Medicated Assisted Treatment

What is Medicated Assisted Treatment?

  • “Medicated Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery” (SAMHSA, 2019). 

  • MAT is mainly used to treat opioid addiction. 

What Medications are Used for MAT?

  • FDA-approved buprenorphine products approved for the treatment of opioid dependence include:

Bunavail (buprenorphine and naloxone) buccal film

Cassipa (buprenorphine and naloxone) sublingual film

Probuphine (buprenorphine) implant for subdermal administration

Sublocade (buprenorphine extended‐release) injection for subcutaneous use

Suboxone (buprenorphine and naloxone) sublingual film for sublingual or buccal use, or sublingual tablet.

Subutex (buprenorphine) sublingual tablet

Zubsolv (buprenorphine and naloxone) sublingual tablets

  • FDA-approved methadone products approved for the treatment of opioid dependence include:

Dolophine (methadone hydrochloride) tablets

Methadose (methadone hydrochloride) oral concentrate

  • FDA-approved naltrexone products approved for the treatment of opioid dependence include:

Vivitrol (naltrexone for extended-release injectable suspension) intramuscular (US FDA, 2019).

What kinds of Counseling/Behavioral Therapies are used during MAT?

“Under federal law, MAT patients must receive counseling, which could include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services” (SAMHSA 2019).  Reality Check offers group and individual counseling with a Masters Level Alcohol & Drug Counselor on Tuesdays and Wednesdays from 4-6pm. Call for details.

Benefits ...

  • “MAT is recommended for adults presenting for clinical treatment of OUD with physiological dependence: it significantly augments treatment retention, reduces illicit opioid use, reduces the burden of opioid craving, and, in the case of agonist therapies, provides effective relief of the opioid withdrawal syndrome. Thus, MAT is a stabilizing addition to relapse-prevention counseling and mutual help groups (such as Narcotics Anonymous) in that it increases the effectiveness of those interventions. Longer-term, abstinence-based residential treatment without MAT shows limited effectiveness, especially among recently detoxified heroin users,97,98 and loss of tolerance during this period of abstention poses an increased risk of fatal overdose if one relapses to opioid use upon discharge to home. Youth is a predictor of early dropout from psychosocial treatment of OUD,99 whereas medication adherence and early opioid abstinence predict greater retention and treatment success among youth treated with buprenorphine/naloxone” (Connery 2015, p.69). 

Cons ....

  • The stigma affiliated with addiction is very much intertwined with people’s opinions of MAT. Unfortunately, MAT is often looked down upon, because some people do not like the idea of treating substance use disorder with another substance. This outlook is narrow-minded however, as the substances used during MAT do not induce a high, but rather ease the pain of withdrawal and help subside cravings. Potential misuse of these medications also raises concern.  

MAT Now Offered at Reality Check ...

  • Reality Check has partnered with Better Life Partners to offer medication-assisted treatment and recovery services using a multi-disciplinary team of clinicians. Services include individual and group counseling, medication management, and wraparound support services, with most major insurance plans and Medicaid accepted. For more  information at 603-563-0837.  

Empathy Brain

Addiction is one of the most poorly understood, heavily pathologized experiences of distress. Especially in the western world, we tend to think of addicts as people with poor impulse control, people who just "can't get it together," people who are "irresponsible," careless people who hurt themselves and others with no care for the impact.

Not only does the false narrative above individualize distress (that is, it doesn't take into account the systemic injustice, poverty, racism, and other "isms" that lead to manifestations of emotional distress), but this narrative leaves no room for hope, for change, for evolution.

In reality, humans are vastly beautiful and complex beings whose needs for connection and warmth and belonging are vastly underserved by the isolated, colonized culture we've built. In reality, we reach for substances as a way of managing trauma, because drugs have direct correlations to our own brain chemistry that can help us sooth the imbalances that come as a result of adverse childhood experiences.

And in reality, our brains can permanently rectify and heal those imbalances, no matter how old we are, or what adverse experiences we've endured; we CAN learn other strategies and bid goodbye to choiceless behaviors and substance use... with gentleness and resonance.

Wait - so addiction actually makes sense?

Yes! We attempt to meet our needs for self-regulation with substances, behaviors, anything we can grab that might bring a little bit of peace, make it just a little easier to live inside our lacerating brains and aching, lonely bodies. When those behaviors or substances become choiceless, and when we use them again and again, despite the fact that they are causing harm, this is when we might describe our behavior as compulsive or addictive.

I've come to think of addiction as the natural result of not having developed a warm, intact resonating self-witness.

When we have not developed a solid and stable part of ourselves that can turn toward our distressed parts with warmth the way a loving parent would, we turn to substances and behaviors that help to sooth us, to make it easier to exist.

What causes addiction?

We know addiction is VERY heavily correlated with adverse childhood experiences (ACEs). For instance, a male child with a 6 ACEs score is 4,600% more likely to become an IV drug user later in life. The more we've experienced trauma (which changes the chemical neurotransmitter balance in the brain), the more our brains will try to compensate for the experience by using external substances and behaviors.

And so it is not the drugs that are addictive. Addiction occurs in the brain that is attempting to find a solution for a brain imbalance that has been caused by trauma.

Now, many of us think of ACEs as the "capital T" trauma experiences like sexual, physical and psychological abuse, a parent who has been incarcerated, or physical neglect that comes from not having enough food or shelter. However, ACEs also include relational neglect.

