Medical Assisted Treatment is always evolving as new drugs used in the treatment of substance use disorders are trialled by various physicians’ world-wide.
MAT can be used to aid withdrawals from alcohol or drugs or in place of the drug of choice to maintain the participant and encourage them to remain abstinent from their chosen substance.
Withdrawal from alcohol or drugs can create negative side effects which are uncomfortable for the patient. Assisting withdrawal with specific medicines has been shown to aid the withdrawal symptoms and reduce the incidence of relapse due to craving and discomfort.
Maintenance drugs such as methadone are prescribed to reduce the harm related to using opiates and the dangerous ways in which it may be delivered into the body.
Blockers or antagonists can be used to block the effects of the drug upon the user reducing the craving as the desired effect can no longer be achieved.
There are four main purposes to MAT:
- Reduce cravings
- Aid the withdrawal process
- Maintenance and Prevention
- Block the effects of the drug of choice.
As there are various drugs (alcohol is a drug) that create a chemical dependence and there are various types of MAT used to produce the desired result as outlined in the four main purposes.
MAT can also be known by the term Harm Reduction as the medicines prescribed are working to reduce the harms associated with excessive use. Harms can create underlying mental and physical health problems leading the user into a more difficult situation as the body reacts to overuse of the drug.
Overuse of alcohol and drugs can also be dangerous to the user and as well as developing health conditions death can occur due to overdose.
Some of the contraindications or creation of secondary health conditions can affect the user in a variety of ways from:
Physical Health Problems
- Liver damage
- Heart problems
- Respiratory Disorders
- Blood Disorders
- Stomach problems
- Bowel disorders
- Brain damage
- Seizures and blackouts
This list does not cover all the contraindications to physical health but clearly shows the possibility of secondary health conditions that may relate to excessive consumption of drugs and alcohol.
Due to these physicians are passionate about reducing the harms related to use and decreasing the incidence of ill health and in some cases death related to overuse.
Mental Health Problems
- Borderline Personality Disorder
- Post-Traumatic Stress Disorder
The incidence of mental health problems may not be directly linked to the use of a substance in some cases it may be an after effect of trauma related to the situations surrounding the lifestyle.
Also, it must be noted that some may have had mental health disorders prior to drug use and may have self-medicated their mental health condition with alcohol and drugs.
However, it is commonly accepted that alcohol and drugs are mood- and mind-altering substances and are placed in a classification system to dictate their incidence of danger to the consumer.
Drugs can be classed into three categories A, B or C. Alcohol is not included in this classification.
Example of Class A:
- Cannabis (currently recommended as Class C)
- Anabolic Steroids if not for personal use
These lists show some examples of commonly used drugs and what classification of danger to the user they hold. Historically drugs have been classed into specific categories to assist the criminal justice system in sentencing of those found in possession i.e. more dangerous the drug the higher the sentence.
The UK is currently reviewing and discussing treating justice services as a public health problem and diverting those arrested who are vulnerable to crime due to their dependence on alcohol/drugs or mental health problems into more supportive and less punitive services.
Medical Assisted Treatment MAT and Alcohol
These medicines with the exception of Gabapentin are part of the Benzodiazepine group of medicines designed to produce a calming effect to the user. Those with anxiety problems, back injuries or alcohol withdrawal (leg spasms, anxiety, fear, trouble sleeping and restless legs) may have prescribed them.
Gabapentin (4) – has been shown to be effective with mild alcohol withdrawal and may reduce alcohol cravings and sleep disturbance.
- Acamprosate (2) – this tablet has not been designed to help people stop using alcohol. Instead the tablet helps reduce alcohol cravings and is usually prescribed for up to 12 months after alcohol detox.
- Naltrexone (1) – is used to block the pleasure derived from alcohol. The reward system in the brain (for drugs) is deactivated and cravings eventually begin to decrease.
- Antabuse (3) – works to deliver adverse results to the drinker. Such as nausea, vomiting, headaches and a racing heart causing palpitations. Antabuse can act as a deterrent to using alcohol as the participant knows they will become unwell immediately.
