For many people struggling with addiction to opioids or alcohol, the battle isn’t only psychological, but physiological. Physical cravings, withdrawal symptoms, and long-term neurological effects can make it feel impossible to recover from these addictions without an appropriate support system in place.
Medication-assisted treatment has changed that dynamic.
Our MAT program at All In Solutions uses FDA-approved medications in combination with evidence-based behavioral therapy to offer each client the greatest chance of long-term recovery.
What Is Medication-Assisted Treatment?
Medication-assisted treatment (MAT) is a combination of FDA-approved medications, counseling, and behavioral therapy that helps to treat substance use disorders, primarily opioid use disorder (OUD) and alcohol use disorder (AUD). MAT is one of the most researched and clinically supported treatments for addiction, and, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Drug Abuse (NIDA), is a first-line treatment for opioid and alcohol addiction.[1]
MAT is not an alternative to addiction treatment, but a supplemental aspect of a recovery plan. The medications involved in MAT work by addressing the neurological mechanisms that contribute to addiction: reducing cravings for opioids, blocking the euphoric effects of opioids or alcohol, alleviating withdrawal symptoms, and stabilizing brain chemistry in a manner that allows clients to better engage in their recovery through other therapeutic avenues.
When MAT is employed in conjunction with individual and group therapy and a complete recovery plan, treatment retention is significantly improved, the chance of relapse is lower, and the rate of fatal opioid overdoses is reduced.[2]
MAT at All In Solutions is never one-size-fits-all. It is one of many tools used to build a personalized recovery plan for each client, depending upon their particular medical history, comprehensive history with substance use, and recovery objectives.
MAT Medications: How They Work
Medications for Opioid Use Disorder
Methadone — Due to its long-acting nature, methadone helps reduce withdrawal symptoms and cravings for opioids without creating euphoria. Methadone binds to the opioid receptors in the brain to help stabilize brain chemistry and lower compulsive behavior associated with use. Methadone has evidence supporting its effectiveness in the reduction of opioid use and improvement of treatment retention. Methadone must be prescribed by a licensed provider and provided under strict medical supervision at a licensed opioid treatment program.
Buprenorphine — Buprenorphine partially binds to opioid receptors in a similar manner to methadone; however, because of its ceiling effect, it manages withdrawal symptoms and cravings without producing the full euphoric effects of opioids. The common clinical form is a fixed-dosage combination of buprenorphine and naloxone sold as Suboxone. Suboxone is an office-based medication and, given its lower risk of abuse, is widely available for patients with OUD.
Naltrexone — Naltrexone is an opioid antagonist that blocks the opioid receptors so that opioids cannot produce their euphoric effects. Naltrexone is available for daily oral administration or monthly injectable administration known as Vivitrol, providing significant benefits for both the client and provider by eliminating the need for daily dosing and improving compliance. Naltrexone is a medication of choice for many prescribers and patients due to its lack of abuse potential. It is also effective in reducing alcohol cravings and the euphoric effects associated with alcohol consumption.
Naloxone — Although not used independently as an MAT medication, naloxone is an opioid antagonist used in emergency situations for the rapid reversal of opioid overdoses. It plays a vital role in harm reduction for those receiving treatment for opioid use disorder and is most frequently prescribed in combination with buprenorphine in products such as Suboxone.
Medications for Alcohol Use Disorder
Naltrexone — As stated above, naltrexone is effective in treating both OUD and AUD. By blocking the effects of opioids at the opioid receptor, naltrexone diminishes the pleasurable effects of alcohol and results in decreased motivation to consume alcohol and reduced alcohol cravings. Both oral and injectable (Vivitrol) formulations are utilized in treating AUD.
Acamprosate — Acamprosate is an FDA-approved medication for managing AUD. It works to rebalance the neurotransmitters in the brain that have been altered due to chronic alcohol consumption. Acamprosate is especially effective at decreasing symptoms of dysphoria, insomnia, and increased anxiety that many experience when they first stop drinking — all of which are significant contributors to relapse. It does not treat physical withdrawal and is generally initiated only after the individual has completed detoxification.
