Medication-assisted treatment (MAT) is a controversial but commonly used method to treat addiction and drug dependence. Addiction is a chronic disease and it comes with a plethora of medical needs. Addiction treatment often involves medically managed interventions, especially during the detoxification process. According to the National Institute on Drug Abuse, one of the factors that make foreffective addiction treatment is the ability to meet multiple needs. However, the line for appropriate use of medical interventions is a hotly debated topic in the addiction field.
Learn more about medications used to treat addiction and why it’s such a controversial subject.
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What Are the Dangers of a “Cold Turkey” Detox?
If you have been chemically dependent on an addictive substance for long enough you know that missing a dose or going long enough without one can come with some uncomfortable symptoms. This is because your brain and body have gotten used to the drug through a buildup of tolerance. This occurs when the chemicals introduced by drugs or alcohol begins to replace normal neurochemical processes in balancing brain chemistry. Your brain may even produce its own natural chemicals to counteract the effects of the drug.
For instance, alcohol suppresses your central nervous system by activating a receptor that is responsible for inhibiting certain functions. After a while, your brain will stop producing its own nervous system inhibiting effects and rely on alcohol, which is when dependence begins. Then it will start producing excitatory chemicals to counteract the effects of alcohol, which is when you will start to feel your tolerance levels build.
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When you suddenly stop using a drug that you have become dependent on, you will be abruptly removing a source of chemicals that your brain is both relying on and working to counteract and balance. Your brain’s efforts to balance against the drug are now unleashed, causing uncomfortable withdrawals.
Different drugs have different withdrawal symptoms, ranging from uncomfortable to deadly. Here is a brief description of the withdrawal effects of the major categories of addictive drugs:
Opioids like heroin, oxycodone, and fentanyl cause flu-like effects during withdrawal. They are generally not medically dangerous although sweating, vomiting, and diarrhea can cause dehydration which can be life-threatening without treatment.
Stimulants like cocaine, crack, and methamphetamine can cause serious psychological symptoms in withdrawal including anxiety, depression, and even psychosis. In some cases, especially with meth, depression can be extreme enough to cause suicidal thoughts or actions.
Depressants include alcohol, benzodiazepines, and barbiturates, which can produce some of the most dangerous withdrawal symptoms. During withdrawal, your nervous system will become overactive, which can cause seizures and a potentially deadly symptom called Delirium tremens. Without treatment, Delirium tremens has a mortality rate betweenfive and 15 percent.
Withdrawal symptoms are often at their worst when a heavy drug user stops abruptly. Weaning off of a drug is still difficult but it’s generally safer. However, the safest option is to seek medical detox, especially when it comes to depressants.
How Medications Can Help
Medications are used at some point during the addiction treatment process in the majority of cases. In some cases, medical interventions are mild and only involve basic medications in order to manage symptoms. But addiction can affect your life in a number of ways. Withdrawal symptoms can be painful and need to be effectively managed in treatment, but drug use is often associated with other medical complications, the contraction of infectious diseases, and the existence of co-occurring disorders.
For treatment to be effective, it needs to treat the whole person and that includes physical and psychological problems they might have. Addiction can feed off of other problems and in some cases, these simultaneously occurring issues can be an underlying cause of addiction. When you enter a treatment program, you will be placed in a level of care based on your specific needs. If you need medical interventions you will be placed in the highest level of care according to the American Society of Addiction Medicine’s (ASAM)continuum of care. This level is called medically managed intensive inpatient service, better known as medical detox.
Medications can be used for three different purposes in addiction treatment:
Since withdrawal symptoms can be extremely uncomfortable and potentially dangerous, medications can be used to treat symptoms and alleviate withdrawal.
Addiction is a complex disease that affects your life in multiple ways including your physical and mental health. Addiction is also closely related to mental health issues. According to the Substance Abuse and Mental Health Services Administration’s 2014 national survey,7.9 million people in the U.S. experience a mental health issue and a substance use disorder simultaneously. For treatment to be effective, the SUD and the mental issue must be treated and psychopharmaceuticals can be used in drug and alcohol treatment.
This is a treatment modality called Medication-Assisted Treatment (MAT) and involves replacing a harmful substance with a carefully controlled medication in a way that stops cravings and uncomfortable symptoms. This type of therapy can last from a year to an indefinite period of time. It is a controversial method of treatment (more on that later) but there are a number of medications approved for MAT.
What Medications are Used in Detox?
There are a variety of addiction treatment options available to combat dependence on prescription and illicit drugs. The U.S. Food and Drug Administration (FDA) has approved several medications to help in addiction treatment, especially for alcohol and opioids. Aside from a number of medical interventions used to alleviate pain, discomfort, anxiety, depression, and other symptoms of withdrawal, there are no FDA approved medication specifically designed to treat stimulant addiction.
Medication-Assisted Treatment for Opioids
Opioids are the leading drug of abuse in the United State’s current addiction epidemic. The opioid crisis has led to a nearly exponential increase in annual overdose deaths each year. In 2016, over42,000 people were killed by overdose involving opioids. There are several effective treatment options for opioid addiction and medical detox can involve medications that treat some of the uncomfortable symptoms of withdrawal. The FDA has approved several medications to treat opioid overdose, addiction, and withdrawal.
Methadone is, itself, an opioid that has a generally less potent effect on the brain and body than other, commonly abused opioids. It binds to the same receptors in the brain as heroin and opioid pills and prevents withdrawal symptoms and cravings. Methadone can also be used as a pain reliever.
