Alcohol changes the chemistry and functioning of the brain. These changes become more severe; the longer a person abuses alcohol. When you quit consuming alcohol, the mind and body start experiencing cravings and then withdrawal symptoms. Withdrawal symptoms can be painful and even fatal.
Most side effects of acamprosate are mild and fade the longer you take the medication. Acamprosate is broken down in the digestive tract and not the liver, making this medication safe for those with liver disease. Some of the side effects are mild, but some of the side effects are serious and life-threatening. A few of the side effects include:
- Renal failure
- Suicidal thoughts
- Stomach issues
- Muscle weakness
The benefits of acamprosate include:
- Fewer side effects
- No known drug interactions
- Actively reduces cravings and dependency
- Absorbed through the digestive tract and not the liver
Naltrexone was initially used to treat opioid use disorder. Research showed that naltrexone had the same effect on alcohol as it did opioids. Naltrexone suppresses the euphoric and pleasurable sensations produced by drinking alcohol. Individuals do not receive the “reward” of drinking alcohol, and they quit drinking altogether.
This drug does not reduce cravings or reduce withdrawal symptoms of alcohol. The use of Naltrexone should be combined with therapy, other medications, and 12-step programs. Naltrexone has shown to be most beneficial in individuals who have relapsed.
One reason naltrexone is still a popular medication for alcohol use disorder is that it is comparably safe and has more mild side effects. This being said, naltrexone can have some serious side effects that need to be monitored.
Common side effects of naltrexone include:
- Ringing in the ears
- Nausea and vomiting
- Increase or decrease in energy
Less common but more severe side effects include:
- Liver toxicity
- Blurred vision
- Allergic reaction
- Suicidal thoughts
- Shortness of breath
- Hypersensitivity to the drug
Medication-Assisted Treatment in the Sober Living Community
The National Alliance for Recovery Residences (NARR) released guidelines in March of 2019 on how sober living homes should handle residents in a medication-assisted treatment program.
Many sober living homes are based on the principle of 100% abstinence from all substances, including those in a MAT program. This principle leaves many vulnerable individuals fresh out of treatment without a safe, sober environment to go to.
Sober living homes should not discriminate against those in a MAT program. Individuals should not be refused residency because they use drugs to maintain sobriety. NARR encourages admittance into sober living programs and equal treatment to those in medication-assisted treatment.
More MAT specific sober living homes are opening. Some of these homes are made up of residents who are in a MAT program and those who are not. These sober living homes have not reported any issues when these residents are living together.
NARR strongly suggests that sober living homes become knowledgable on the benefits of MAT and the drugs used to treat addiction. House managers should be trained to be aware of their resident’s prescriptions. House managers should also be trained to dispense, log, and follow strict house rules involving medicines.
Individuals in a medication-assisted treatment program deserve the same safe, sober living environment as those who are not in a medication-assisted treatment program. They are just as motivated and driven to live a life of sobriety, and they just need a little more assistance than others. No one knows another person’s struggles or past, and no one has the right to judge another’s addiction or recovery journey.
MAT In Sober Living: A Long Term Solution
Addiction is classified as a chronic disease, which means it can be managed but not cured. People with high blood pressure can manage their condition with medication, but if they stop taking medicine their disease becomes unmanageable. Some individuals need medication to maintain their sobriety, and going off their medication severely risks their sobriety.
People who enter a medication-assisted treatment program are more likely to stay in treatment. 40% of patients in a MAT program stayed in treatment at least two years, while 20% were still in treatment five years later. More than 90% of individuals who submitted urine samples remained free of opioids other than prescribed.
Studies show that individuals who stay on drugs used to treat addiction are 50% more likely to remain in treatment. This is compared to the 30% of individuals who were stabilized and then tapered off the drugs used to treat addiction. Those who tapered off the drugs to treat addiction even tapered off, showing up for the study. This suggests that those in medication-assisted treatment are more committed to treatment.
MAT As a Long-Term Solution: Am I Still Sober?
YES! You are still sober if you use medication-assisted treatment as a long term solution. Drugs used to treat addiction can help avoid relapse and maintain sobriety. People who don’t know any better say that a MAT program is just “trading one drug for another.” This is so far from the truth. Medication-assisted treatment provides safe, controlled, and effective medications.
When used correctly and under professional supervision, drugs used to treat addiction do generally not have adverse effects. When used as directed, they also do not produce any of the euphoric and rewarding feelings of drugs or alcohol. So why should you be viewed any differently for being in a medication-assisted treatment program?
MAT Provides Continued Addiction Treatment
Keep in mind that addiction is a chronic disease, just like diabetes. Individuals can treat diabetes with medication and lifestyle changes. Experts agree that we should treat addiction like every other chronic disease – with medication and lifestyle changes.
Many people in AA or NA will say that those in a medication-assisted treatment program are NOT sober. But this is very misleading and false even if the person has the best intentions. This statement is not based on scientific or the 12-step philosophy. In fact, it violates a long-held policy that AA members should not give medical advice.
According to Misti Storie, the former Director of Training for NAADAC (Association for Addiction Professionals), “neither Alcoholics Anonymous literature nor either of it’s founding members spoke against using medications as a component of a recovery plan for alcohol dependence.” She also states that “Alcoholics Anonymous doesn’t endorse encouraging AA participants to not use prescribed medications or to discontinue taking prescribed medications for the treatment of alcohol dependence or related disorders.”
So are you sober if you are in a medication-assisted treatment program? What you think and how you feel about this matter is truly all that counts. Are you clean off the substances that started your addiction? Are you only taking the medications as prescribed? Are you succeeding in your recovery? Has a medication-assisted treatment program helped you achieve all your recovery successes this far? Do you feel good about your recovery journey?
Then YES you are sober! It does not matter how you reach sobriety or how you maintain your sobriety as long as you get sober. What other people think does not matter.
Combining Sober Living and Medication-Assisted Treatment
At A Fresh Start Sober Living, we understand the impact that having a safe, sober environment is after leaving inpatient treatment for addiction. We have walked in your shoes and fought the hard battle of recovery. Now we are waiting to guide you to a successful recovery.
As a men’s only sober living home, we understand the challenges men face in everyday life; the pressures of providing for a family and still be the “cool” guy who likes to party. Give us a call and let us tell you how you can be the “cool” guy who provides a good life for his family while free from the struggles of addiction.
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About A Fresh Start Sober Living
A men’s only sober living facility, a Fresh Start is dedicated to helping courageous men in recovery make a smooth and successful transition back into the real world, one step at a time. We offer 24/7 on-site supervision by staff who truly care about your wellbeing and want to help you achieve the dream of lifelong recovery.