Disulfiram — Disulfiram has a different mechanism of action compared to other AUD medications. Disulfiram does not eliminate cravings, but rather produces a negative experience following alcohol consumption through facial flushing, nausea, and rapid heartbeat. This creates a significant deterrent to drinking alcohol. When used in conjunction with a solid social support system and behavioral therapy, disulfiram may provide an even more powerful deterrent. The impact of disulfiram is maximized when the individual is determined to remain sober.
Who Is MAT Right For?
MAT is an evidence-based treatment for a range of clients, and will only be incorporated into a client’s recovery plan based upon the collaborative decision-making of the client and their treatment providers. Some examples of clients who commonly benefit from MAT include:
- Clients at high risk for opioid overdose who would have their relapse risk significantly reduced with an opioid receptor blockade.
- Clients with opioid use disorder, including those with a history of heroin, prescription opioids, fentanyl, or any other opioid drugs.
- Clients with alcohol use disorder who have not achieved long-term recovery using behavioral therapy on its own.
- Clients with severe withdrawal symptoms that are likely to create challenges in their ability to participate in treatment without medically supervised withdrawal management.
- Clients who are returning to treatment after a relapse and require additional medical support to become stable enough to participate in a program.
If you have questions regarding whether you or a loved one should pursue MAT, please call our admissions office to arrange for a clinical assessment to help determine the appropriate level of care.
The Efficacy of Medication-Assisted Treatment
There is considerable evidence supporting the use of MAT for OUD and AUD. According to SAMHSA and the NIDA, MAT represents one of the most successful components of OUD treatment, and the results of numerous studies demonstrate many positive outcomes, particularly:
- Reduces addiction to illicit opioids and decreases the incidence of opioid overdose deaths [3]
- Increases retention in treatment for those with OUD; those who received MAT were at least twice as likely to remain engaged in treatment than those receiving behavioral therapy alone [4]
- Reduces criminal activity associated with drug use [5]
- Improves social functioning, employment rates, and family outcomes for those with OUD [6]
- When combined with behavioral therapies, MAT produces superior outcomes than either behavioral therapy or MAT alone [7]
For those with AUD, both naltrexone and acamprosate have been shown in randomized clinical trials to substantially lower the risk of relapse and increase the length of abstinence compared to placebo.[8] Disulfiram has been shown to be a strong deterrent to alcohol consumption among motivated individuals who have the appropriate clinical resources.
There is abundant evidence supporting the use of MAT; however, it continues to be underutilized in part due to the ongoing stigma associated with the use of medications in addiction treatment. At All In Solutions, we reject the notion that using medications to treat a clinically diagnosed disease is a shortcut or incomplete recovery. MAT is a medical treatment for a medical condition. For some clients, MAT represents the foundation upon which all other aspects of recovery can occur.
What to Expect From MAT
MAT typically begins with a detailed clinical assessment. The evaluation determines the type and severity of substance use disorders, medical history, co-occurring mental health disorders, and previous treatment. From this assessment, the clinical team determines if MAT is clinically appropriate and which medication or combination of medications will best support the client’s needs.
Clients receiving MAT usually participate in another treatment program alongside their medication protocol — engaging in individual and group therapy with their case manager through a treatment plan that addresses all aspects of recovery. Medication is frequently monitored and adjusted during treatment, and transitions across levels of care are coordinated to maintain continuous MAT support.
Discharge and aftercare planning includes a clear plan for how to continue, taper, or transition from MAT medication after the completion of a formal treatment program — because MAT, like recovery itself, does not end with discharge.
What to Expect from MAT at All In Solutions
At All In Solutions, MAT is delivered as a part of a comprehensive care model, not independently. Our model recognizes that MAT treats only the physiological aspect of addiction; to achieve long-term recovery, psychological, behavioral, and social issues must also be treated.
Every client receiving MAT receives a complete course of evidence-based behavioral therapy concurrently with their medication regimen, including cognitive-behavioral therapy (CBT) to address the thought processes that may be driving addiction, group therapy to build meaningful connections with others in recovery, and individual therapy to address the underlying trauma, co-occurring mental health issues, and personal circumstances that have contributed to substance use.
Throughout the course of treatment, our medical professionals continuously monitor each client’s response through ongoing clinical assessments, which may result in adjustment of dosage or medication.
MAT is offered at multiple levels of care, including inpatient, outpatient, and intensive outpatient, which allows for continuity of medical support throughout the continuum of recovery.