This is another opioid that’s used to treat pain and opioid addiction. It tends to have less of a chance of causing respiratory depression than other opioids
Naltrexone is used to block the euphoric effects of opioid drugs. It removes the positive reinforcment that comes with opioid use and addiction. It has a relatively long half-life and can stave off withdrawal symptoms for hours.
Naloxone isn’t used to treat withdrawal symptoms or addiction on their own. Instead, it binds to opioid receptors and blocks the binding of other opioids. Naloxone is an opioid receptor antagonist and doesn’t active the receptors in the way that opioids do. By itself, a user wouldn’t feel any effects. If it is administered to someone who is intoxicated by opioids or is experiencing an overdose, it immediately binds to the receptors, kicking off the existing opioids. Because it can abruptly stop the effects of an opioid, it can quickly send a person into withdrawal symptoms. However, this drug is used by paramedics and other first responders to save the lives of people during an overdose. It can also be bought over the counter in some states.
Medication-Assisted Treatment for Alcohol
Alcoholism is a serious disease and, because alcohol is so available, it’s very common in the United States. Alcohol abuse and excessive drinking accounts for88,000 deaths annually and about1 in 8 people in the U.S. has an alcohol use disorder (AUD). Alcohol was among the first drugs of abuse that were considered in the creation of modern addiction treatment methods like 12-step programs. There are dozens of treatment and therapy options for people with AUDs and the FDA has approved several medications for MAT:
This is a drug used to treat chronic alcoholism and it’s best used alongside other treatment options, especially detox. The drug causes incredibly uncomfortable symptoms when mixed with alcohol. If it is taken within 12 hours of an alcoholic beverage it can cause nausea, vomiting, chest pains, headache, and difficulty breathing. The idea is that, along with treatment, disulfiram will act as a deterrent. The negative experience will reinforce your brain to associate alcohol with unpleasant side effects rather than euphoria.
This is a drug that is exclusively used to treat alcohol and is thought to alter chemical signaling in the brain to help people avoid drinking alcohol after they have already achieved some sobriety. This medication is typically only effective after detoxification and alongside treatment. It doesn’t stop withdrawal but may prevent some cravings.
Naltrexone can also be used to treat an alcohol use disorder by blocking the euphoric effects of alcohol intoxication. This breaks the positive reinforcement of alcohol and helps to motivate people to stay in treatment for longer.
The number one drawback of both naltrexone and disulfiram is that they both require the willpower to take the medication in order to deter the use of alcohol. Many people with an alcohol use disorder have incredible impulses to drink and if all it takes to feel the euphoric effects of alcohol is to skip medications then the drugs won’t be helpful for some people who are not med compliant. For this reason, treatment is essential to use in conjunction with these medications.
Though there are no pharmacological treatment options that are specifically used to treat cocaine, crack, or meth addiction, there are a number of medical interventions available to someone going through stimulant withdrawals. Since serious depression is a common side effect of stimulant withdrawal, antidepressants like mirtazapine, desipramine, and bupropion can be used.
What Are the Risks?
Medication-assisted treatment can make a big difference in the lives of people struggling with addiction, especially if they have already gone through a pattern of recovery and relapse several times. However, like most medications, MAT medications are not without their risks. Opioids that stop withdrawal symptoms like methadone and buprenorphine come with a number of risks like other opioids. First of all, it’s important to wait enough time before starting methadone treatment. If you are coming off of opioid addiction or recent treatment using opioid painkillers, taking methadone too quickly can result in dangerous overdose symptoms.
Some MAT drugs have their own risk of tolerance and dependence.
Methadone maintenance is designed to essentially replace and harmful, powerful opioid with a more safely manageable opioid. Still, you will be dependent on methadone, and in many cases, it is more difficult to break methadone tolerance than it is for other opioids. Methadone withdrawal symptoms are said to be more severe than many other common opioids of abuse like heroin.
Medically-Assisted Treatment Controversy
The use of medically-assisted treatment is one of the most hotly debated topics in the addiction treatment field. In MAT, drugs like methadone are used on a long-term basis to stop withdrawal and cravings without breaking drug dependence. While this helps people avoid the dangerous consequences of using illicit or illegally-acquired drugs, clients in a long-term MAT continue to depend on a chemical substance.
Proponents of MAT point out that people who may otherwise continue use drugs, risking their health and life, can live productive lives on carefully controlled replacement medications. According to SAMHSA, the medications used in MATshow no evidence of causing adverse effects on a person’s cognitive function, psychology, or physical well-being. These medications are closely regulated and can only be dispensed by certified sources. Many people who go through treatment are chronic relapsers and some argue that MAT may be their only viable option.
However, people who receive long-term MAT often never break dependence. In some cases, replacement drugs can be used therapeutically, to wean someone off of a drug. However, they are often used to replace the drug of abuse indefinitely, lasting years. In these cases, long-term MAT is used as a crutch where addiction treatment may successfully lead to long-term sobriety.
Overall, effective treatment and behavioral therapies that can lead to lasting abstinence from drug use is the best option. However, when someone suffers from chronic relapse, MAT may be an effective therapeutic tool. But the indefinite use of replacement drugs should only be a last resort.
Start Your Journey to Recovery
Addiction may be a complicated, chronic disease but you don’t have to go through it alone. The first step in overcoming addiction is to explore your options for treatment, whether you need medication-assisted services or clinical services. Our staff is ready to take your call at any time day or night.