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What is Medication-Assisted Treatment?

According to the Substance Abuse and Mental Health Services Administration (SAMSHA), Medication-assisted treatment (MAT), “including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.”


For more on MAT, see Medication Assisted Treatment Guide: Opioid Use Recovery Can Become Long-Term


Medicated-Assisted Treatment (MAT) employs a “whole-patient” approach to substance use disorder treatment, combining counseling and behavioral therapies with FDA-approved medications.

Medication-Assisted Treatment for Opioid Addiction

Three medications to treat opioid addiction are methadone, buprenorphine, and naltrexone. They are used to “treat opioid dependence and addiction to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.” Of course, in certain cases, individuals can MAT medications safely for extended periods of time. Here’s how SAMHSA describes each drug:

  • Methadone: “Methadone tricks the brain into thinking it’s still getting the abused drug. In fact, the person is not getting high from it and feels normal, so withdrawal doesn’t occur. Learn more about methadone.”
  • Buprenorphine: “Like methadone, buprenorphine suppresses and reduces cravings for the abused drug. It can come in a pill form or sublingual tablet that is placed under the tongue. Learn more about buprenorphine.”
  • Naltrexone: “Naltrexone works differently than methadone and buprenorphine in the treatment of opioid dependency. If a person using naltrexone relapses and uses the abused drug, naltrexone blocks the euphoric and sedative effects of the abused drug and prevents feelings of euphoria. Learn more about naltrexone.”

People also know about naloxone. It is a “FDA approved injectable drug used to prevent an opioid overdose.”

Medication-Assisted Treatment for Alcohol Use Disorder

According to SAMHSA: “Disulfiram, acamprosate, and naltrexone are the most common drugs used to treat alcohol use disorder. None of these drugs provide a cure for the disorder, but they are most effective in people who participate in a MAT program.” The medications that SAMHSA notes include:

  • Disulfiram: “Disulfiram is a medication that treats chronic alcoholism. It is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. This drug is offered in a tablet form and is taken once a day. Disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol.”
  • Acamprosate: “Acamprosate is a medication for people in recovery who have already stopped drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consume illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days.”
  • Naltrexone: “When used as a treatment for alcohol dependency, naltrexone blocks the euphoric effects and feelings of intoxication. This allows people with alcohol addiction to reduce their drinking behaviors enough to remain motivated to stay in treatment, avoid relapses, and take medications.”

Misconceptions in Medication-Assisted Treatment

SAMHSA notes several misconceptions about MAT, including the idea that all it does is swap one drug for another.

The agency writes: “Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability.

“Medications used in MAT for opioid treatment can only be dispensed through a SAMHSA-certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse.”

Gender Differences in Drug Addiction

To think about Medication-Assisted Treatment, it may help to understand gender differences in drug addiction.

Men and women are very different when it comes to addiction and treatment for addiction.  Research is often geared at gender differences when it comes to drug abuse and addiction.

The National Institutes of Health reports: “Men are more likely than women to use almost all types of illicit drugs, and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women. ‘Illicit’ refers to use of illegal drugs, including marijuana (according to federal law) and misuse of prescription drugs. For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women. However, women are just as likely as men to develop a substance use disorder. In addition, women may be more susceptible to craving and relapse, which are key phases of the addiction cycle.

Some recent statistics from the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention and The National Institute on Drug Abuse point out some interesting facts about men and addiction. These key facts are listed below:

  • Men are four times more likely than women to be heavy drinkers and two times as likely to be dependent upon alcohol.
  • About 5 million men report past-year misuse of drugs or alcohol.
  • Men are more likely to develop an addiction disorder and abuse more than one substance.
  • Most often, men begin using substances at an earlier age, and use them more often.
  • Men are 2.3 times more likely than women to enter treatment for their addiction, however, many men enter via the criminal justice system.
  • Men are more likely to struggle with pride and denial as well as relapse triggers such as depression and anxiety during addiction recovery.
  • Interestingly, more than half of men who struggle with addiction also have another mental illness, including depression, bipolar disorder and PSTD.
  • Men are almost 4 times more likely to commit suicide while drinking.
  • Men are nine times more likely to die of an alcohol-associated heart disease.
  • Men are more at risk than women to drink alcohol excessively and are therefore more likely to take other risks (for example: reckless driving, or driving without a seat belt). These risks further increase the possibility of injury or death.

