Will I lose my job if I go to treatment?
A common concern amongst people seeking treatment is whether or not they will be able to retain employment during their recovery process. We will discuss federal protections that have been put in place for members seeking treatment for substance abuse later in this article.
Something to consider… How long will you really maintain that job if you continue to drink and/or use? Regardless of your situation, you could possibly have an excuse not to seek treatment on any given day. The longer that you go without getting help for your addiction, the more likely it is that the consequences will increase. Not only could you potentially lose your job, you could lose your house, loved ones, other material possessions, children and end up with serious medical issues and legal problems.
A job is never a justification not to seek treatment. The sooner that you are willing to set aside those reservations, the sooner you can get your life back. Many have fears about the stigma they could potentially be placed under for admitting that they have a problem to employer’s or co-workers. It is recommended that you go to someone that you can trust with this information. Remember, you don’t owe anyone else an explanation but the people that control the fate of your employment. Only disclose what you feel is necessary to disclose to said people.
We urge you to have a treatment location picked out ahead of time with an admission date set. Maybe you have a job where you can work from home. There are (occasionally) client’s that still maintain full employment status during their time in treatment. This is something that you should discuss with your case manager and therapist to determine if this would be conducive to your recovery journey. Notify your admission counselor if this is something you plan to do.
Federal protections for people seeking drug treatment:
Americans with Disabilities Act (ADA) – this protects people from being fired for seeking drug/alcohol treatment. It also protects you from being demoted, fired or refused to hire because you have a substance use history.
Family Medical Leave Act (FMLA) – Allows you to take up to 12-weeks off of work to deal with substance related problems. Please do research to find out if you qualify for this under your employer. Varies by length of time at employer and size of organization.
There are union protections as well. Please research The National Labor Relations Act for more information.
Our admissions team can help support you through this decision. Please reach out today! 866-757-0474
An addiction can lead to severe emotional and physical pain if left unaddressed. If you are a friend or a family member of someone suffering from an addiction, you may be struggling with how to help them get sober. Start by researching addiction treatment programs and approaching your loved one about the problem. Interventions are an option if the person refuses treatment. Enabling is a common behavior of family members and friends of addicts that can lead to further substance abuse. It can be difficult to escape this cycle and help your loved one recover. Learn how to set boundaries with the person and remember to take care of yourself.
An addiction is a chronic condition characterized by continuing to use drugs or alcohol despite negative consequences. It’s important to be aware of the signs and symptoms of addiction so you can support your loved one in getting the help he or she needs.
Below are the common signs and symptoms:1
Taking more of the substance than originally intended.
Failing to quit or cut down on substance use.
Spending an inordinate amount of time getting and using the substance, as well as recovering from its effects.
Experiencing strong cravings to use the substance.
Neglecting home, school, or work responsibilities in favor of substance use.
Continuing to abuse the substance regardless of interpersonal or social problems caused by use.
Abandoning previously enjoyed hobbies or activities in favor of substance use.
Using the substance in dangerous situations, such as while driving a car.
Continuing to abuse the substance despite physical and psychological problems caused or worsened by use.
Taking more of the substance to feel the desired effects, or feeling less of an effect with the same amount of the substance.
Experiencing withdrawal symptoms when use is stopped, or taking the substance to prevent or alleviate withdrawal symptoms.
Why Can’t They Quit?
Many people who are addicted to drugs or alcohol cannot simply stop using. It can be extremely difficult for the person to quit, even if he or she wants to stop. Over time, changes to brain chemistry and altered signaling pathways may occur as a result of chronic drug and alcohol abuse. These brain changes can undermine efforts to quit and ultimately serve to promote continued substance abuse behavior. These neural adaptations also contribute to cravings and drug-seeking behaviors. 2
Keep in mind that your loved one’s addiction is not your fault. You can be supportive and helpful, but ultimately the decision to get treatment is up to the individual. Accepting what you can and cannot control is a big part of surviving a loved one’s addiction.
