5 Benefits of Effectively Combining Medication-Assisted Treatment (MAT) and Addiction Counseling

What is Medication Assisted Treatment?
Medication-assisted treatment (MAT) uses FDA approved pharmaceuticals to treat opioid addiction and facilitate a sustainable recovery. Methadone, buprenorphine, and naltrexone products have been approved to be used as a treatment in opioid use disorders (OUD). Methadone functions as a full opioid agonist by binding to the same opioid receptors in the brain that create a euphoric high when activated by drugs such as opioid pain medication or morphine. Unlike other opioids, however, methadone has a long half life which prevents any highs or lows to develop. This eliminates many withdrawal symptoms and simultaneously alleviates drug cravings in a person with opioid dependency. Buprenorphine functions similarly to methadone, however it acts as a partial opioid agonist. This means that buprenorphine activates  opioid receptors at a lower level, causing it to have a threshold, known as the “ceiling effect”, that decreases the risk of misuse. The ceiling effect also allows buprenorphine to be administered in a home setting in addition to a clinical setting. Naltrexone, on the other hand, is an opioid antagonist. Less commonly used than methadone and buprenorphine for MAT, naltrexone blocks any activation of opioid receptors thereby eliminating any euphoric effect of opioid drugs rather than the withdrawals or cravings. 

What is Addiction Counseling?
Addiction counseling helps addicts manage obstacles in their lives without dependence on substances and better understand the factors that led to their addiction.  After and during detox, individuals are at high risk of relapse especially when faced with triggers in their social or physical environments. Counseling allows individuals to learn how to recognize and cope with these stressors in healthy ways to facilitate long-term recovery and prevention. There are several types of therapy including group therapy, individual therapy, cognitive behavioral therapy, family therapy, maintenance therapy. Since counseling is not a one size fits all treatment, the type of therapy needs to be personalized and specific to each individual person.  

Benefits of Creating a Well Rounded Treatment Plan 
Research has shown that MAT is most effective for Opioid use disorder (OUD) when used in combination with counseling and/or behavioral therapy. This combination creates a well-rounded comprehensive treatment plan for individuals to have a sustainable recovery. Listed below are five major benefits of treating OUD with both counseling and MAT: 

1. Allows Treatment of Additional Areas 

Along with the careful prescription and treatment of individuals using methadone or buprenorphine to ease a person off of opioids, psychosocial counseling allows a licensed professional to assess the individual’s mental health and address any underlying behaviors. Individuals with a mental health disorder are more likely to have a substance abuse disorder than those that do not have a mental disorder. The combination of a substance abuse disorder and a mental disorder is known as a co-occuring disorder. The most common mental disorders that co-occur with addiction include bipolar disorder, PTSD, anxiety, and major depressive disorder. The addition of therapy helps create a specific plan for each individual patient, leading to treatment of the addiction and any additional psychiatric disorders. Through the inclusion of counseling, patients are given a safe environment to discuss trauma, confront emotions, and address any mental health conditions that may have contributed to the substance abuse. 

1. Effective Results - Decrease in Relapse and Overdose 

MAT has been reported on several instances to effectively decrease both the risk of relapse and overdoses. The increased use of agonists as a treatment for OUD has been associated with the decrease in heroine deaths starting in 2000. Additionally, a long term follow up of MAT recipients indicated that 18 months after their initial therapy session, 50% of individuals had remained abstinent from opioids. Furthermore, a 3 ½ year follow up indicated that abstinence had increased to 61% and only 10% of individuals fell under the criteria for drug dependence. These results indicate that the combination of counseling and medication contribute greatly to both the recovery and further prevention of substance abuse when applied in a consistent and safe manner. 

1. Decreased Infectious Disease Transmission 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 9% of new HIV infections appear among injection drug users. Individuals participating in MAT have shown a decrease in their illicit drug use, causing them to be less likely to partake in the sharing of dirty needles or other high risk behaviors. This, in combination with risk-reduction counseling that can be incorporated in MAT programs, facilitates the decrease transmission of infectious diseases, such as HIV or Hepatitis C, among individuals who follow OUD treatments. Certain MAT programs also include HIV testing which can identify infectition and help deter spread. The integrated care of both medication and therapy encourages individuals to make safe decisions and maintain a safe lifestyle. 

1. Encourages Social Integration and Support

As reported by the SAMHSA, the counseling that coincides with MAT gives individuals the opportunity to develop certain life skills that can be applied during and after their recovery. Therapy covers topics such as setting reasonable goals, coping with cravings, managing stressors, embracing a changing lifestyle, maintaining meaningful relationships, and creating healthy habits. These topics, and more, contribute to the holistic approach that helps a person not only decrease illicit opioid use, but do so while also having support and guidance in other aspects of their life. 

1. Harm Reduction  

The use of opioid agonists with long half lives allows for individuals to slowly wean off of substances. This slow, methodical process of harm reduction limits the pain and physical consequences that come with detoxification. MAT allows addicts to have smaller, realistic goals of detoxification rather than unfeasible objectives than can quickly lead to relapse. The long term structure of MAT is especially beneficial to those that do not have support systems in place to provide help during their withdrawals and cravings. The counseling that is associated with MAT also gives an outlet to those that are having difficulty during their detoxification to learn how to manage their emotions or behaviors. 

1. https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat
2. https://atforum.com/2013/02/buprenorphine-vs-methadone/
3. https://atforum.com/2013/02/buprenorphine-vs-methadone/
4. https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work OR https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone
5. https://www.webmd.com/mental-health/addiction/counseling-and-addiction-how-therapy-can-help#1
6. https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/11/medication-assisted-treatment-improves-outcomes-for-patients-with-opioid-use-disorder
7. https://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670653/
9. https://archives.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism
10. https://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities
11. https://ct.counseling.org/2018/09/group-counseling-with-clients-receiving-medication-assisted-treatment-for-substance-use-disorders/
12. https://www.shatterproof.org/harm-reduction-medications-addiction-treatment