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The rise of opioid overdose and the number of people in the United States who relapse after rehabilitation have led medical professionals to look into alternative treatment methods, such as medication-assisted treatment (MAT). MAT is an evidence-based strategy that features the clinical use of medications to block withdrawal symptoms and cravings. This approach, when used appropriately, saves lives and diminishes the destructive effects that addiction has on millions of families.
Every year in the United States, 95,000 deaths are caused by excessive alcohol use. The use of dangerous drugs continues to impact nearly half of the U.S. either directly or indirectly. The Pew Research Center found that 46% of Americans knew a close friend or family member who had a substance use disorder at some point in their life.
The rise of opioid use and prescription drug addiction has introduced new considerations. The Centers for Disease Control and Prevention reports that almost 50,000 Americans died of an opioid overdose in 2019, and that heroin and fentanyl has soared during the COVID-19 pandemic, leading to an increase in overdoses.
While there are many treatment options for alcohol and drug use disorders, not every rehabilitation method is effective for each individual. Abstinence-only treatment programs have a history of helping many people transition away from substance use, but people with more severe addictions may need more help. Medication-assisted treatment can help people with substance use disorders begin and continue treatment for a long-term recovery.
Medication-assisted treatment (MAT) uses medications that either block cravings or act as substitutes for the substance the patient has been taking. This helps people with substance use disorders fight the cravings that often lead to relapse after treatment is over. Setbacks and relapses are common, especially in people who do not attend at least 90 days of rehab.
MAT is not a rehab addiction treatment used by itself, but part of a comprehensive rehab program. A full rehab treatment plan often involves a medical detox, where the person slowly rids their body of the drug under medical supervision. Patients attend counseling and therapy to learn coping mechanisms to dissuade psychological cravings in the days, months and years following their treatment. MAT joins these other treatment techniques when the person has a severe alcohol or opioid addiction or when it’s medically appropriate.
Considering the prevalence of opioid addiction and alcohol use in the U.S. and the number of people who relapse after rehab, more medical professionals are looking to MAT as an additional treatment to help people with more severe opioid or alcohol addictions.
When someone uses drugs over a long period, their body can become dependent on that drug to feel normal. When they miss a dose or try to detox off the drug, they’ll experience uncomfortable withdrawal symptoms that may encourage them to relapse and use the drug again. Unfortunately, many individuals who start drug use after stopping have a decreased tolerance for the substance, often leading to a potentially fatal overdose.
MAT medications can often prevent or reduce withdrawal symptoms that usually come with the detox portion of addiction recovery. This advanced treatment strategy could reduce the potential for relapse and the number of overdose deaths. For this reason, MAT is the gold standard treatment for severe opioid addiction.
Opioids, including prescription drugs like codeine and illicit substances like heroin, interact with the brain and body similarly to alcohol. Opioids interact with the brain’s opioid receptors to release dopamine, causing a euphoric feeling.
The medications used in MAT programs for opioid addiction are opioids themselves or similar to opioids. They interact with the brain’s opioid receptors to satisfy physical cravings while blocking euphoric effects. Since these drugs are administered in a medical setting and doses are restricted, patients avoid overdosing or building a new tolerance.
Methadone was first approved by the FDA in the 1940s to suppress coughing and has since become one of the most commonly used opioid-replacement medications for treating physical pain and substance use disorders.
Since it is an opioid itself, methadone interacts with the brain’s opioid receptors the same way as heroin or other more extreme opioids but with milder effects. Since methadone is administered in a medical setting, the dosage is restricted enough to block withdrawal symptoms, but not enough to release dopamine and cause the high that other substances trigger.
Buprenorphine is a partial opioid agonist that the FDA first approved in 2002 under the brand names Suboxone and Subutex. Since then, buprenorphine has also been approved in the form of Bunavail buccal film, Probuphine implant and Zubsolv tablets for MAT programs.
As a partial opioid agonist, buprenorphine has less severe effects and dependency potential. It can block the effects of other opioids in addition to diminishing opioid cravings. Buprenorphine can stay attached to opioid receptors longer than other opioids, which means buprenorphine can remove other opioids from receptors and block some effects that opioids usually have on the brain.
Naltrexone is also an opioid agonist, blocking opioids from interacting with opioid receptors and reducing the overproduction of dopamine. Vivitrol is the only FDA-approved naltrexone brand that can be used in an MAT program.
Naloxone stops and reverses overdoses caused by opioids such as oxycodone, morphine or heroin by blocking opioids from interacting with opioid receptors. Naloxone is used primarily as an emergency response drug to stop an overdose, and it can also be taken by someone at risk of overdose while entering rehab.