How to Talk to an Alcoholic or Addict
There is a misconception that people addicted to drugs or alcohol have to hit rock bottom before seeking help. If you suspect that your loved one has a problem, don’t wait to talk to him or her about it. The earlier an addiction is treated, the better.
Although it was once thought that confrontation was the best way to approach a loved one who is addicted to drugs or alcohol, current research reveals that confrontation can be counterproductive and can cause the person to become defensive.3
Community Reinforcement and Family Training (CRAFT) is an alternative approach to a confrontation that teaches concerned family members how to communicate effectively with the addicted person. This program is designed to teach family members strategies that will motivate the substance abuser to seek and enter a recovery program. 4
How to Talk to Your Loved One
If you’re worried about your loved one’s drug or alcohol problem, there are some things you should remember as you approach him or her:
If you can, approach your loved one when he or she is already trying to quit using. This means that he or she has acknowledged the problem and wants to get sober.
Express your concern in an empathetic and caring manner.
Remain calm, regardless of the response you get.
Suggest treatment options and express your willingness to attend family therapy with the person, if desired.
How Not to Talk to Your Loved One
Avoid approaching the person in public or when he or she is under the influence.
Avoid judgment and blame. Those suffering from an addiction often feel shame and guilt associated with substance abuse, and family members should be accepting and open-minded.
Avoid being aggressive or confrontational. This behavior could push the person away.
As tempting as it may be to continue making excuses for your loved one’s behaviors, CRAFT encourages you to let the person face the consequences of his or her actions. Lying for the person will only cause more harm in the long-run.
When to Use Interventions
If your loved one is unwilling to go to addiction treatment, you may want to consider holding an intervention. This can be done on your own or with the aid of a professional. 5
In an intervention, significant people in the user’s life, such as family and friends, gather together to share how the addiction has affected them and try to get the user to accept treatment. 5 Some users are unable to see the negative consequences of their drug use, which is why a structured intervention is valuable.
If you aren’t comfortable holding a meeting on your own, you can contact an addiction specialist, interventionist, social worker, or psychologist to help you orchestrate an intervention either in the person’s office or at home. A professional can help suggest treatment approaches and design a follow-up plan. When a family uses a professional for an intervention, it can increase the odds of success. 5Intervention Services and Interventionist Options
Interventions are face-to-face meetings between someone who is abusing drugs or alcohol and people who are affected by the person’s behavior. An interventionist is someone trained in organizing effective interventions.
Holding an intervention comes with some risks, however. The individual may:
Become defensive and leave the situation.
Feel alienated and isolated from family and friends.
Feel stigmatized and shame associated with addiction.
Although a professional is not necessary, interventions are more likely to be successful if they are facilitated by a professional. Still, interventions may not work for everyone. Your loved one may refuse addiction treatment right away but may seek help later on as a result of the intervention. 5 Don’t try to force him or her to get help before he or she is ready.
How to Stop Enabling and Set Boundaries
Many people are in denial about having an addiction to drugs or alcohol. This denial may partially be due to enabling, which means that the loved one allows the addiction to continue without consequences.
It can be easy to fall into the habit of enabling your friend or family member’s addiction, under the impression that you are helping. But it can actually prolong the problem and cause more harm in the long-run.
Some signs that you are enabling include:
Repeatedly bailing the person out of jail.
Lending the person money.
Lying to others to cover up negative behaviors.
Allowing the person to deal drugs out of your house.
Blaming others for the person’s behavior.
Enablers often neglect their own needs in favor of the addict, which can lead to serious emotional, financial, and interpersonal problems.
What Are Boundaries?
Decide what you are no longer willing to accept.
It can be difficult to escape the cycle of enabling, which is why you need to begin by setting boundaries, which help to protect your emotional and physical health. You must decide what you are no longer willing to accept and make these boundaries clear to your loved one.
Boundaries won’t work if you aren’t willing to follow through. Enforcing boundaries can be extremely difficult, but without them, the addiction is likely to continue and keep harming the family.
