How to Choose a MAT Program That Is Right for You

MATs for Alcohol and Opiates

A critical first step in choosing a MAT program that is right for you is knowing what medications are available.

These three MATs have been approved by the FDA to treat alcohol addiction:

• Acamprosate (Campral) – first approved by the FDA in 2004 for treating alcoholism, the medication has been in use for this purpose in Europe since the 1980’s. The drug has been shown to help patients maintain abstinence.
• Disulfiram (Antabuse) – as the very first medication approved by the FDA to treat alcohol dependence, disulfiram acts as an alcohol deterrent. When users taking disulfiram drink, they experience a toxic and acutely unpleasant reaction.
• Naltrexone (Vivitrol) – blocks the euphoric effects of alcohol and relieves alcohol cravings.

These four MATs have been approved by the FDA to treat opiate addiction:

• Buprenorphine – approved in 2002, the drug helps to blunt and even prevent opiate cravings, block the effects of opiate drugs, and relieve opiate withdrawal symptoms. Unlike methadone, which requires regular maintenance through a clinic, buprenorphine can be administered in pill form— which makes it more easily accessible through a physician’s office.
• Naltrexone (Vivitrol) – blocks the same opioid receptors in the brain that opiate drugs activate, so when taken as directed effectively prevents relapse and maintains abstinence.
• Methadone – unlike buprenorphine, methadone has been in use much longer, having been shown to have the same favorable effects for recovering opiate addicts (alleviated withdrawal, reduced cravings, etc.) With methadone, however, there is a dramatically higher risk of abuse.
• Lofexidine (Lucemyra) – as the newest drug on the market for opiate addiction, its manufacturer describes it as “the first and only FDA-approved, non-opioid treatment for relief of multiple symptoms of opioid withdrawal after abrupt discontinuation.”

In addition to these formally FDA-approved medications for opiate addiction, clonidine is a drug that has been used off-label for 35 years in treating opiate addiction (particularly the symptoms of withdrawal).

If a pattern of substance abuse has involved both alcohol and opiates, it’s possible that naltrexone (Vivitrol), which is used to treat both addictions, may be a good choice of medication for your needs. Ultimately, though, deciding on what medication to include in your MAT program of care will first require an initial screening by medical professionals. Based on factors like the following, they should be able to determine whether you are eligible to receive MAT:

• Your primary goals in recovery
• Medical and psychosocial risk factors that could affect treatment
• Mental disorders
• Any other existing substance use
• Family concerns
• Vocational, financial, and transportation concerns

Eligibility Criteria for MAT

Following an initial screening, you should then receive an in-depth medical and comprehensive assessment. Its purpose is to help your treatment provider tailor their interventions for your individualized needs, thus maximizing your prospects of recovery.

The medical assessment employs certain tools and methods for determining your eligibility for MAT, including toxicology reports, lab results, a psychosocial assessment, and a review of these results by a physician and/or medical director of the prospective rehab program. They, based on this data, will make recommendations regarding an appropriate MAT (assuming you have been found to be eligible for MAT).

There are certain federal eligibility requirements for administering MAT:

• The candidate for MAT must exhibit current opiate addiction.
• Their addiction must have lasted for a minimum of one year prior to seeking MAT. (Note: a physician can invoke an exception to this guideline in certain circumstances.)

“Opioid Treatment Program” Designation

A MAT program that is right for you will be licensed as an “Opioid Treatment Program” (OTP), which is the highest federal certification that treatment providers can qualify for.  OTP was established by the Substance Abuse and Mental Health Services Administration. The accreditation was developed in an effort to improve the quality of patient care, treatment and services. OTP-certified treatment programs like Beach House Center for Recovery had to undergo a rigorous screening and certification process that, if passed, permits them to have an on-site pharmacy dispensing MATs.

The takeaway: when choosing a MAT program that is right for you, ask about whether it is OTP-certified.

Learn more about the importance of choosing a MAT program that is OTP-certified.

Behavioral Therapies for Addiction

Medication is only one prong of MAT, the other being counseling and behavioral therapies that address the roots of an addiction to alcohol and/or opiates. Any MAT program worth considering should therefore offer a variety of evidence-based group and individual therapies that have proven useful at boosting rates of recovery, including these interventions:

• Cognitive Behavioral Therapy (CBT) – CBT is associated with better treatment outcomes in multiple controlled clinical trials. This form of psychotherapy focuses on correcting and replacing negative and unhelpful thoughts and behaviors that feed the addiction cycle and can contribute to relapse. The goal of CBT is to identify irrational thoughts and negative emotions, so these can be modified. Clients learn healthier anger management skills and better ways of coping with stress and other cues and triggers for substance abuse. A MAT program that employs CBT could very well be right for you. Be sure to check, however, that any clinicians practicing CBT are trained and certified in this modality.
• Trauma-Informed Therapy, including Dialectical Behavioral Therapy (DBT) skills – So prevalent is trauma in cases of addiction that it is virtually a given that anyone struggling with an opiate or alcohol problem is dealing with some form of unresolved trauma. Trauma-informed DBT is one of the most effective interventions out there for helping clients heal from the experiences of trauma and post-traumatic stress disorder (PTSD) that are at the root of their substance abuse. Clients learn how to manage the painful emotions associated with a post-traumatic stress response to past traumatic events, so they can successfully overcome this very common relapse trigger. In addition to these DBT skills, clients learn how to develop the following cognitive-behavioral tools through trauma-informed therapy: grounding skills, resource building, safe place work, and resiliency skills. As with CBT, DBT therapists should have the appropriate credentialing.
• Motivational Interviewing (MI) – MI’s therapeutic effectiveness has been most widely studied among the alcohol abuse population where at least 32 studies have linked MI to improved treatment outcomes. MI is a highly client-directed form of psychotherapy, encouraging clients to identify and articulate for themselves the kinds of core life changes they will need to sustain long-tern sobriety. Therapists should also be credentialed to administer MI.
• 12-Step Group Therapy – A large body of evidence has found that 12-step group participation correlates with better long-term recovery outcomes. The 12-step, self-help approach combines the spiritual recovery principles of the “12 steps” with the practical support and help of group members who share the same problem.

In addition, a trusted, high-quality MAT program should have a continuing care program, with options for individual maintenance therapy, medication maintenance with an on-site psychiatrist, recovery support groups and opportunities to stay connected with other alumni in the program. A trusted MAT program will also give you the option of including close loved ones in your plan of care— if you feel you need it.

Finally, keep in mind that finding a MAT program that is right for you is one of the best ways to ensure you have a positive experience in rehab, are more motivated and engaged in treatment, and, ultimately, improve your prospects of achieving lasting sobriety.