When considering MAT, one might want to consider this NIH note: “Research has shown that women often use drugs differently, respond to drugs differently, and can have unique obstacles to effective treatment as simple as not being able to find child care or being prescribed treatment that has not been adequately tested on women.”

Often, drug addiction or alcohol consumption or smoking is depicted in the media in either a watered-down “no big deal format” or an exaggerated manner. Sitcoms often portray someone who is deemed “a total loser” by viewers hitting rock bottom or a completely ordinary family laughing at someones serious addiction problem.  In the real world, people fighting addiction experience  the battle very different than it is portrayed in the media. Watching a scene on TV with emotion due to alcohol or drugs can be captivating and entertaining.  In reality, the emotions experienced by individuals dealing with addiction can be stressful or embarrassing.  Viewers turn on a movie or a TV show for entertainment, not for reality or accuracy in most cases. Further, one cannot watch any type of sports programming without being bombarded by alcohol advertisements.

The data characterizing the impact that visual representation of drugs and alcohol in the media has on spectators is shocking. Due to the $25 billion per year that is spent by advertisements for alcohol products, on average —every 22 minutes— someone is shown on television consuming alcohol. In conjunction with that statistic, regarding the $8.9 billion being spent on the promotion of tobacco products each year, it was shown that 90% of rated R movies have smoking scenes. Most often, the individuals portrayed smoking in those shows are generally intelligent, successful, beautiful and handsome people. Thus, many media viewers are impacted by the portrayal of addiction in such a way that they believe smoking and drinking are a great way to become, successful, beautiful, and interesting, neglecting the less attractive hard truth of addiction.

Drugs, TV Shows & The Media and Addiction Portrayal

It’s important to maintain a philosophy around substance abuse and recovery.

Indeed, the Council on Communications and Media of the American Academy of Pediatrics writes: “Although parents, schools, and the federal government are trying to get children and teenagers to ‘just say no’ to drugs, more than $25 billion worth of cigarette, alcohol, and prescription drug advertising is effectively working to get them to “just say yes” to smoking, drinking, and other drugs. In addition, television programs and movies contain appreciable amounts of substance use. Unlike traditional advertising, media depictions of legal drugs are generally positive and invite no criticism, because they are not viewed as advertising.The result is that young people receive mixed messages about substance use, and the media contribute significantly to the risk that young people will engage in substance use.”

It continues: “The contribution of the media to adolescent substance use is only recently becoming fully recognized and appreciated…  the evidence supports strong actions aimed at the entertainment industry about media depictions of tobacco use and strong actions aimed at motivating and assisting parents of children and young teenagers to restrict access to adult media venues with excessive substance use exposure.”

Gambling: Fun or Addiction?

Gambling is a fun way to blow off  steam or even get lucky and make a few bucks..right?  For most people, this is true.  However, some people struggle to stop gambling and the games go from fun to addicting.  Gambling addiction (sometimes called problem gambling) can be hard to detect and even those struggling with the addiction may not realize it.  Often, by the time the addiction is uncovered, there are devastating financial consequences.

Some signs of a gambling addiction may include: excessive, unaccounted for time away, up and down mood swings, disappearing items of value or constantly thinking of how to obtain more money (to gamble), and secrets-like hiding tax documents or lottery tickets, or lying about whereabouts or income, etc.