Relational neglect refers to experiences in childhood where our social experience is one of being ignored. When we are not called by our names, when our caregivers do not make regular and warm eye-contact with us, and when we are "invisible" and not paid attention to, our brains experience a kind of starvation (literally - children who've experienced neglect have brains that are lighter in weight) as a result of not having received relational nourishment. Similarly, we can see the impact on the hearts of people who have experienced chronic loneliness, impacts that are more severe than a lifetime of cigarette smoking.

Our brains are very good at finding work-arounds when we are not able to access the energy and connection we need in life as a result of relational, as well as other traumas. We often find these work-arounds in substances and choiceless behaviors.

So: How Do We Work With Addiction?

The imbalances that are caused by trauma are NOT permanent. Our brains are infinitely neuroplastic and can change and heal at any age. The most efficacious techniques I have found are based in the neuroscience that teaches us how to identify the root of our distress patterns, and intervene with warmth and resonance in order to create brain change.

In my upcoming May webinar, we'll be working with addiction specifically, including exploring the way the human brain works in relationship to substances. Every external substance/drug has a counter-point in the human brain (for example, benzodiazepines are a direct remedy for the FEAR circuit, opioids are remedies for an activated PANIC/GRIEF circuit).

When we understand this, we can then move into deep self compassion and understanding of where the longing for the substance comes from, and how we might meet that need in a different way.

The Words of an Addict

Looking back on things has been difficult and helpful I suppose. My child hood was normal. Good parents, siblings, and school. I got in fights, I had decent grades. So, to really try and pin point a downfall that led me to where I am is extremely unfathomable. To those that don’t understand the complicated equation of how addiction works, and I can’t say that with anymore sarcasm in my being, there isn’t always a turning point. Sometimes its good kids making a poor decision.

I don’t know if I even would qualify myself as such, however my parents always said that I was. My decisions came fast and steady as they usually do for young adults. My turning point was just one of many poor decisions I was about to make. In the back of my head, I should have known. I was naive to the fact; it wasn’t such a topic that it was always in the news. For fuck sake, we were still doing current events in high school at this point. It all started at a party, harmless yeah, I know, but still where it all began. The alcohol, and the drugs. Some hard, some not. What really interested my soft and suicidal mind, was how to make things quiet, with out, the finality of pulling a trigger.

I found it, in that one instance, I was just calm, not thinking about what needed to be done the next day, or, worrying about what my parents were going to think of any of this. Because it didn’t matter. The needle hit the vein and I depressed that brown fluid into myself, slow and steady, and bam instant relief. That's how it started. I don’t know who brought it, or how I even came across it. All I knew was in that moment in time, I liked it, and I liked it a lot.

Now just to back track a little bit, because hindsight of course is always 20/20, my biological father was an addict, and well it happens to be in some other parts of the family as well. So, if I knew then what I know now? Would that have made any difference? I can almost with certainty tell you that it wouldn’t. The high lasted for what seemed like forever, a high I had never experienced before, and holy fuck was it amazing, and the only thought I had while coming down, was that I had to do that again...... so I did.

That just happened to be poor decision number 2.... or was that 3? Not sure, but it probably is irrelevant anyways. But what's to come, at least for me, defined me and who was around me in a way that you could never imagine if you haven't been touched by addiction. The pain is relevant in every aspect of my being. The slow push of a needle, the immediate relief. Rock bottom came quickly, between the suicide attempt, and the most devastating event of my life time, which didn’t coincide with what I thought was possible. Rock bottom is usually the turning point of someone's life. For me it was a jumping off point, but in what direction was still uncertain.

When I would use, everything sounded like a good idea, if the high kept coming, it didn’t matter. But even while high, you get to a point where you just want it to stop. It's being possessed and not having any control. It is pushing the ignition switch but having ultimate failure. My ignition switch happened to be Russian roulette with my so-called best friend, that happened to be a junkie as well, and as I use that term so lightly, just know how I hate it. The game is straight forward as we all know, and it all came down to a coin flip. Heads was my call, and as that coin rattled around on those pine floors, it fell to tails. This moment has led to more nightmares then I can even count, if I so in fact did care to count them.

The spin of the rolling chamber and that distinctive click, that it won’t be me type of attitude, but really hoping it to be, so the madness will stop. The turn happened quickly, the shock has lasted the last 13 years, the sound still echoes through my head, the spray felt like water, like sitting at the ocean right on the shoreline during a storm. The disbelief of what I had just seen should have set me into oh fuck mode. But I sat there, staring, unable to move. Not a sound came out, no screaming, no emotion, just a blank expression. A coward looking for a way out, was partly responsible for another who had found the wrong door unknowingly, and absolutely hated him for it.

This was by far the lowest point in my life, I needed a way out, and had to find one. I found solace in writing, as the notebooks started to pile up, and the meetings kept coming, while trying anything to get me to where I needed to be. Nothing has come easy since, its been so long, but I can remember things like they just happened. The more I write about things, the more I remember of how I was. I loathe who I was, with every inch of my being. To me there is almost nothing I can do, to atone for my sins. The more friends I bury, or watch start on that path is insane, and when the masses don’t have the definition of insanity, well they are doomed to repeat it.

The meetings I attend now, I look to see what I can do to help, it makes me feel more human, a way to cope with the all the destruction I caused through this little adventure of mine. The streets are littered with landmines and trying to dodge them to stay sober is so stressful in a way, that this will surely bring me to an early end. Its all been worth it in the end. we all start on this journey in a similar fashion, and while the middle is always different for everyone, the outcome has always remained the same. Get clean or die!