As with all medications there is no guarantee these tablets will stop those using alcohol from resuming drinking. A participant can stop taking the tablet at any time and recommence their use of alcohol.
NB: in some cases Naltrexone can be administered by injection instead of tablet and its effects can last for one month.
It must be mentioned that the information given above is a brief overview of certain prescriptions and does not cover every area of alcohol withdrawal/blocker. The information also does not consider every learned school of thought on the best way to detox or help block and cease the use of alcohol.
Medically Assisted Treatment – Narcotics
Opiate Withdrawal – Heroin, Morphine, Opiate Prescription Medications
- Buprenorphine such as Subutex, Buvidal
- Suboxone – Buprenorphine/naloxone
The area of opiate withdrawal is considerably large, there are many components to opiate withdrawal as well as schools of thought around the most effective prescription.
Methadone has generally been favoured by local health care authorities for the last four decades however Suboxone, Subutex and currently Buvidal are being prescribed as an alternative to Methadone. Or to use after a methadone programme finishes.
Suboxone combines Buprenorphine and Subutex and works to reduce pain from opiate withdrawal as well as blocking the cravings for the further use of opiates.
Buvidal injection is of current interest to those involved in the prescription of maintenance and prevention drugs due to its recent release into statutory drug services. Buvidal is a slow release drug that allows participants to receive results from up to 7 days or up to one month before it is required to be re-administered by a healthcare professional.
Lofexidine is also prescribed to aid with opiate withdrawal. Each drug mentioned in the list has different purposes and may be favoured more so by local authority areas and addiction specialist such as GP’s responsible for writing opiate related prescriptions.
Historically tablets with Di-Hydrochloride were prescribed by GP’s for the symptoms of withdrawal but due to the addictive nature of those tablets prescriptions have decreased.
Opiate Blockers or Antagonists
The two main Opiate or Opioid Antagonists or Blockers to be found in the UK are Naloxone and Naltrexone. Naloxone is more commonly used to reverse the effects of overdose.
And its distribution is becoming more widely spread amongst drug users and frontline professionals in all the emergency services including the fire brigade and the police force as well as the public health sector.
This is due in part to the UK turning the tide and beginning to treat addiction more commonly known now as Substance Use Disorder SUD as a public health problem reducing the punitive measures of the past. As well as considering a Whole Population Approach to the UK’s drug/alcohol problems.
Naltrexone when used after opiate withdrawal and in combination with any future opiate intake will create an adverse reaction to the user. This reaction is meant to act as a deterrent to future opiate use such as Heroin.
Naltrexone attaches to the opiate receptors of the brain to act as an antagonist to opiate use by the participant.
NB: It must be mentioned that the information given above is a brief overview of certain prescriptions and does not cover every area of opiate withdrawal/blocker. The information also does not consider every learned school of thought on the best way to detox or help block and cease the use of opiates.
Stimulant Withdrawal – Cocaine, Amphetamine, Cannabis, Green, Crack etc.
Diazepam and Valium can be used to aid with sleep although it is possible to detox from stimulants without MAT. This being said care and attention must be paid to anxiety levels and mood levels with those using stimulants.
Those detoxing are encouraged to access professional or community support groups to reduce any negative feelings or worries attributed to withdrawal. And to feel supported throughout a difficult time.
MAT – The Best Results – Additional Therapies
MAT is generally prescribed by the local authority drug/alcohol statutory service and by a specialist nurse practitioner or doctor by the assistance of a recovery worker. However, some GP’s will also prescribe MAT.
NB: The term recovery worker is now preferred to addiction worker as the word addiction has been slowly phased out of most drug/alcohol services. If you live in Glasgow for example they have renamed their main statutory service Glasgow Alcohol and Drug Recovery Services instead of the previously known Community Addiction Teams.
Medically Assisted Treatment delivers the best results when used in conjunction with psychotherapies such as Cognitive Behavioural Therapy (CBT), Motivational Enhancement Therapy (MET), Dialectical Behaviour Therapy (DBT), Psychodynamic Therapy, Experiential Therapy.