Examples of Boundaries
Every relationship and addiction is different. But a few examples of boundaries and rules you may set include:
I refuse to bail you out of jail anymore.
I will not tolerate you drinking or using drugs in the house. If you do, you will not be allowed to live here anymore.
I will not lie about your intoxication or hangovers anymore.
I refuse to call in sick to work for you.
I refuse to lend you money to support your habit.
I will not tolerate your angry outbursts toward me. If you exhibit aggressive behaviors, you will not be allowed to live here anymore.
Boundaries don’t need to be limited to the examples above. Behaviors vary.
It’s also important that you begin taking care of yourself, both physically and emotionally. Enablers often avoid self-care and suffer emotional consequences as a result.
Once you stop making excuses and covering up for your loved one, he or she will be forced to face the consequences of his or her actions.
Exploring Treatment Options
If your loved one is willing to go to treatment, you can do some research on the types of programs in your area. Below are the most common forms of recovery programs:
Inpatient: An inpatient or residential program can provide treatment for someone suffering from a relatively severe addiction because it requires that the person live at the facility for the duration of treatment while participating in a structured and intensive program.
Outpatient: Outpatient treatment settings are good options for individuals with relatively less severe or long-standing addictions who cannot afford to neglect their home, work, or school responsibilities while receiving treatment. Your loved one can reside at home while attending the recovery program about 1-2 times per week.
Individual therapy: A therapist will use interventions designed to address underlying issues influencing your loved one’s addiction. A goal of therapy is to rectify negative or maladaptive behaviors while building healthy coping skills.
Group counseling: During group counseling sessions, recovering users share stories, successes, and coping strategies with one another. Social support is a powerful factor in addiction recovery.
Dual diagnosis: Dual diagnosis refers to the presence of substance addiction and a co-occurring mental health disorder. If your loved one suffers from a mental health condition, find a treatment center that has experience treating dual diagnoses.
12-step programs: Fellowship programs, such as Alcoholics Anonymous and Narcotics Anonymous, are free to join and provide members with support and encouragement as they work the 12 steps of recovery.
Alternative programs: SMART Recovery and Secular Organizations for Sobriety are evidence-based, alternative groups that focus on self-empowerment and self-reliance.
One type of treatment is not superior to another. The kind of program that will work best for your loved one largely depends on his or her specific needs. Factors that can affect which type of treatment you choose are how serious the addiction is, whether the person needs treatment for medical or mental health problems, the type of insurance you have, and whether the person needs a detox.
How to Support Someone in Recovery
It can be helpful to learn about the recovery process so you know what to expect when your loved one enters treatment. You may also be asked to take part in family therapy sessions as part of an inpatient or outpatient program. These sessions are meant to identify any unhealthy patterns in the family that may be contributing to addiction and to improve communication. Family therapy can be helpful in undoing enabling behaviors and replacing them with healthy and supportive behaviors.
No matter what recovery program you choose, make sure that your loved one’s program sets him or her up with some kind of aftercare, which is ongoing treatment following the completion of the initial program. Some examples of aftercare include:
Sober living homes.
Therapy and counseling.
Recovering From Relapse
Aftercare plans are meant to decrease the risk of relapse. But if your loved one relapses, it’s OK. Relapse is a common part of the recovery process. Have the person discuss the relapse with his or her therapist or sponsor and decide whether he or she needs to re-enter treatment.
Be empathetic and supportive. Recovery takes time, and some people require multiple treatment programs before finding one that works best for them.
Once your loved one completes his or her recovery program, it may take some time for both of you to adjust to new dynamics in the family. Patience and encouragement are essential following release from rehab.
Help for Family Members of Addicts
Safety should always come first. If you or others in your family are in physical danger, you should leave the situation and find a secure environment.
Find a support group or see a therapist in order to care for yourself. Some examples of support groups for family members include:
Nar-Anon: for family members of drug addicts.
Al-Anon: for family members of an alcoholic.
Co-Dependents Anonymous: designed to help loved ones stop enabling and heal damaged relationships.
