Medication Assisted Treatment for Alcohol and Drug Use Disorders

Medication Assisted Treatment, commonly referred to as MAT, is nothing new in the treatment of addiction, but has frequently been approached with trepidation by people in recovery and those treating them. Some of the history of this is understandable as early advertisements for Librium included using to reduce alcohol abuse. There is also the belief that patients should not need the "crutch" of medications to stay clean and sober. On the other hand, few organizations have been as successful as 12-step programs have been in espousing the disease model of drug or alcohol abuse (what is now officially referred to as Substance Use Disorders). The disease model then leads to the concept with in medicine to look at the risks and benefits (including effectiveness) of any intervention for a symptom, disease or syndrome. We attempt to recommend treatments that based on the best evidence available will provide a greater chance of benefit relative to the related risks. Within the area of Substance Use Disorders, we have focused on the benefits of complete sobriety from addicting substances and behaviors. As much as this is legitimately the preferred outcome for the clear majority of people with substance use disorders, the overall success of such an approach is not what we seek as patients, physicians and a society. Most of the accepted behavioral interventions for Substance Use Disorders have at best a 60% success rate and in fact is likely significantly under 50 percent. The success of intervention for Opioid Use Disorders is closer to only 10% for any one intervention. Whether 10% or 60%, we would not find this level of success as adequate for any common disorder that untreated can lead to death or incarceration.

While no one is advocating for the elimination of organizations that provide behavioral interventions, and in fact we need more and easy access programs for drug and alcohol treatment, we also must seek other interventions that improve the outcomes for people with these serious disorders. This is where MAT comes in. We have several medications that improve the outcomes for patient with substance use disorders. Few if any of the medications provide a complete solution. Some medications assist in achieving and maintaining sobriety, while others seek to mitigate the negative effects of use (commonly referred to as the "harm reduction" model). A few can be used in either model.

At PMA, we strongly support 12-step and other sobriety oriented interventions. However, we also understand the limits of such approaches for individual patients. We do our best to understand the available science to match treatment to the needs of the patient, whether under a sobriety model or a harm reduction model. As such, we believe no one intervention has shown such overwhelming success and we must be open to all effective interventions that have a favorable balance between benefits and risks.

While MAT for some conditions have limited scientific support, we will be addressing the medication available to improve outcomes in the treatment of alcohol and opioid use disorders in future blogs.