Far too often there is a disconnect in opinions regarding addiction. As a chronic illness, there is no question that to overcome addiction, individuals that suffer from substance use disorder require long-term treatment, monitoring, and recovery support. However, the approaches that are taken to treat addiction can unfortunately vary.
Often on one side are those that believe recovery from addiction equates to sobriety and only sobriety, where an individual must learn to live a life completely free of substances. Often on the other side is the outcry for Medication Assisted Treatment (MAT), the use of medications to support recovery. This is often discussed in relation to opioids, opioid use disorder and opioid addiction and involves specifically medications like methadone, buprenorphine, Suboxone, and naloxone. Often one side believes in an “old school”, 12 Step approach of total abstinence and complete sobriety, believing that MAT is just trading one substance for another. The other side believes in a harm reduction approach, saying that people can’t recover if they’re dead from an overdose and that the approach of complete sobriety is harmful and kills people. There are benefits to both sides, as both approaches have helped millions of people recover, just differently.
The truth is that addiction is a complex, chronic disease and there is no one-size-fits-all approach. The truth is that the issue is not either/or, black or white, or the right way or the wrong way. If we are truly attempting to deliver patient-centered treatment by meeting the patient where they are at, as well as offering the best approach that will help a patient overcome addiction and live a high quality of life, there is absolutely a way that these two approaches work together to offer evidence-based treatment for those suffering from addiction. The argument is not either detox from all substances or full MAT for everyone. The approach is utilizing evidence-based medications to best support a patient to overcome a harmful illness and create a life of productivity, meaning, direction, and purpose. Where and how to use these evidence-based medications is key.
Medication-Assisted Treatment (MAT) is the use of FDA-approved medications that have been studied and peer-reviewed as evidence-based approaches that are effective in the treatment of opioid used disorders and other substance use disorders and can help some people sustain recovery. MAT is used in best practices in combination with counseling and other behavioral therapies. MAT approaches are also often used in detox protocols, withdrawal management, and medical stabilization to aid patients in accessing treatment and allowing for treatment approaches to be most effective.
What is important to understand is that behavioral health is complex, and addiction is different for everyone, so addiction treatment approaches must be comprehensive and tailored to the needs of each patient. Two patients that look the same can have different underlying issues driving their addiction. And even if two people have similar issues, the treatment approaches that help each find recovery may be different. As an example, two 22-year-old Caucasian males that meet the criteria for opioid use disorder may have completely different issues, such as trauma, co-occurring disorders, family dynamics, or the like. Similarly, two 50-year-old African American females with alcohol use disorder who may have similar emotional and behavioral issues driving their addiction, may need two completely different approaches to help each overcome their difficulties and find sustainable recovery. This is one of the major difficulties in treating addiction- it is not so cut and dry. We do not have scans or blood tests that say “Yes, you have addiction” nor specific approaches that say “You have this type of addiction so this type of treatment will absolutely give you a 90% chance of recovery.” We have numerous evidence-based approaches, including medication interventions like MAT, but we do not have a one-size-fits-all treatment for addiction. As an example, while EMDR may be wildly successful for an addiction treatment patient with trauma, another addiction treatment patient with similar trauma may not respond well at all the EMDR approach.
So how does Medication Assisted Treatment work in conjunction with a detox approach and protocol for addiction? First, it can be used in a protocol to detox a patient from opioids. However, if a specific patient has a history that indicates MAT may be beneficial on a longer titration period or a long-term basis, MAT can be included in that patient’s discharge plan from detox. This means that a patient may enter detox, get medically stabilized, then discharge from detox with an aftercare plan to continue moving through a comprehensive treatment continuum of care while continuing MAT. Additionally, many patients suffer from polysubstance use, meaning that they are misusing or abusing a consumption of more than one drug. A patient may need detox and treatment not just for opioids, but for using opioids, alcohol, cocaine, and benzodiazepines. Therefore, once entering a detox facility, the medical and clinical team will need to assess the patient and create a truly patient-centered plan for their care both while in detox and continuing after they are through withdrawals and medically stable. Part of that approach may include total sobriety or part may include a more harm reduction approach. Finally, to reiterate the point, what is best for one patient may not be best for another. Many patients enter detox for misusing many of the FDA-approved MAT medications, such as methadone or Suboxone. This needs to be taken into account. Is this patient, who has been misusing MAT medications, right to continue on certain medications? Sometimes, yes. Sometimes, no. Just as the idea that no one should be on MAT and in order to find recovery they must be completely clean and sober is an old, antiquated notion, it is also short-sighted to believe that every individual that meets criteria for an opioid use disorder needs to be on long-term MAT. Neither belief is truly patient-centered. However, both approaches, when used in a patient-centered approach, can be utilized.
Addiction is a complex illness and it is paramount that all information be taken into account when creating a treatment approach and ongoing treatment plan for that individual patient: Their history of substance use disorder, their treatment history, their family of origin and family dynamics, their education, their life skills, their life station, their mental health, trauma, or other co-occurring issues, their housing or living situation, and all necessary biopsychosocial information. Millions of individuals have found recovery through complete abstinence, sobriety, 12 Step fellowships or similar groups. Hosts of others have found recovery through the use and support of Medication Assisted Treatment. Both are evidence-based approaches, but neither is necessarily the “right” approach for everyone suffering from addiction. MAT absolutely decreased chances of overdosing and saves lives. Sobriety absolutely has given millions a life free of dependency and the chains of addiction. Both are viable options, but best practices can utilize both approaches for a specific patient, depending on that patient’s clinical needs. A detox and treatment center needs to work with a patient to find what fits best for them, but while remaining cautious that the approach is actually the best for that patient to find recovery and not simply letting the patient choose what is easiest or less painful for them. Recovery is difficult, regardless of approach, and it is important that patients are challenged to do what will give them the very best chance of long-term sustainable recovery and freedom from active addiction.
If you need or someone you know needs help for addiction or co-occurring disorders, please give us a call. Innovo Detox offers the latest in evidence-based medical, psychiatric, and clinical care for those in need of detox and medical stabilization in Pennsylvania and the surrounding Mid-Atlantic area. If we aren’t the best fit for you or a loved one, we will take the necessary time to work with you to find a detox, rehab, treatment center or provider that better fits your needs. Please give us a call at (717) 619-3260 or email our team at [email protected]. For more information on our company or services, please visit our website at www.innovodetox.com.