SMART Recovery Family & Friends: a science-based, secular alternative to Nar-Anon and Al-Anon.
Support groups put you in contact with other people who have been through similar situations. You can share experiences, offer and receive advice, and realize that you are not alone.
In addition to seeking outside support, engage in activities that you enjoy. Enablers spend so long putting the addict’s needs before their own that they must make it a point to engage in previously enjoyed hobbies once again. Surviving a loved one’s addiction can be taxing, which is why stress-management is vital.
Below are some different options that can help to relieve stress:
Listening to music
Drawing or painting
Throughout your loved one’s recovery process, it can help to remind yourself that his or her addiction is not your fault. The only person you can control is yourself and how you respond to situations.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association.
. National Institute on Drug Abuse. (2012). Understanding Drug Abuse and Addiction.
. HBO. Getting an Addict into Treatment: The CRAFT Approach.
. Robert J. Meyers, Ph.D. (2014). CRAFT.
. National Council on Alcoholism and Drug Dependence. (2016). Intervention – Tips and Guidelines.
The history of treatment for substance abuse is a long one. The types of medication-assisted treatment we use today have histories dating back to the 1930s. Over the course of the 1900s, two types of treatment developed. One is based on total abstinence and the other focused more on harm reduction or maintenance.
Abstinence Based Treatment: Definition and History
Abstinence based treatment is a treatment based on the complete cessation of substance use. Any use of substances is considered a relapse and is dealt with accordingly. Abstinence based drug and alcohol treatments got their start in the mid-1900s and are better known as the Minnesota Model.
The History of Abstinence Based Treatment
The creation of AA in 1935, followed by the publishing of its primary text, “The Big Book,” coupled with several medical advances slowly led to the acceptance of alcoholism as a disease, which was a precursor to the Minnesota Model.
In the late 1940s, the addiction rehab industry had no idea how to handle the population of alcoholics. They were most often jailed, put in institutions for the mentally ill, or left to the fate of their addictions. However, at the same time, Alcoholics Anonymous’ membership had grown to over 90,000 and it had been working.
The Minnesota Model of addiction treatment was created in a state mental hospital in the 1950s by two young men. Neither had prior experience working with addicts and alcoholics.
The model would become the basis for over 90% of addiction treatment rehabs today by first spreading to a small nonprofit organization called the Hazelden Foundation, and then throughout the country. The key elements of the abstinence approach were the blending of professional and trained nonprofessional (recovering) staff around the principles of Alcoholics Anonymous.
There was an individualized treatment plan with active family involvement in a 28-day inpatient setting and participation in Alcoholics Anonymous, both during and after treatment. The education of patients and family about the disease of addiction made this a busy program from morning to night, seven days a week.
Medication-Assisted Treatment (MAT): Definition and History
Medication-Assisted Treatment for opioid addiction is the use of medications in combination with counseling and behavioral therapies. MAT is primarily used for the treatment of addiction to opioids, such as heroin and prescription painkillers. The prescribed medication in MAT operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused substances. Unlike abstinence-based treatment, the therapeutic definitions of progress and success are determined by small improvements and not in staying totally abstinent. For instance, if a drinker normally has 10 drinks, if they only have 5—that is a successful implementation of the harm reduction treatment/MAT.
The History of MAT
For the purpose of keeping this blog focused we are going to solely focus on the history of medication-assisted treatment for opioid addiction.
Opioid addiction first emerged as a serious problem in the United States during and after the Civil War when opioids were prescribed to alleviate acute and chronic pain, other types of discomfort, and stress. By the late 19th century, probably two-thirds of those addicted to opioids were middle-and upper-class white women, attributed to “the widespread medical custom of prescribing opiates for menstrual and menopausal discomfort, and the many proprietary opiates prescribed for ‘female troubles.’” Civil War veterans who were addicted by medical procedures composed another group, but their numbers were dwindling. By 1900, an estimated 300,000 persons were opioid-addicted in the United States.
