Medication Assisted Treatment
Substance Abuse Disorder and Opioid Addiction are chronic diseases that can be successfully managed in a way that helps individuals return to a healthy and productive life. People can’t just quit addiction – they need sustained help. We’re happy you’ve made it here to our page to find out more about treatment.
Kentucky Mental Health Care professionals can help you in overcoming your substance abuse or opioid addiction. They will work with you to understand your previous treatment experiences, medical conditions, and other aspects that relate to your individualized care.
What is Medication-Assisted Treatment?
Designed to meet the needs of each person, Medication-Assisted Treatment (MAT) is the use of medication combined with counseling for treating opioid addiction such as prescription pain relievers, cocaine, heroin, and fentanyl dependence. At Kentucky Mental Health Care we have seen success with the medications listed below in detail.
These prescription medications work to normalize brain chemistry, block the euphoric effects of alcohol and opioids, alleviate physiological cravings, and normalize bodily functions without the adverse effects of the previously abused drug(s).
Research shows that a combination of medication(s) and therapy can effectively treat these disorders. Medication Assisted Treatment may help maintain a sober lifestyle and is approved by the Food and Drug Administration (FDA).
This therapeutic approach has been shown to:
- Improve patient survival
- Increase treatment retention
- Reduce the use of illicit opiates and other criminal activity among people with substance use disorders
- Increase the ability of patients to obtain and retain employment
- Improve birth outcomes for women with substance use disorders and are pregnant
Treatment options for addiction and substance abuse disorder
There are a number of services available at Kentucky Mental Health Care through our sister company, Kentucky Recovery, to help people experiencing substance dependency. It can be challenging to determine which type of treatment is best, as this is highly dependent on your needs, but our skilled providers are here to help determine your best path to recovery.
Treatment options include:
- individual therapy
- medication-assisted treatment
- personalized case management
- group therapy
The intake and assessment process at Kentucky Recovery ensures a streamlined process and delivery across service and treatment options combined just for you.
The intake process enables providers to understand:
- How severe your substance use is and how it impacts your life.
- Who is at risk and needs immediate support.
- What level of support is needed.
- Who may need extra support.
- Ways to improve support services.
With your consent, the results from the intake process may be shared among healthcare providers to develop and implement your customized plan to support your treatment and goals.
Initial Treatment Plan
Our providers conduct an assessment and develop an initial treatment plan with you. The initial treatment plan includes information collected from the screening and assessment process and your identified treatment needs and preferences. The client then follows the treatment plan with regular monitoring and guidance by our providers with dignity and respect.
Individual Therapy for Substance Dependency
You can receive individual or group therapy as an outpatient or as part of inpatient treatment. The different models of therapy may include:
- The Egan Model – you decide which issues are important and the best ways to address them, with the therapist as a ‘sounding board.’
- Motivational Interviewing – you are encouraged to reduce your level of drug use by exploring the consequences of their addiction and the benefits of behavioral change. Taking responsibility for your behavior and decision-making helps you see your ability to make changes in your life.
- Cognitive Behavior Therapy (CBT) – you are helped to overcome irrational thoughts. The theory aims to change the way you think about your behavior.
- The Systems Theory – a form of therapy that places you in the context of family, social, cultural, and other environments in which you live. The theory proposes that change in one area creates change in other areas.
Types of Medication to treat Substance Dependency
Sometimes, prescribed medication replaces the substance a person is trying to stop using, called substitution pharmacotherapy. ‘Pharmacotherapy’ is the term used to describe the use of medication (such as methadone or buprenorphine) to assist in treating substance dependence. Taken daily, these medications help by managing physical drug dependence, drug craving, and compulsive drug use behaviors.
Substitution pharmacotherapy may not be suitable for everyone and is not available for all substance dependency; below is an outline of the Kentucky Mental Health Care and Kentucky Recovery Medication-Assisted Treatment options.
The most common drugs used in the Medication Treatment of opioid dependence are Suboxone and Methadone. Sometimes another medicine called naltrexone is used, there are many specialized medicines for addiction that you can find out about below. We also have the ability to administer the Vivitrol shot. You can find out more by calling us to schedule an appointment with a medical professional.
Medication-Assisted Treatment (MAT):
Even as a drug or alcohol addiction threatens to rewrite a person’s life, substance abuse treatment options exist that can address the harm done and help the person achieve health and balance.
While counseling and aftercare support address many mental and emotional challenges, the drugs used for addiction treatment or substance abuse can assist with breaking the chains of physical dependence. They can help ease an often difficult withdrawal period and manage any other medical or mental health issues that may have been left untreated (and, in some cases, undiagnosed) along the way. Certain treatment medications may have some risks of their own. Still, they can be instrumental in stabilizing those in early recovery and helping them to manage the symptoms of withdrawal during detox.
How Do Medications for Addiction Treatment Work?
The addictive nature of many substances derives from the way they manipulate the brain’s pleasure and reward centers. Though their precise mechanisms of action vary, many pharmacotherapeutics in treating addiction restore balance to the very neurochemical process disrupted by drug and alcohol use.