Often, those caught in a gambling addiction will use excuses such as, “it’s been a long day (or week, or whatever) and I just needed to unwind a little.” Gam-Anon is a “12 Step self-help fellowship of men and women who have been affected by the gambling problem of another.”  Their website (gam-anon.org) has a very helpful list of 20 questions that you can ask of yourself or your loved one if you are concerned about a gambling addiction. These are listed below:

1      Do you find yourself constantly bothered by bill collectors?

2      Is the person in question often away from home for long unexplained periods of time?

3      Does this person ever lose time from work due to gambling?

4      Do you feel that this person cannot be trusted with money?

5      Does this person promise that he or she will stop gambling, yet gambles again and again?

6      Does this person ever gamble longer than he or she intended?

7      Does this person immediately return to gambling to try to recover losses or to win more?

8      Does this person ever gamble to get money to solve financial difficulties?

9      Does this person borrow money to gamble with or to pay gambling debts?

10    Has this person’s reputation ever suffered due to gambling?

11    Have you come to the point of hiding money needed for living expenses?

12    Do you search this person’s clothing, go through his or her wallet, or check on his or her activities?

13    Do you hide his or her money?

14    Have you noticed personality changes in him or her?

15    Does this person consistently lie to cover up or deny his or her gambling activities?

16    Does this person use guilt induction as a method of shifting responsibility for his or her gambling onto you?

17    Do you attempt to anticipate this person’s moods to try to control his or her life?

18    Does this person ever suffer from remorse or depression due to gambling sometimes to the point of self-destruction?

19    Have you ever threatened to break up the family because of the gambling?

20    Do you feel that your life together is a nightmare?

If you or your loved one is suffering from a gambling addiction, it is vital that help is sought for the addict as well as involved loved ones as a gambling addiction can severely impact more than just the addict.

Sometimes people get frustrated and wonder why their loved ones can’t just stop using drugs? Why is addiction so powerful? Why would people not stop using substances that are hurting them physically and ruining so many aspects of their lives? It can be really difficult for friends and family to understand why these individuals continue to use drugs knowing the harmful effects.

The simple reason it is so difficult for individuals struggling with addiction to drugs or alcohol to stop using is that drug addiction is an actual disease. When people are addicted to drugs and alcohol and take them for a long period of time changes in their brain circuits occur. These changes make it really hard for users to stop their addictions to drugs and alcohol. Recently, researchers have termed this the “brain disease model of addiction” that views drug and alcohol addiction. This view categorizes addiction not as a lack of willpower but as an actual illness that needs treatment.

Addiction can harm the brain in the following three ways:

1- the brains reward circuits become less sensitive. Drugs that are addicting can cause ether brain to release dopamine which creates feelings of pleasure. After time, the brain circuit becomes imbalanced and individuals need more and more of the drug to create the same pleasurable response. This can cause individuals to lose interest in things they use to enjoy like friends, or other natural rewarding situations.

2-The brain’s reaction to stress increases with addiction. In an addicted individual’s brain, the circuits become overactive and people feel stressed whether they are using drugs or not.

3-Decision making skills are compromised. Drug addiction affects the prefrontal cortex which is the center of the brain that controls decision making. Even when addicted individuals try to stop using drugs, they can’t make the decision and stick with it to do so.

Many factors impact the disease of drug addiction and research is constantly uncovering and learning more about how to help those individuals struggling.

source: www.teens.drugabuse.gov

Memory and Addiction

A recent study was published in the Journal of Neuroscience by Washington State University researchers. They indicated that found a mechanism in the brain that enables memory in the process of drug addiction. This is important because the discovery opens a new area of research geared at discovering a therapy that could alter or stop this mechanism in addiction; making drug addiction less addictive.

Turning off the tool that creates these powerful memories will hopefully lessen the impact and content of the memory – thereby decreasing the motivation for relapse and addiction. Memories associated with drug use definitely drive the impulses behind drug addiction. The brain reinforces memories, and in so doing, gives them emotional weight. The result of the memories being reinforced is a perfect list of what guides and directs the basic decisions.

The NIDA (National Institute on Drug Abuse) indicates that the amygdala, a part of the brain’s limbic system, which is critical for memory and responsible for evoking emotions, becomes active and a craving for drugs is triggered when an addicted individual thinks about, sees, or hears about drugs.