During the late 19th and early 20th centuries, U.S. society generally viewed this kind of addiction among women and disabled war veterans sympathetically—as an unfortunate medical condition—and treated these groups with tolerance and empathy, particularly because neither group presented major social problems.
Doctors usually prescribed more opioids for these patients, and sanatoriums were established for questionable “cures” of the resulting addictions. The chronic nature of opioid addiction soon became evident, however, because many people who entered sanatoriums for a cure relapsed to addictive opioid use after discharge.
In the 1920’s, an increase in crime related to the acquisition of illicit opioids was reported in cities throughout the country. In 1929, Congress appropriated funds to establish two new treatment facilities, initially called “narcotics farms” in Fort Worth, Texas, and Lexington, Kentucky. The Lexington facility, which opened to patients in 1935, was renamed the U.S. Public Health Service Narcotics Hospital in 1936.
These institutions detoxified patients with opioid addiction who entered voluntarily, and they also served as hospitals for prison inmates who had opioid addictions and were legally committed through a Federal court. The prescribed stay was about 6 months, although some patients stayed longer. Prisoners could stay for up to 10 years. These hospitals offered social, medical, psychological, and psychiatric services in addition to detoxification and had a low patient-to-staff ratio (about 2 to 1), but the atmosphere was described as prisonlike. Two major follow-up studies showed the program to be a failure.
The next major change in opioid addiction during World War II as many European immigrants moved from crowded cities into areas with pre-existing abuse problems and then acquired the addiction. This shift also led to a hardened attitude when it came to those with addiction disorders.
The increase in heroin addiction in New York City after World War II led, in 1952, to the establishment of Riverside Hospital for adolescents with addiction disorders, this program also proved to be a failure. A follow-up study in 1956 showed a high post-treatment relapse rate (e.g., at least 86 percent of patients admitted in 1955), and the Riverside facility was closed in 1961
Later in the 1960s, heroin use among the middle class, young white Americans, was on the rise as was an addiction-related crime. By the 1970s, the US military involvement in Vietnam was also having an effect. The New York Academy of Medicine recommended, in 1955 and again in 1963, that clinics be established in affiliation with hospitals to dispense opioids in a controlled manner to patients addicted to illicit opioids. In 1956, the AMA advocated a research project to investigate the feasibility of dispensing opioids in an OTP (opioid treatment program). In 1963, the Kennedy Administration’s Advisory Commission on Narcotic and Drug Abuse also recommended research to determine the effectiveness of outpatient OTPs’ dispensing of opioids to people addicted to opioids.
Then there was methadone.
Short-acting opioids (morphine etc.) were eliminated as options for maintenance therapy, so research focused on methadone. Methadone appeared to be longer acting and more effective when administered orally. It also was selected on the basis of observations of its use in patients withdrawing from heroin and as an analgesic in the experimental treatment of pain with medication-assisted treatment.
In 1964, technology was not available to measure blood levels of heroin, morphine, or methadone to assess the duration of action. Proof of the efficacy of methadone maintenance treatment depended on observation and recognition by researchers. In general, the team found that patients’ social functioning improved with time in treatment, as measured by the elimination of illicit-opioid use and better outcomes in employment, school attendance, and homemaking. Most patients were stabilized on methadone doses of 80 to 120 mg/day. Most patients who remained in treatment subsequently eliminated illicit-opioid use.
The 1980’s and 1990’s
By the 1980s, an estimated 500,000 Americans used illicit opioids (mainly heroin), mostly poor young minority men and women in the inner cities. Addiction became not only a major medical problem but also an explosive social issue. By the end of the 1990s, an estimated 898,000 people in the United States chronically or occasionally used heroin and the number of those seeking treatment was approximately 200,000.
Then, there was naltrexone. In the early 1980s, the National Institute on Drug Abuse (NIDA) completed initial testing of naltrexone to treat opioid addiction, and FDA approved naltrexone for this use in 1984. In 1995, naltrexone received FDA approval as a preventive treatment for relapse to alcohol use among patients dependent on alcohol.