To help treat certain types of addiction, a person may be prescribed treatment drugs that diminish cravings and withdrawal, counter the intoxicating effects of a drug, or have “off-label” uses that support the individual in recovery.
Drugs that may be used to manage substance dependence or have otherwise been considered for use as part of an addiction treatment regimen include:
The National Institute on Drug Abuse says that naltrexone works by blocking the receptors in the brain that opioids would otherwise bind to and activate, rendering those drugs incapable of eliciting their addictive high. Naltrexone is safest when used after the person has finished medically supervised detox because using it when opioids are still in the body may prompt extremely severe withdrawal symptoms. Naltrexone is viewed to be an ideal drug for treating opioid abuse because of the ease of administration, minimal side effects, and lack of abuse/addiction liability.
While naltrexone works by completely blocking the activation of opioid receptors in the brain, a drug like buprenorphine works by partially activating them. This is why naltrexone is referred to as an opioid antagonist, and buprenorphine is called a partial opioid agonist—meaning that it activates the brain’s opioid receptors but not to the extent that a “full opioid agonist” like heroin does.
Since buprenorphine is only a partial agonist drug, there is a “ceiling” to its opioid effects. It is incapable of eliciting as strong of a high as many full opioid agonist drugs of abuse. According to the Substance Abuse and Mental Health Services Administration, this lowers its potential for misuse, as well as the degree of the withdrawal effects associated with the treatment drug itself. Used this way, buprenorphine can help wean individuals off their dependence on full opioid agonists.
Naltrexone has also shown applicability as a tool to treat alcoholism. An injectable, extended-release form of naltrexone known as Vivitrol has been called “the most important breakthrough in addiction treatment in the past 25 years.” A medical director tells the New York Daily News that while naltrexone requires a pill to be taken once every day or two days, Vivitrol is administered via injection once a month. According to the director, patients find this route of administration helps them remain sober.
On the other end of the spectrum of opioid agonist drugs like methadone and buprenorphine are the opioid antagonists, including naloxone. In addition to blocking the activation of opioid receptors, naloxone acts as a competitive antagonist and can actively reverse the narcotic effects of many full opioid agonist drugs. It is this ability that makes naloxone such a vital medication in treating opioid overdoses and saving lives.
Naloxone’s use extends beyond its role as an “antidote” to opioid overdose. It is often found in a combination formulation with buprenorphine (e.g., as the opioid dependence treatment medication Suboxone—a drug which the Washington Post describes as “the drug [that] could combat the heroin epidemic.”). Its inclusion in such a drug is done to curb abuse of the treatment drug itself. People trying to misuse Suboxone may not only experience blocking of the desired opioid effects but may also experience immediate opioid withdrawal.
Other drugs that are used to help people struggling with alcoholism include disulfiram and acamprosate. When used as prescribed, disulfiram (trade name: Antabuse) will result in a very unpleasant reaction should the individual consume even small amounts of alcohol. It achieves this effect by blocking the activity of a specific enzyme important in metabolizing ethanol. The resultant buildup of a chemical intermediary (acetaldehyde) is what’s behind the adverse physical effects. Reactions can include headache, nausea, vomiting, chest pain, sweating, blurred vision, and breathing difficulty, among others. Experiencing such uncomfortable symptoms and knowing that they will occur is thought to deter individuals from drinking.
Acamprosate (trade name: Campral) is specifically designed to maintain the chemical balances in the brain that are disrupted in a person with pronounced alcohol dependence. It is another drug used to assist in the treatment of alcoholism. Acamprosate may work by protecting the brain from overexcitation that results when a person tries to withdraw from alcohol in the wake of its significant disruption of excitatory and inhibitory signaling. In doing so, relapse likelihood may be decreased and abstinence promoted.
Sometimes, the weapons in the fight against addiction come from unexpected places. In 1998, the U.S. Food and Drug Administration approved modafinil (under the brand name Provigil) as a treatment for narcolepsy.
Modafinil is a non-amphetamine central nervous system stimulant and eugeroic—a drug that promotes alertness/wakefulness. It is prescribed for those who struggle to function in their day-to-day lives because of irregular or diminished sleep patterns. Irregular sleep can be caused by long work shifts, sleep apnea, PTSD, or other reasons.
Modafinil’s effects have also drawn attention for possible use as a treatment for cocaine dependence—a condition for which there is currently no FDA-approved drug. It has been theorized that the stimulant effects of modafinil could help alleviate some of the symptoms of acute cocaine withdrawal.
Furthermore, there is evidence that modafinil may reduce cocaine cravings and mute some of the subjective responses to this addictive drug. When used in combination with individual behavioral therapy, it could prolong abstinence. More research into any direct effects is needed.
Primarily used for depression, seasonal affective disorder, and smoking cessation, bupropion also sees some off-label use in managing attention deficit disorder. It has been investigated for a potential role in different types of addiction treatment.