They indicate, “This craving demands the drug immediately. Rational thoughts are dismissed by the uncontrollable desire for drugs. At this point, a basic change has occurred in the brain. The person is no longer in control. This changed brain makes it almost impossible for drug addicts to stay drug-free without professional help. Because addiction is a brain disease.”

In the WSU study they found that their processes did not erase the drug memory completely, but perhaps diminished its emotional power. Hopefully, Learning how to hone in on emotional strength in memories and what allows for them will hopefully, ultimately, lead to information that can allow for control over these memories. This type of finding could help end the vicious cycles of drug abuse and addiction.

Sources: sciencedaily.com, wsu.edu, nida.gov

 

Common Street Drugs Part 1: Oxy, Cocaine, Mushrooms

A recent article published by USA today states some quick, hard facts about 6 common street drugs in Wisconsin. But the information discussed is true for most of the US. These drugs make up the more dangerous and prevalent substances that law enforcement have been concerned about recently.   The first 3, discussed here, include Oxycontin, mushrooms, and cocaine. The latter 3 will be discussed in a later blog – part 2.

  1. OxyContin – what is it made of and what does it do? How widespread is the use of this drug?
  • Oxycondone (oxy) is a painkiller made from the Persian poppy and the opium poppy. It it has a medical use, but also a high potential for abuse and dependency. Street names for oxycontin include: ox, roxy, perc, oxy, hillbilly heroin, kicker, and OC. Oxy can be swallowed or crushed and snorted or dissolved and injected. Use of oxy is widespread and the use is increasing drastically across the nation.

2. Psilocybin mushrooms – what are they made of and what do they do? How widespread is the use of this drug?

  • Mushrooms contain psilocybin, a hallucinogenic substance and are a schedule I drug but have no approved medical use. Called “shrooms” or “magic mushrooms,” they are usually dried and eaten but can brewed as a tea, mixed with other foods or, coated with chocolate and then eaten to mask their bitter taste. Use of mushrooms is less than it once was in the 1960s and 70s, but many individuals still use this street drug.

3. Cocaine – what is it made of and what does it do? How widespread is the use of this drug?

  • Cocaine is a Schedule II drug – meaning it may have limited medical usage, but it has a high potential for abuse and addiction. Cocaine is a stimulant that most often looks like a white powder. It can be cut (mixed) with sugars and can be inhaled or dissolved and then injected. Crack cocaine is smoked and produces a shorter high than snorted/inhaled cocaine. Users often have white powder around their noses from snorting. Street names for cocaine include snow, crack, coke, or flake. Although cocaine use was more widespread in the 1980s, it continues to have a strong street presence currently.

 

Source: usatoday.com

Take Care of Yourself when Helping Others in Recovery

Sometimes, when helping others in recovery, individuals forget about their own needs too much and suffer themselves. It is really important to take care of yourself when helping others in recovery. Supporting someone else takes vast amounts of time and emotional energy. Most of the time, financial pressure is involved as well. Often, those taking care of the individual in recovery let themselves fall to the bottom of the list of priorities.

Thinking that you will take care of yourself when your loved one is completely done with recovery seems like the right thing to do when they seem to be suffering so much and need so much support. However, if you don’t take care of yourself, it’s easier to be reactive, frustrated or unnecessarily anxious. Instead, if you are meeting your own needs, you can be positive, caring, and calm for your loved one in recovery.

Remember the safety announcement on airplanes about securing your own oxygen mask first before helping others? Doing things to enhance and uplift yourself and your life can benefit the individual in recovery too. Sometimes its ok to go to dinner with friends or go to a movie even though you feel like that seems selfish knowing what your loved one is dealing with. Knowing you are happy and secure and healthy can help your loved one want the same thing for themselves.