Some opioid treatment providers have found that naltrexone is most useful for highly motivated patients who have undergone detoxification from opioids, and need additional support to avoid relapse or who desire an expedited detoxification schedule because of external circumstances. Naltrexone may benefit some patients in the beginning stages of opioid use and addiction. Other patient groups frequently have demonstrated poor compliance with long-term naltrexone therapy, mainly because naltrexone neither eases craving for the effects of illicit opioids when used as directed nor produces withdrawal symptoms when discontinued.
In 1997, a National Institutes of Health (NIH) consensus panel called for an expansion of methadone maintenance treatment. Since then methadone treatments, suboxone treatments, and naltrexone treatments have all be on the rise as MAT. Many rehabs today are utilizing MAT while coupling it with behavioral therapy.
Many treatment facility staff, who conquered their own addictions without medication, favor an abstinence model, and provider skepticism may contribute to low adoption of MAT. Staff in community corrections contract facilities (CCFs) have expressed that their corporate offices do not support the use of MAT and are therefore hesitant to personally participate in MAT expansion. Additionally, many individuals utilizing MAT are met with harsh criticism from the 12-step community.
Substance Use Disorders has been generally treated as if it were an acute illness, rather than a chronic disease. Research results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. The use of MAT for those suffering from addiction should be insured, treated, and evaluated like other chronic illnesses.
In recent years, information has shown that the United States is in a state of emergency in regards to substance use, particularly with opiates. Pennsylvania has seen this issue arise both in communities and in its state correctional institutions. Statistics from December 1, 2016, through November 30, 2017, show that 21% (3,025 out of 14,150) of the individuals that completed a drug and alcohol assessment, The Texas Christian University – II Assessment (TCU), reported opiates as their drug of choice. Another 5% (751) reported that opiates were their 2nd or 3rd drug of choice.
In January 2017, the DOC made changes to the general population Therapeutic Community Curriculum and the Co-Occurring Disorders Therapeutic Community Curriculum to provide evidence-based treatment. On March 12, 2018, the department converted six therapeutic communities (TCs) to opiate specific therapeutic communities.
Institutions with Opiate Specific TCs:
Albion (Co-Occurring TC)
Quehanna Boot Camp (State Intermediate Punishment [SIP])
Cambridge Springs (SIP and Female)
While these are the first institutions to implement this program, the goal will be to continue to increase the program based on successes and need.
Oral Naltrexone Maintenance
The DOC has expanded its MAT programming to include oral naltrexone maintenance, which is now available at each of the Opiate Specific TC sites listed above. Participants are switched to Vivitrol prior to institutional release.
In January 2018, Governor Wolf declared the opioid crisis in Pennsylvania as a disaster emergency and directed that Medication-Assisted Treatment (MAT) be provided within the DOC’s prison system. These medications include methadone, naltrexone (Vivitrol and Revia), and buprenorphine (Suboxone, Subutex, and Sublocade).
MAT is not new to the DOC. It has always provided methadone maintenance to pregnant inmates to protect the fetus from withdrawal. Newer programs include Vivitrol injections for inmates being released and most recently oral naltrexone for select new intakes with short minimums who will be admitted to one of our Opioid Use Disorder Therapeutic Communities (OUDTC).
On April 1, 2019, the DOC began a Sublocade Pilot Program at SCI Muncy. Select parolees who are diverted to an SCI for a 14-day “detox only” placement will be prescribed Suboxone induction and then a long-acting Sublocade injection prior to being continued on parole in an outpatient or inpatient treatment setting. Once the Pilot Program concludes, it will be rolled out gradually throughout other institutions.
Beginning June 1, 2019, inmates received into institutions (PV or new intakes) who are enrolled in a verified MAT Program (community or county jail) will continue on MAT. Suboxone and oral naltrexone will be available immediately and will also be offered to those on methadone until it can be added at a later date. Any instances of an inmate entering our system on an MAT that is not available, or who does not meet the criteria for continuing MAT, will be forwarded to the Bureau of Health Care Services (BHCS) for review on a case-by-case basis.
