Medication-assisted recovery, often referred to as medication-assisted treatment, is an evidence-based and highly effective tool in helping people break free from addiction. But before starting a medication-assisted recovery program, it can be useful to understand how this treatment method works, what medications are used, and which myths surrounding it should be dismissed.
What Is Medication-Assisted Recovery?
Medication-assisted recovery is a style of addiction treatment that treats both the body and the mind. By using targeted medications designed specifically to treat certain substance use disorders in tandem with the best talk therapy options available, people can find relief from both the physical and mental health effects of a substance use disorder.
This style of treatment has repeatedly been linked with several beneficial outcomes. According to the Substance Abuse and Mental Health Services Administration, medication-assisted recovery has been shown to:
- Increase the likelihood of staying in treatment
- Reduce the likelihood of relapse
- Improve people’s ability to find employment and stay employed
- Reduce the risk of overdose
These benefits, alongside countless others, are why medication-assisted recovery is typically considered the gold standard of evidence-based addiction care.
But even further, medication-assisted recovery can be used in conjunction with countless other addiction treatment methods to further enhance its effectiveness. Medication-assisted recovery is typically just one component of a comprehensive addiction treatment program, which can include treatment modalities such as:
- Cognitive behavioral therapy
- Dialectical behavior therapy
- Equine-assisted therapy
- Eye-movement desensitization and reprocessing
- Individual and group therapy
- Mindfulness training
Working medication-assisted recovery into a comprehensive addiction treatment plan ensures that you or your loved ones have the best chance of overcoming a substance use disorder and living a healthier life in recovery.
What Medication-Assisted Recovery Can Treat
Medication-assisted recovery is used to treat a wide number of substance use disorders. However, this style of treatment is particularly effective for people struggling with opioid use disorder and alcohol use disorder, where targeted medications can produce the greatest effects.
Opioid Use Disorder
Opioid use disorder is one of the most common addictions people face in the world today. Opioids include illicit drugs such as heroin and fentanyl, as well as prescription opioids like Vicodin, Oxycontin, morphine, or codeine.
To understand how medication-assisted recovery can help people overcome opioid use disorder, it’s important to first recognize how opioids and opioid addiction can interact with the brain and body.
All opioids, whether they are prescription medications or illegal drugs, have a similar drug action. When opioids enter the bloodstream, they attach to sites throughout the brain and body known as opioid receptors and activate them. This causes a number of effects, including:
- Pain relief
- Euphoria
- Drowsiness
- Relaxation
Activating these receptors classifies these drugs as “opioid agonists.”
When a person develops an opioid use disorder, their body becomes accustomed to this heightened receptor activation. This leads to tolerance — which means that more opioids are needed to produce the desired effect — as well as symptoms of physical withdrawal.
All of the medications used in medication-assisted recovery for opioid use disorder work on these same receptors, but in a different way. There are three main medications used in the treatment of opioid use disorders: buprenorphine, methadone, and naltrexone.
Buprenorphine
Buprenorphine is one of the most common medications used in medication-assisted recovery. Buprenorphine belongs to a class of drugs known as partial opioid agonists. This means that it works very similarly to opioid agonists like fentanyl or oxycodone, but to a much lesser degree.
When people take buprenorphine, opioid receptors are activated at a much lower intensity than when a person uses prescription or illicit opioids. This opioid receptor activation provides tangible relief from the symptoms of opioid withdrawal, including dramatically reducing the experience of craving.
This means that a person with opioid use disorder who takes buprenorphine can find relief from the negative physical and mental effects of an opioid use disorder, without experiencing the addictive euphoria from full opioid agonists.
Further, buprenorphine has a ceiling effect, so taking higher doses of buprenorphine won’t result in a euphoric high. Due to this unique property, buprenorphine is available as a take-home prescription with limited potential for misuse.
Methadone
Methadone is another commonly used medication in the treatment of opioid use disorders. Unlike buprenorphine, methadone is a full opioid agonist, similar to the opioids commonly used recreationally.
This means that taking methadone will alleviate many of the uncomfortable and long-lasting symptoms of opioid withdrawal, as a client’s opioid receptors are still being activated. But unlike illicit opioids, methadone use is carefully controlled by the prescribing provider.
Methadone is typically provided in a dosage that provides relief from uncomfortable side effects, without being so potent as to create a euphoric high. Additionally, methadone has a significantly longer half-life than most other opioids, which means that people only need to take their medication once a day.
Since methadone has no ceiling effect, it is generally only provided at specialized clinics. Clients on a methadone maintenance plan need to visit their clinic daily for their dose and can slowly titrate off of methadone as they grow more confident in their recovery.
Naltrexone
Naltrexone is a unique medication that is used to treat several different types of substance use disorders. Naltrexone is known as an opioid blocker because it attaches to the opioid receptor without activating it and blocks other opioids from latching on to these receptors.
In other words, people who use an opioid while taking naltrexone experience no effect. Ingesting a drug such as heroin after taking naltrexone provides no euphoria or pain relief, as naltrexone blocks the opioid receptor from other drugs.
