How Medication-Assisted Treatment Helps People With SUD in Massachusetts
Substance use disorder (SUD) is a complex mental health condition that impairs one’s quality of life. Someone who has SUD values continued use of the substance most highly, irrespective of the possible negative consequences to friendships, familial bonds, job security, and mental and physical well-being.
In most cases, SUD falls into one of three categories: mild, moderate, or severe. It’s also possible to have SUD regarding more than one substance at a time and be in more than one category at once. For example, someone might have severe alcohol use disorder (AUD) and mild opiate use disorder (OUD). Research shows that 43% of people with SUDs have comorbid mental health disorders, especially depression and anxiety. In many instances, the SUD stems from a trauma associated with the comorbid disorder: the proverbial “drinking to forget problems.”
Only 11.8% of the 20 million people in the United States who experience substance use disorder receive treatment. Of those, one in three never finish the treatment program for a variety of reasons. Because of this, there are serious consequences for both the person involved and society as a whole. These consequences include an elevated chance of death for the person with SUD. Effective medication-assisted treatment (MAT), however, yields uniformly positive results: lower risk of overdose and/or death, fewer criminal convictions, greater productivity, and less chance of returning to use.
There are notable hurdles that prevent individuals from accessing treatment in the United States, including high costs, limited affordable insurance coverage, distance to treatment facilities, and uneven availability of treatment options in different regions of the country.
Approximately 95% of people with SUD deny that they need treatment, and only 40% of those who see a need for treatment attempt to receive it. A significant reason for this is the emphasis on abstinence as the goal of most SUD treatment for clients in the United States. Readiness for treatment in America most often implies a commitment to abstaining completely from drugs and alcohol.
Researchers have found that most people with SUD or in recovery from it don’t make abstinence a priority. Rather, they prize staying alive, improving quality of life, reducing substance use, improving mental health, meeting basic needs, increasing self-efficacy, and increasing connections to support services. Studies have also shown that “the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use.” For many people with SUD who would rather control their disorder than try to eliminate it, they concluded, “offering nonabstinence treatment may provide a clearer path forward…”
Medication-Assisted Treatment
Because modern SUD treatment practice is moving away from the total abstinence model, part of the alternative is to provide the client with SUD with medication to assist with the most important goal of treatment: staying alive.
The reasons for this are varied, but the primary reason is that, after long and/or excessive use, some substances, such as heroin, cause permanent and irreversible personality changes along with a dangerous kind of physical dependence. Because of this, the shift in treatment strategy has been to combat the associated opiate use disorder with two classes of medications: agonists and antagonists.
An agonist is a drug that pretends to be the person’s drug of choice. It will fulfill the same function for the affected cells but won’t include the harmful effects. An antagonist is a drug that blocks the applicable receptors from receiving the stimuli that produce the euphoric effect. The idea is that people would take these drugs instead of the substance they were misusing. Additionally, they would be prescribed to be taken much as someone with high blood pressure or another chronic condition would take prescribed medications. They become an essential part of drug rehabilitation programs.
When it comes to SUDs involving other drugs, such as meth or cocaine, there are no FDA-approved MATs. However, some drugs, such as disulfiram and bupropion, have shown promise in the limited number of studies that have been conducted.
The Importance of Fully Monitored Detox
Some substances are more deadly to use than others. For example, heroin slows breathing, so chronic use and/or an overdose can cause death by respiratory failure. Interestingly, withdrawal from heroin isn’t nearly as dangerous as its use. Yes, it’s possible for someone to die due to dehydration from the vomiting and diarrhea that go along with heroin withdrawal, but when the withdrawal is properly managed, it’s seldom fatal. By contrast, severe withdrawal from alcohol produces delirium tremens, also known as “the DTs.” Without treatment, it can be fatal in up to 37% of cases.
It’s not just heroin or alcohol that needs controlled detox. Meth, inhalants, cocaine, fentanyl, and deadly combinations of any or all of these drugs will need 24-hour medical supervision for detox. The withdrawal symptoms can range from mild to life-threatening. Further, the medical team that’s overseeing the detox can do additional tests to determine the existence of other comorbid mental or physical conditions the person experiences.