Addiction is one of the most pressing public health crises that the United States faces today. Approximately 21.5 million Americans above the age of 12 had some form of substance use disorder in 2014, according to the National Survey on Drug Use and Health (NSDUH). With so many people struggling, addiction is a problem that touches nearly everyone in some way.
To help combat this issue and connect individuals to the care they need, rehab centers across the country offer a broad range of care options, including medication-assisted treatment (MAT). MAT is a method of addiction care that combines traditional rehab approaches in combination with medications. These medications can be used to increase client safety, alleviate withdrawal symptoms, lessen cravings, and help promote long-term recovery.
While MAT is an evidence-based practice that has been shown to yield positive client outcomes, it’s currently underutilized. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the proportion of heroin admissions with treatment plans that included MAT fell from 35 percent in 2002 to 28 percent in 2010.
What Is Medication-Assisted Treatment (MAT)?
MAT is a method of drug and alcohol rehab that uses medication in combination with behavioral therapy to address substance use disorders. MAT programs can be customized to every client’s needs, so they receive quality, tailored care. MAT is particularly useful for people struggling with addictions to physically addictive substances, including alcohol, prescription opioids and illicit opioids like heroin.
Individual and group counseling are key components of all forms of MAT. With the help of a medication-assisted treatment counselor, clients can begin to understand the roots of their addiction and build a new life in sobriety, while curbing much of the initial discomfort and cravings that come with recovery. Group counseling, including 12-step programming, helps clients find support and build solidarity with peers who share in their recovery. This comprehensive approach is largely why medication-assisted treatment works so well: It addresses many of the roadblocks that can lead to relapse while allowing clients to focus on the inner, personal work of recovery.
Medication-Assisted Treatment for Opioid Addiction
It’s no secret that opioid addiction is a growing problem. According to the National Institute on Drug Abuse, more than 115 people in the United States die of an opioid overdose every day. Incidents of neonatal abstinence syndrome (NAS), or babies born addicted to opioids because of maternal opioid use during pregnancy, are also on the rise, increasing five-fold from 2000 to 2012.
With the opioid epidemic reaching such extremes and impacting so many lives, the need for evidence-based opioid treatment programs is higher today than ever before. That’s where medication-assisted treatment for opioid addiction comes in. With MAT, a person’s chances of sustaining long-term recovery from opioid addiction increase significantly when compared to non-drug approaches. MAT for opioid addiction can be used to alleviate withdrawal symptoms, curb cravings, block the effects of opioids and reverse overdose.
Opioid Addiction Medications
Opioids are extremely addictive, making recovery from an opioid use disorder (OUD) particularly difficult. Fortunately, opioid addiction medications can help alleviate many of the roadblocks in the way of recovery from an OUD. For example, opioid replacement therapy medications, like methadone and buprenorphine, can be used to help curb cravings and diminish withdrawal symptoms. Others, like naltrexone, block the effects of opioids altogether. When used in combination with a comprehensive rehab program, opioid addiction medications can dramatically improve patient outcomes.
One of the most common opioid replacement medications, methadone is used to alleviate opioid withdrawal symptoms and cravings by providing a controlled, mild dose of opioids. Each dose is customized to the client’s needs, which is typically the smallest dose necessary to stabilize their condition. This medication is available in pill, liquid and wafer form, and is typically taken once a day. The effects of each dose can last anywhere from four to eight hours.
When taken as directed, methadone can be a useful tool in MAT. However, methadone is still an opioid with the potential for abuse; it’s crucial that it only be used in a professional, supervised treatment setting. According to the National Institute on Drug Abuse, methadone treatment should be used for a minimum of 12 months. Once a patient is ready to stop methadone treatment, they must do so gradually to prevent withdrawal symptoms.
