Medication Assisted Treatment (MAT) is the use of prescription medications in combination with behavioral therapy and counseling that has proven to be effective in the treatment of opioid use disorder and alcohol use disorder.
In inpatient settings it is prescribed to stabilize individuals, and prepare them for reentry into society, where they can continue to remain engaged in a lower level of care. Studies indicate that continued engagement in treatment for a significant period equates with improved recovery success rates.
At St. Joseph’s we provide MAT services in both the Inpatient and Outpatient settings. The decision to begin MAT is made within the therapeutic relationship between the doctor and the patient and is done on an individual basis.
There is an understandable reluctance among some in the addiction treatment community to MAT. Properly administered, MAT is intended to be provided in small doses and combined with cognitive, behavioral, and spiritual interventions to counteract regular drug use.
Cravings management has become a significant treatment issue in the field of addiction and MAT is an effective tool in managing cravings, increasing engagement in treatment, and long-term opportunities for clients to connect to the recovering community. The longer a client remains abstinent from illegal drugs and alcohol the better their chances are of continued recovery.
The most commonly used medications are Suboxone, Naltrexone, and Vivitrol (a 30-day injectable form of Naltrexone).
Suboxone can be used as a medication to aid in withdrawal, and more importantly to curb cravings for opioids. Suboxone, which is a combination of Buprenorphine and Naloxone, acts as both a partial agonist and antagonist and has an anxiolytic effect and helps reduce anxiety for our clients. (It should be noted that many of our clients suffer from co-occurring disorders, which indicates a significant proportion of our clients have both substance use disorders and mental health disorders.)
Buprenorphine is the chemical in Suboxone that acts as a partial agonist that binds to opioid receptor sites of the brain partially activating these sites and helps to increase the release of endorphins. Naloxone, the active ingredient in Narcan and combined with Buprenorphine in Suboxone, is an opioid antagonist which blocks the receptor sites and reverses the effects of opioid agonists. In combination these two medications stabilize the brain resulting in a reduction of cravings, increased amounts of endorphins, and does so without the effects of getting high. Essentially the drug allows clients to be more open and receptive to behavioral interventions, cognitive behavioral interventions, and other forms of therapy aimed at skill development in the recovery process.
Naltrexone and Vivitrol block receptor sites and therefore reduce cravings. Naltrexone is effective in blocking cravings for both opioids and alcohol. Unfortunately, there are no medications available at this time to reduce cravings for other drugs other than the opioids and alcohol.
As with any new medication there are myths about the efficacy of the medications. As the field continues to evolve, MAT will play a significant role in the engagement of clients and their continued treatment. Studies have proven that continued engagement yield higher success rates in the treatment of addicted individuals.
Although we are in the beginning process of tracking outcomes for St. Joseph’s MAT program, we have been able to track Suboxone clients after completion of treatment with our Inpatient program and have noticed an increase in rates of engagement in aftercare. In addition, we have experienced an increase in attendance and compliance at our Outpatient settings.
– Dave Munn, Mental Health & MAT Coordinator