Individuals on MAT can also request Psychotherapy through their statutory services such as Trauma Counselling. However due to demand waiting lists can be high. If this is the case private counsellors can be accessed by the participant of MAT and they will incur a cost.
These private counsellors can be found online, Abbeycare recommends the credentials and reviews are researched before committing to a therapist.
MAT also works well when the participant is socially connected with like-minded people striving to improve their current life circumstances or find an end to loneliness and stigma.
In most areas third sector or charity ran community rehabs and community drops ins are available for people to access. A community rehab will generally offer 121 support and recovery groups.
All community drop ins are different but generally offer a café where people in recovery can talk and connect with like-minded people over a cuppa or low price and nutritious meal. The drop ins usually host recovery meetings such as: SMART, Alcoholics Anonymous, Narcotics Anonymous and Cocaine Anonymous.
In most recovery drop ins, there can be found opportunities to volunteer as the services are led by people in recovery for people in or looking for recovery and their families.
Recovery Drop Ins are inclusive and those ‘dropping in’ can access the support at any stage of their personal recovery journey i.e. actively using alcohol/drugs, on MAT or completely abstinent from all substances.
MAT - The Pros and Cons
MAT is a highly researched and contentious area in the field of substance misuse due to the many variations on delivery, types of prescriptions available and schools of thought regarding what is best for the drug user.
MAT can be delivered by GP’s in their own surgeries and in statutory alcohol and drug services. In those statutory services specialist nurse practitioners and doctors work as part of a team to write prescriptions for those accessing the service.
Types of prescriptions as mentioned beforehand can illicit great debate by medical practitioners and recovery workers. This is due in part to the different schools of thought that exist in how to treat a problematic substance user.
The different schools of thought regarding substance use disorder can be sectioned into two main categories:
- Harm Reduction
Harm Reduction services work to reduce the harms associated with problematic alcohol and drugs use some examples may be:
- Brief Interventions
- Controlled Drinking
- Needle Exchange
- Drug Testing Kits
- Drug Consumption Rooms (currently being trialled in some areas of the UK)
Abstinence approaches work to support abstinence from all substances and once abstinent work to maintain this approach and cease the use of potentially addictive substances. Some examples:
- 12 Step meetings such as AA, CA, NA or GA
- SMART Recovery meetings
- Private Rehab
- Local Authority Rehab
- Faith Based Rehab
The Road to Recovery 2008 Scotland’s Drug Strategy initially sought to have the two areas working in unison to provide a person-centred approach to recovery from alcohol and drugs. The new strategy Scottish Rights, Respect & Recovery 2018 and English HM Government 2017 Drug Strategy’s continuing to empathise the importance of both sectors working together.
MAT is a fascinating and multi-faceted area in the field of substance use disorders. This area has never assigned itself to one set way of thinking or working even though linked to a Harm Reduction approach.
Meaning there are many services and schools of thought that exist in the prescribing and treating of those with problematic alcohol and drug problems.
The information involved in this article relates to only a small percentage of MAT available in the UK and the treatments multiple and varied facets.
When considering the treatment of both mental health and physical health conditions there are also many schools of thought.
Consider Depression for example if prescribing an anti-depressant there are many to choose from and sometimes it takes trial and error from the GP or Psychiatrist to find the correct one.
However, there are those who believe Psychotherapy instead of an anti-depressant prescription is more beneficial.
And there are those who believe in a combination of both anti-depressants and psychotherapies to deliver the best results.
Hopefully, the above description shows how professionally subjective the world of medicine can be. As some choose MAT alone, Holistic Therapies alone or the combination of both MAT and Holistic Therapies when treating a patient.
Humans are intensely fantastic unique beings, and it is only right that the professionals delivering MAT work to provide the correct service for each one of their clients. The world of MAT is constantly evolving and improving as researchers, pharmaceutical companies and medical practitioners work towards finding the ultimate solution to conquer their clients need, want and desire to consume substances in a manner which is hazardous to health.
The magic MAT pill that delivers this result ‘to all’ has yet to be found!