The Importance of Ongoing Evaluation and Continuing Care
In the United States, 40% to 60% of clients relapse after treatment for SUD. But relapse does not mean rehab has failed. As treatment for SUD evolves, the emphasis on following up with clients is shifting from the concept of “aftercare” — something that follows primary treatment but is not a part of it — to continuing care as part of the whole treatment plan. Reducing recurrence, maintaining gains, and putting clients in touch with support services to help them manage their SUD over the long term are all crucial parts of a successful lifelong treatment program. SUD is chronic, and through primary care, doctors can provide MATs for opioid and alcohol use disorders for long periods.
The Importance of Psychological Support
Psychological support is crucial because many people with SUD have associated trauma in their past even if they don’t have comorbid mental-health conditions other than the SUD itself. Such psychological and/or psychiatric help consists of various forms of therapy that include both one-on-one and group settings. In fact, as the Substance Abuse and Mental Health Services Administration (SAMHSA) points out, providing counseling and other psychological services is mandated by federal law when it comes to opioid treatment programs.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is the practice of thinking about thinking and then changing thoughts to inspire healthier behavior. Specifically, it’s about determining the unhealthy ways that the client thinks, analyzing the bases for these forms of thinking, and then devising coping strategies for overcoming that unhealthy thinking. Usually, it’s a short-term method of psychotherapy, lasting from 12 to 20 weeks.
The therapist in cognitive behavioral therapy is a kind of cheerleader, asking questions of the client in an effort to encourage self-realization and then giving positive reinforcement when the client achieves a success. One example would be to recognize a harmful pattern of thought for being harmful and then take steps to mitigate or eliminate that way of thinking. Calmness is important as is actively relaxing the body to relieve stress.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy, on the other hand, is a long-term strategy that often takes place over a year or more. Its focus is on people who have intense emotions. Often, it’s the first choice of psychotherapists who have patients with borderline personality disorder (BPD). Despite the difference in length of treatment compared to cognitive behavioral therapy, the two disciplines have much in common.
The word “dialectical” means “opposite.” The key strategy is to reinforce two opposing concepts to the client: that the client’s feelings and sense of self are both valid and also that, though valid, those feelings, if harmful, must be changed. One example would be self-harming. Let’s say that a female client cuts herself with a razor blade as a way to ground herself from feelings of helplessness and despair. Those feelings could have come from a childhood trauma.
People with borderline personality disorder also frequently misuse substances to avoid dealing with the stress of life. In these cases, the SUD takes the place of the razor blade and is every bit as harmful.
Generally, the cycle of treatment lasts six months, but it is not unusual for clients to repeat the training, taking the treatment to a fully year’s duration. In some cases, it may be necessary for treatment to cover multiple years. Dialectical behavioral therapy sometimes takes place one-on-one and sometimes in groups. When in groups, particularly in cases of SUD, it’s beneficial because the person will receive support from people who understand the person’s situation.
Motivational Enhancement Therapy
Motivational enhancement therapy focuses on the positive aspects of change. As such, it is sometimes an adjunct therapy to either cognitive behavioral therapy or dialectical behavioral therapy. Many clients find themselves uncaring about change, neither striving for nor against it. Motivational enhancement therapists aim to get their clients excited about change for the better. The approach is client-centric. That is, the therapist won’t tell clients that they need to change. Instead, the therapist will encourage clients to ask pertinent questions of themselves and come to the realization on their own about needing to change. The excitement comes from the therapist’s motivation.
EMDR
Eye-movement desensitization and reprocessing, or EMDR, is a method of therapy that uses flashing lights of different colors to help clients reconfigure traumatic memories. The idea is to “rewire” the way the brain has stored the memories to turn them from traumatic into normal memories. People don’t forget what happened to them, but they no longer remember them as traumatic and harmful.
This method is useful in treating SUD if the substance use began as a result of trauma. By reducing the effect of the trauma on the brain, it lessens the stimulus to misuse whichever substance is the person’s choice.
How Charles River Recovery Can Help
Charles River Recovery focuses on a compassionate approach. You’re not defective because you have SUD. It’s not a moral failing. You have a disease and need treatment. We provide a comprehensive approach from detox to discharge, and we also work with partners in the community to put you in touch with ongoing support systems after you complete the program with us. So, take your first step toward a new life where you have control over your SUD instead of the other way around. Give us a call today to set up an appointment.