Keeping you energy up, your life intact, things running smoothly, and continuing to foster other important relationships in your life can help you navigate the bumpy road that may be ahead with your loved one. The road may be longer than you think and taking care of you sets an important example for your loved one while in recovery.

traumaandaddictionTrauma and Addiction

Almost everyone has experienced some sort of trauma in life. While some individuals can recover quickly and easily from trauma, when trauma is particularly significant or when there is not support for the traumatized individual, trauma can lead to addiction. In fact, people who have experienced high amounts of trauma are at an increased risk for drug and alcohol abuse.

A recent study titled, The Adverse Childhood Experiences Study (ACEs) examined 17,000 people in California who reported severe trauma. The results of the study found a correlation between severe childhood stress and several types addictions. The study addressed several adverse childhood experiences, including:

  • Abuse (emotional, physical and sexual)
  • Having a parent who was incarcerated
  • Neglect
  • Living in a house with domestic violence
  • Having an addicted or mentally ill parent
  • Losing a parent to death or divorce

The study found that the higher the amount of adverse experiences, the more likely the child will develop an addiction.

When trauma is left untreated, individuals may turn to poor behavior to numb their feelings or make the hurt, shame, or fear go away. This avoidance of treatment can lead to many difference types of addictions including gambling, drugs, alcohol, sex and food. Research shows that trauma and addiction go together and until you recover from one, you can’t completely face and recover from the other

 

 

drug patternsExamining Drug Use Patterns

A recent article posted on psychcentral.com is very helpful in identifying whether or not you (or someone close to you) truly have an addiction problem. What’s the difference between social drinking and being an alcoholic? How do you know if you are on the road to dangerous addictions or not? Truly, this varies for each individual, but the author of the aforementioned article gives some good guidelines as to how to define these boundaries in defining 4 degrees of drug use.

#1 Experimentation

People experiment with drugs for all kinds of reasons. Some are curious about what it will feel like, others are pressured by someone else. Most people who, despite their motivations, experiment with drugs or alcohol do not become addicted. However, the thought that ”just once won’t hurt anything” is incorrect because one could drink and drive for instance. Further, in individuals who are predisposed to addictions, partaking of a substance one time can set in motion a pattern of drug abuse and dependency.

#2 Social Use

“The social drinker or drug user uses substances in social situations, usually to relax, fit in or have fun. Although it seems innocent enough, especially compared to the solitary drug user, social use often leads to greater degrees of substance use. If the social user continues using even in the face of negative consequences, they’ve crossed the line into substance abuse” (psychcentral.org).

#3 Binge Drinking

Binge drinking is a dangerous pattern of drug use. Many tend to overlook binge drinking as being problematic because it doesn’t occur on a daily basis. However,

“binge drinkers are 14 times more likely to report driving under the influence than those who do not binge drink. Binge drinking has also been linked with alcohol poisoning, unintended pregnancies, sexually transmitted diseases, assaults, accidental injuries, liver disease and high blood pressure, among other negative consequences…. But despite these dangers, more than half of the alcohol consumed by adults and 90 percent of the alcohol consumed by underage drinkers in the U.S. is in the form of binge drinks. Young adults are the most likely to binge drink, even though early drug use is strongly associated with drug and alcohol addictions later in life” (psychcentral.org).

#4 Substance Abuse and Addiction

Defining substance abuse and addiction can be challenging, but the behaviors that are exhibited when substance abuse and addiction occur are fairly basic. In the basic sense, when a substance interferes with one’s daily life and routine, it can be an addiction. Psychcentral.org outlines a few of these: (psychcentral.org)

  • Trying to control your drug or alcohol use unsuccessfully
  • Using drugs or alcohol in dangerous situations (e.g., before driving)
  • Spending a great deal of time finding, using and recovering from the effects of drugs
  • Withdrawing from friends and family, or giving up other activities to use drugs
  • Needing more of a drug to get the same high (i.e., tolerance)
  • Experiencing withdrawal symptoms when trying to quit drugs

AddictionsAddictions defined:

