Over the past decade there have been tremendous scientific advances made in our understanding of addiction and the nature of recovery. We now know that addiction is more than just a behavioral disorder due to poor decision-making or lack of willpower. While personal choices, environmental factors, and belief systems do influence the course of addiction, it is now understood that we are dealing with a brain disorder, often requiring both medical and psychosocial interventions.
The American Society of Addiction Medicine (ASAM) has recently declared that “addiction is a primary, chronic, disease of brain reward, motivation, memory, and related circuitry.” By using brain imaging technology, scientists have demonstrated that there are fundamental changes in how the brain functions over time due to prolonged exposure to substances of abuse. These changes are not just in how the brain responds to the drug, but in actual changes in the structure and chemistry of the brain. These changes remain long after abstinence is achieved. This is one reason for “relapse” and why addicted individuals say they use drugs “just to feel normal”.
And it does not seem to matter which addicting substance is used, be it alcohol, cocaine, methamphetamine, opiates, or other drugs of abuse. While the actual neurological and chemical processes may vary, the result is the same: drug craving and compulsive use despite the consequences. Add to this loss of control the emotional, financial, legal, and spiritual devastation that occurs, then it is obvious that a comprehensive, well integrated treatment approach is required.
One effective tool in treating addiction is through medications that either reduce the intensity of cravings (withdrawal) or essentially block the euphoric effect of the drugs (including alcohol). Medication-assisted treatment (MAT) can help re-establish normal brain function and to diminish cravings while the client engages in important psycho-social outpatient interventions such as individual and group therapy and in community support activity like AA and Narcotics Anonymous. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as “the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.”
Medication-assisted treatment can help the client become more engaged in treatment by “feeling normal” without resorting to illicit drug use (including abuse of prescribed medications). In addition, research has shown that MAT improves the survival rate of those addicted, increases retention in treatment, decreases criminal activities and reduces hepatitis and HIV infection.
With Aspire’s new smoke free initiative for clients, our prescribing physicians and nurse practitioners will be engaging in MAT as one part of a comprehensive strategy to help clients recover from nicotine addiction. Use of MAT in treating alcohol-related disorders has been an option for our clients for some time. What is new at Aspire is the use of MAT as part of our opioid addiction treatment program.
Opioid addiction is very powerful, with intense cravings and withdrawal symptoms. Clients addicted to opioids (Fentanyl, Morphine, Heroin, Methadone, Dilaudid, Darvocet, Darvon, Percocet, Oxycontin, Vicodin, and Lortab to name a few) have among the highest rate of relapse and premature termination from treatment. In the past, individuals could go to a special Opioid Treatment Program for methadone but had few options for medication assistance in an outpatient program. Recently, our Willowbrook-Indianapolis location started a Suboxone program under the direction of Dr. Jason Ehret, a psychiatrist who is also certified to prescribe Suboxone.
Suboxone provides relief from cravings and also blocks opioid chemicals from attaching to neuro-receptors in the brain. In other words, it blocks the high of opiate drugs. It does not lend itself to abuse (snorting or injecting it will cause withdrawal). While it can be used to taper down for detoxification, Suboxone is generally considered a maintenance medication that the client should expect to stay on for an extended period.
Just as detoxification is not the end of treatment but only the beginning, taking Suboxone is only part of a comprehensive plan needed to help achieve recovery from addiction. Participation in counseling and other outpatient treatment strategies is required of all Suboxone participants. Medication does little to change distorted beliefs, repair broken relationships, find a job, or change self-defeating attitudes. Recovery is a process that takes dedication, hard work, and support. Managing “triggers” that can incite cravings well into recovery is a skill developed over time. Similarly, the client must essentially develop a new identity, one that involves healthy lifestyle changes and positive, non-using relationships.
—About the author: Dan Brown is Director of Outpatient Services at Aspire Indiana’s Willowbrook office in Indianapolis. Follow Dan on Twitter: @DannyCBrown. Learn more about Aspire Indiana at http://www.aspireindiana.org/ or on Facebook at https://www.facebook.com/AspireIndiana.