The Primary Care Companion to the Journal of Clinical Psychiatry published a review article detailing some of ”the many uses of bupropion.” Though reports were mixed and the results far from conclusive, the author cites several studies that may support the use of bupropion to treat specific types of substance abuse.
- Bupropion was “helpful” in reducing cravings for cocaine use in one study.
- Sustained-release bupropion (e.g., Wellbutrin SR) combined with participation in a 12-step program may reduce methamphetamine cravings.
As with bupropion, mirtazapine (trade name: Remeron) is mainly used to help patients with depression. There is some data, albeit limited, that mirtazapine in conjunction with therapy may benefit people during alcohol detoxification.
One study suggests that this therapeutic value is achieved by decreasing collateral anxiety, depressive symptoms, and minimization of physical and perceived discomfort in the post-withdrawal period.
Suboxone reduces cravings and helps fool the brain into thinking the illicit drug is still being used. The person taking the medicine feels normal, not high and withdrawal does not occur. This medication can be a pill or a sublingual tablet/film placed under the tongue.
Methadone as a treatment for heroin, oxycodone, or fentanyl dependence. Methadone is cheaper than heroin, oxycodone, or fentanyl and remains active in the body for longer. Its effects last about 24 hours, with the peak effects felt 4 to 8 hours after taking the dose. This extended-release means only a single daily dose is needed.
Methadone reduces risky behaviors such as injecting and the quest for product that allows someone to remain stable while making further positive changes in their lives. Methadone treatment can be long-term (months or years), to help the person reduce the risks of using illicit drugs, or short-term (two weeks or less), to help the person safely withdraw from heroin, oxycodone, or fentanyl.
Methadone is taken as a drink.
Other isolated examples of research into additional pharmacotherapeutic agents include:
- Baclofen, a skeletal muscle relaxant used primarily to treat muscle spasticity, has been investigated for its potential role in maintenance treatment for opioid dependence.
- Some research evidence shows that the anticonvulsant medication, gabapentin, may help manage specific withdrawal symptoms in methadone-assisted detox.
- Like gabapentin, the anticonvulsant vigabatrin may reduce some alcohol withdrawal symptoms.
- Low-dose topiramate could warrant attention for a potential role in preventing alcohol relapse. It may help reduce alcohol cravings, anxiety, and depression when used to treat alcohol dependence.
Though in these instances, official approval as addiction treatment medications has not been given, they serve as indicators of how researchers continue to look for new pharmaceutical options to add to the toolbox of addiction treatment.
With ongoing investigation, the hope is that we will soon be able to augment our proven therapeutic methods and practices to make additional headway in substance abuse treatment.
MAT has been widely proven to reduce the need for drug addiction services significantly. Supplemented with behavioral and cognitive therapy, MAT can lead to a full recovery from addiction. Patient survival rates and resistance to relapse are greatly improved by MAT. Depending on the substance a person is using, the benefits of pharmacotherapy can include:
- An easing of withdrawal symptoms allows you to function in day-to-day life.
- You no longer take a substance manufactured in an unregulated lab with no quality control or knowledge of its purity.
- You are no longer using a substance in harmful amounts or using a potentially dangerous method, such as injecting with used needles.
- You have the chance to address life issues without having to worry about finding enough money each day, getting the substance, and using it.
Personalized Case Managment
Preventing relapse during substance dependency treatment. If you are undergoing treatment for substance dependency, you need considerable support to make a successful transition to a substance-free lifestyle. Our case managers work exclusively with our clients that have a substance abuse issue primarily work to help their clients access much-needed resources such that they can stay clean. Typical duties of substance abuse case management are common across all case management fields. Much time is spent assessing clients and identifying appropriate interventions that will aid in their recovery.
Substance abuse case managers also engage in advocacy on behalf of their clients, whether to access a needed service, help their client find employment or anything in between.
A crucial function of substance abuse case managers is to monitor the progress of their clients. This monitoring could involve periodically checking in with the client’s therapist to determine if the client is cooperating with treatment. It could also mean touching base with the client’s landlord or employer to ensure they stay current on rent and perform well on the job. Naturally, monitoring the client’s drug or alcohol usage is essential as well.
Substance Abuse Case Managers and Mental Health Case Managers can help. There are various support programs available – such as help to find employment or housing through our Kentucky Mental Health Care & Kentucky Recovery Case Managers.
Group Therapy for Substance Dependency
You gain insights into your substance use by talking to others who have been in a similar situation. Many of these groups can also offer support services, which encourage personal growth by understanding and caring for others in the community. It’s always your choice to join a group, in the long term they are great for accountability and an understanding ear.
How does our MAT work?
Medication-Assisted Treatment consists of administering very specific medications at very specific doses, tailored to the patient receiving them. The medication does not mimic the effects of the addictive drug, as is generally believed. Instead, these medications treat the withdrawal symptoms that occur due to the discontinuation of the addictive drug.
The psychological dependency that develops as a result of addiction is also reduced by taking medication. It creates a situation where the body can slowly repair itself and normalize its systems to a pre-addictive stage.