The American Psychological Association defines addiction as, “…a condition in which the body must have a drug to avoid physical and psychological withdrawal symptoms. Addiction’s first stage is dependence, during which the search for a drug dominates an individual’s life. An addict eventually develops tolerance, which forces the person to consume larger and larger doses of the drug to get the same effect.” (Apa.org)

However, addictions—long thought to be solely drug related (an uncontrollable habit of using drugs or alcohol in large amounts)—are manifesting themselves in behavioral areas as well.  For example, some are addicted to gambling, pornography, and even ordinary activities such as exercise or eating.  However, what classifies these and other behaviors as addictions is when people who do these things finds them pleasurable in some way.  There is some controversy about which of the “behavioral” addictions constitute scientifically validated “true” addictions, with both professionals and the public failing to reach an agreement. More time research is needed to clarify this issue.

Although the exact symptoms vary from one addiction to another, there are two aspects that all addictions have in common.  First, the addictive behavior is counter-productive to the individual. So, instead of helping the person adapt to things or overcome problems, the addiction tends to undermine these abilities.  About.com states, “For example, a gambler might wish he had more money –- yet gambling is more likely to drain his financial resources. A heavy drinker might want to cheer herself up –- yet alcohol use contributes to the development of her depression. A sex addict may crave intimacy –- yet the focus on sexual acts may prevent real closeness from developing.”

Next, the behavior is unrelenting.  An addict will continue to engage in addictive behavior, despite it causing negative consequences.  Thus, an occasional weekend of self-indulgence is not defined as an addiction, although it may cause different kinds of problems. Addiction involves more frequent engagement in the behavior.

Many people don’t feel like they struggle with addictions because they enjoy the behaviors they participate in and their lives seem normal and high functioning.  This can be deceiving.  Often people’s addictions become ingrained in their lifestyle, to the point where they never or rarely feel withdrawal symptoms. Or they may not recognize their withdrawal symptoms for what they are, putting them down to aging or working too hard, for example. People can go for years without realizing how dependent they are on their addiction.

People with illicit addictions may enjoy the secretive nature of their behavior.  This is also an addictive characteristic: secrecy.  They may blame society for its narrow-mindedness, choosing to see themselves as free-willed and independent individuals. In reality, addictions tend to limit people’s individuality and freedom as they become more restricted in their behaviors. Imprisonment for engaging in an illegal addiction restricts their freedom even more.

When people are fighting an addiction, their enjoyment often becomes very focused on carrying out the addictive behavior and relieving withdrawal, rather than experiencing the full range of life that forms the person’s full potential for happiness. At some point, the addicted person may realize that life has passed them by, and that they have missed out on enjoying so many other things besides than addiction. This often happens when people become aware, begin seeking help, and overcome their addiction.

About.com also indicates that some people who enjoy their addiction don’t feel like it is a problem if it is not harming anyone.  What the addict doesn’t realize, however, is the negative impact of their addiction not only on themselves, but also on those in their life.

They may be in denial about the negative aspects of their addiction, choosing to ignore the effects on their health, life patterns and relationships. Or they may blame outside circumstances or other people in their lives for their difficulties.

Sometimes, it’s hard to recognize the harm caused by addiction when the addiction is the person’s main way of coping with the other problems they have. Sometimes other problems are directly related to an addiction; for example, health problems, and sometimes they are indirectly related to the addiction, for example, relationship problems.  Some people who get addicted to substances or activities are very aware of their addictions, and even the harms caused by the addiction, but keep doing the addictive behavior anyway. This can be because they don’t feel they can cope without the addiction, because they are avoiding dealing with some other issue that the addiction distracts them from (such as being abused as a child), or because they do not know how to enjoy life any other way.

Often, the harm and negative effects of addiction come to light when the addicted person goes through a crisis. This can happen when the addictive substance or behavior is taken away completely and the person goes into withdrawal and cannot cope. Or, it can occur as a consequence of the addiction, such as a serious illness, a partner leaving, or loss of a job.

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