As research into addictions and recovery has advanced, so too have treatment options. Clearer understanding of the biological impact of addiction has given way to a variety of medication assisted treatments (MATs). While it may be reassuring knowing there are a greater number of tools available to treat addiction, it is important to assess the risks and benefits of these medications.
MATs can provide much benefit if used properly. For instance, Antabuse can effectively aid the drinker by providing additional motivation to abstain. This is done by interfering with the metabolization of alcohol in the body (Lyles, n.d.). The result is a buildup of metabolites that results in an feeling of illness for the user. Antabuse’s effects, however, dissipate quickly. Thus, if a patient resolves to drink, all they need to do is stop taking Antabuse prior to consumption (Lyles, n.d.).
Methadone is an opioid agonist designed to serve as a drug replacement allowing the individual to avoid withdrawal by continued activation of the opioid receptors associated with opiate addiction (Bisaga & Chernyaev, 2018). While there could be much appealing about this option for an addict, there are risks to consider. First, Inaba and Cohen (2014) point out that the abuse and overdose rates associated with methadone use have increased in recent years. Second, methadone cessation can induce some of the most severe and long-lasting symptoms associated with opioid withdrawal (Inaba & Cohen, 2014). Other substances, such as buprenorphine are partial agonists thus offering some of the benefits of methadone (though with a lesser degree of neuronal excitation) while also blocking other opioids from attaching to receptors). As with methadone, however, the abuse potential is an ever-present risk (Inaba & Cohen, 2014; Doweiko, 2015).
Drugs such as naltrexone, on the other hand, provide benefit by serving as an opioid antagonist. In other words, they block the opioid receptors from activation by other opioids without activating those receptors themselves (Inaba & Cohen, 2014). Such effects can provide temporary relief from cravings for the short time the medication is in the system. Vivtrol is similar to naltrexone though it remains on the receptors for a greater duration of time.
Reske and Paulus (2009) point out that relapse is best understood as a multidimensional process involving a number of neurological and psychological processes occurring prior to, during, or after re-use. In light of this more comprehensive understanding, MATs ought to be weighed in light of the strengths and liabilities of the client being served. For instance, if an individual is a precontemplative alcoholic who chronically drinks, Antabuse may not be appropriate given it is best used with those who drink impulsively and who have a degree of internal motivation to abstain (Lyles, n.d.). Likewise, methadone maintenance may not be appropriate for the patient presenting with mild to moderate opioid use disorder who reports minimal withdrawal symptoms. It may be appropriate, however, for the chronic relapser with an extensive history of overdose and hospitalization.
In conclusion, when utilizing MAT, it is imperative that clients be provided accurate, understandable information about the biological impact, risks and benefits of such treatments. This can be done by using either group psychoeducation or one on one discussion supplemented by handouts. It is further important that clients be offered opportunities to process ways those risks and benefits may relate to their personal experience of addiction and recovery. Medications can provide valuable assistance in the treatment of addiction but, as with anything, uninformed or improper use can contribute to more harm than good.
Bisaga, A. & Chernyaev, K. (2018). Overcoming opioid addiction: The authoritative medical guide for patients, families, doctors, and therapists. New York, NY: The Experiment. ISBN: 978-