Drinking alcohol has numerous effects on the body. When alcohol is consumed, it triggers the release of dopamine, a feel-good chemical. Consuming alcohol also leads to the release of gamma-aminobutyric acid (GABA). GABA suppresses glutamate, which nerve cells use to communicate with other cells. When glutamate is suppressed, the body slows down, causing intoxication and sedation. The brain then produces more glutamate receptors in an effort to increase glutamate activity.
When people stop drinking alcohol after heavy, long-term use, the opposite chemical imbalance occurs, where too many glutamate receptors are produced. People then experience alcohol withdrawal symptoms such as mood changes, insomnia, hallucinations, anxiety and seizures.
The FDA has approved three drugs specifically to diminish the chemical imbalance created by consistent, severe alcohol use: disulfiram, naltrexone and acamprosate. These drugs either decrease the feel-good effects of dopamine or reduce withdrawal symptoms.
The FDA approved disulfiram in 1951. It’s a tablet-form medication that blocks euphoric feelings associated with alcohol consumption and, in turn, makes people feel sick when alcohol is in their system.
Disulfiram blocks the enzyme acetaldehyde dehydrogenase, which converts alcohol into acetic acid. Once alcohol is consumed, it is converted into acetaldehyde and then into acetic acid. Consumption can cause illness when alcohol stays in the acetaldehyde phase, so the pleasurable feeling that people associate with alcohol is replaced by a negative feeling. This could combat a person’s psychological dependence on the substance.
There are several common symptoms that people experience when drinking alcohol after taking disulfiram:
People who take disulfiram cannot have consumed alcohol within the last 12 hours. This combination could lead to serious side effects, including loss of consciousness or death. Depending on the person’s unique situation, disulfiram might not be the proper treatment method. Not all rehabilitation facilities use or encourage this medication.
Naltrexone, which the FDA approved in 1994, is an opioid-receptor antagonist that reduces the positive effects of alcohol on a person’s brain. It is available as an oral tablet or long-acting injectable. Because it blocks opioids from interacting with opioid receptors, naltrexone prevents the unregulated release of dopamine. When this occurs, people do not experience the same euphoric high from consuming alcohol and could become less psychologically dependent on the substance.
Acamprosate was approved by the FDA in 2004. It helps prevent alcohol relapse by impacting glutamate interaction with receptors and reducing glutamate release. When acamprosate is used, the imbalance that occurs when people suddenly stop drinking alcohol is diminished or removed completely.
Speak with your doctor thoroughly if you’re interested in acamprosate. People who are not recovering from an alcohol use disorder should not take the drug. Some potential side effects of acamprosate include:
Doctors have found a higher chance of long-term abstinence among people who participate in a MAT program. A total of 653 people received two weeks of consistent sublingual buprenorphine treatment, followed by two weeks of tapering off the drug. Anyone who relapsed to opioid pain relievers during the two months of time following the start of the program was given buprenorphine for 12 weeks, followed by four weeks of tapering off the drug.
The researchers, who included National Institute on Drug Abuse Clinical Trials Network affiliates, interviewed 252 of the 653 original participants 18 months after the start of the MAT program. About 51% reported they had been abstinent for 30 days, and more than 83% said they were not dependent on any pain-relief drugs.
Forty-two months after the program started, 300 participants were interviewed and answered the same questions regarding their substance use. More than 61% said they had been abstinent for at least 30 days, and 92.5% said they did not rely on any pain-relief substances.
Patients at treatment programs that do not offer MAT at all, regardless of addiction severity, often do not fare as well. A study of 109 people who completed traditional abstinence treatment for opioid use revealed that more than 90% relapsed, with more than 59% of relapses occurring within the first week following the end of the program.
Opioid addiction can be difficult to live with, especially for those who struggle with chronic physical pain and need to rely on these substances to perform daily tasks. Alcohol addiction can be severe and debilitating, and relapse is common. Multiple treatment options should be considered to determine what’s best for the individual. Not everyone responds the same way to one single treatment method.
People with a moderate-to-severe opioid use or alcohol use disorder can participate in the Orlando Recovery Center’s MAT program, as long as they:
If you or someone you know has struggled with opioid or alcohol abuse, a healthier future is within reach with the right treatment. If you would like to learn more about the Orlando Recovery Center medication-assisted treatment program, call us to speak with one of our skilled specialists about enrollment, insurance and qualification.
The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.