In addition to this unique blocking effect, naltrexone has been shown to substantially reduce substance cravings. Taking naltrexone, either by mouth or through a longer-lasting injection, has repeatedly been shown to reduce the frequency and intensity of opioid cravings, helping people stay sober.
Alcohol Use Disorder
Alcohol use disorder has several effective medications used in medication-assisted recovery as well. Alcohol is a central nervous system depressant, acting primarily as an agonist of the GABA receptor. GABA is the brain’s primary inhibitory neurotransmitter, helping your brain to calm down, relax, and slow its activity.
When people develop an addiction to alcohol, their brains become reliant on this elevated GABA activity. When they stop drinking, the brain becomes overexcited, leading to withdrawal, cravings, and a host of physical and mental health consequences.
There are three main medications used in the treatment of alcohol use disorder.
Acamprosate
Acamprosate is one of the most common medications used to treat alcohol use disorder. Acamprosate can help regulate the balance of neurotransmitters in the brain, helping bring GABA and its opposing neurotransmitter, glutamate, closer to equilibrium.
Acamprosate doesn’t necessarily return neurotransmitter production back to normal levels immediately, but it can substantially reduce the symptoms of withdrawal and the experience of craving.
Disulfiram
Disulfiram, often known by the brand name Antabuse, takes a different approach to helping people overcome alcohol use disorder. Disulfiram modifies the way that your body processes alcohol, such that after taking this medication, any alcohol use results in a rapid onset of uncomfortable symptoms.
Drinking while taking disulfiram can lead to symptoms like:
- Nausea
- Vomiting
- Sweating
- Headache
These effects can occur as rapidly as 10 minutes following a drink. According to the principles of behaviorism, this sudden onset of severe consequences will make it less likely for people to attempt to return to drinking and have an easier time achieving sobriety.
Naltrexone
Naltrexone is also used in the treatment of alcohol use disorders. While the primary drug action of alcohol is on GABA, alcohol also has effects on the body’s opioid system, and blocking the opioid receptors using naltrexone has been shown to substantially reduce alcohol intake and craving.
Other Substance Use Disorders
While alcohol and opioid use disorders have the most robust evidence of effective medications for achieving recovery, research is constantly ongoing to help people with other substance use disorders as well.
One of the most promising avenues from recent research is the use of the antidepressant bupropion in combination with naltrexone in the treatment of methamphetamine use disorder. This drug combination can make it much easier for people to overcome meth addiction and provide substantial relief from lingering withdrawal symptoms.
While less is known about other types of addiction, naltrexone is often prescribed off-label in order to provide some relief. There is substantial evidence that naltrexone reduces cravings for all types of substance use disorders and may even help people break free from behavioral addictions, such as gambling, pornography, or kleptomania.
3 Myths About Medication-Assisted Recovery
As effective as medication-assisted recovery is, it has also seen its fair share of controversy. As a result, a number of myths have circulated about medication-assisted recovery that may be holding you back. Rest assured that the scientific consensus is firmly on the side of supporting this incredibly helpful treatment method.
1. Medication-Assisted Recovery Isn’t True Sobriety
One of the more common myths is that people who recover using medication-assisted recovery aren’t truly sober. This is mostly due to the mistaken belief that the medications used in medication-assisted recovery produce a euphoric high and that people who use this method are just “trading one drug for another.”
This couldn’t be further from the truth. Medication-assisted recovery is designed to help treat the symptoms of substance use disorder without producing euphoric or addictive effects.
2. Medication-Assisted Recovery is Just a Prescription
Medication-assisted recovery is much more than just taking medication. Starting a medication-assisted recovery program means you will also engage in evidence-based therapy and treatment programs, all of which are designed to support you in maintaining your abstinence and building a healthier life in recovery.
3. You Need Medications for the Rest of Your Life
Medication-assisted recovery is not a lifetime sentence. The length of your treatment depends upon your personal preferences, the severity of your substance use disorder and symptoms, and careful consultation with a trained mental health expert.
While it is true that it’s not recommended that people stop medication-assisted recovery suddenly, if you do decide that you no longer want to take medications, your provider will help you develop a plan to slowly titrate off your medicine and monitor your progress along the way.
How to Start Medication-Assisted Recovery
When you’ve made the decision to take action to overcome a substance use disorder, starting medication-assisted recovery can be a valuable first step. Beginning treatment is as simple as reaching out to APN Lodge, which provides a comprehensive suite of addiction treatment services to fit each one of our client’s unique needs.
We can help explain what treatment options are available to you and will be there to support you throughout your entire recovery journey. Reach out to the team at APN Lodge by completing our online contact form or calling us at 855-232-8217 to speak to one of our mental health experts directly.
References
- Connery, Hilary Smith MD, PhD. Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions. Harvard Review of Psychiatry 23(2):p 63-75, March/April 2015. | DOI: 10.1097/HRP.0000000000000075
- Maisel, Natalya C et al. “Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?.” Addiction (Abingdon, England) vol. 108,2 (2013): 275-93. doi:10.1111/j.1360-0443.2012.04054.x
- “Medications for Substance Use Disorders.” SAMHSA, www.samhsa.gov/medications-substance-use-disorders. Accessed 15 June 2024.