Like methadone, buprenorphine is used in MAT to help suppress and reduce cravings for opioids. However, the mechanisms behind this medication are slightly different than those employed by methadone. Buprenorphine is an opioid partial agonist, meaning that it produces effects that are similar — but significantly less intense — than that of other opioids, including mild euphoria and respiratory depression. However, these effects level off after a moderate dose is consumed, even if the dose is increased. This “ceiling effect,” combined with the long-lasting effects of the medication, help improve its safety in MAT and limit the potential for abuse. Typically, treatment with buprenorphine begins after a client has abstained from using other opioids for between 12 and 24 hours.
Buprenorphine is available in four main forms:
Subutex: Available in sublingual tablet form, Subutex is chemically pure, meaning that it only contains buprenorphine. When taken as directed, this medication can be an invaluable part of an MAT program. However, when taken in large amounts or injected, Subutex carries some potential for abuse.
Suboxone: Also primarily available in tablet form, Suboxone is an opioid addiction medication that contains a mixture of buprenorphine and naloxone. While Suboxone is a partial opioid agonist, naloxone is a full opioid antagonist, meaning that it blocks the effects of opioids at receptor sites. This significantly lowers the medication’s potential for abuse. If an individual attempts to inject or consume large amounts of Suboxone, the combination of partial and full opioid agonists can trigger intense and unpleasant withdrawal symptoms.
Probuphine: This medication is delivered into the body through an implant that administers a constant, low dose of buprenorphine over a period of six months. Unlike Subutex and Suboxone, Probuphine is convenient because it does not have to be taken every day. This method of administration limits the potential for abuse, though it should be noted that if the implant is moved out of place or removed altogether, there is still a possibility of intentional misuse or accidental exposure.
Injectable Buprenorphine: One of the newest medications available for opioid MAT, injectable buprenorphine works in much the same way that other forms of buprenorphine do. However, instead of receiving the medication through tablets or implants, this form of the medication is administered in monthly buprenorphine subcutaneous injections. This helps reduce the burden and potential abuse risk that comes with the tablet form of the medication. Treatment with injectable buprenorphine cannot begin until clients have completed the detox process, are psychiatrically stable, and have engaged in the induction phase. The induction phase can last anywhere from three to seven days.
Like most other opioid addiction medications, naltrexone suppresses cravings. However, while medications like methadone and buprenorphine do this by activating opioid receptors, naltrexone works by binding to opioid receptors, effectively blocking them off. This suppresses cravings, but it also has an additional, useful effect: even if a person relapses and uses an opioid, naltrexone prevents them from achieving a high. This medication carries few risks and there is no potential for abuse since naltrexone blocks opioid receptors instead of activating them.
Withdrawal from all opioids or all other opioid addiction medications must be complete for at least seven to ten days before naltrexone can be administered. This medication is available in both pill (ReVia and Deparde) and injectable, extended-release forms (Vivitrol).
Opioid Overdose Medication
Consuming illicit opioids, prescription drugs, or opioid addiction medications in high doses can have life-threatening consequences, including overdose. However, it’s important to keep in mind that overdose isn’t always the result of deliberate misuse. Overdose can also occur after an individual accidentally takes an extra dose of an opioid addiction medication, or combines one of these medications with another psychiatric drug. Because of this risk, it’s important that individuals receiving MAT for opioid use disorder have access to overdose-reversing drugs. Fortunately, there are opioid overdose medications available that can stabilize individuals in the midst of an overdose, including naloxone.
Naloxone is a medication that can be used to reverse the effects of an opioid overdose. Within a few minutes after it is administered through an intranasal spray (Narcan), injected into the muscle or injected under the skin, naloxone temporarily binds to opioid receptors in the brain, preventing additional opioids from binding to and activating these receptors. This reverses respiratory depression, which could otherwise lead to death, and gives emergency professionals enough time to transport the overdosing individual to a medical facility for further care and examination.
This drug is often prescribed to patients undergoing MAT, particularly if the individual is taking opioid addiction medications that carry some risk of overdose. It can also be given to friends and family members to administer to their loved ones in case of emergency overdose.
Medications for Alcohol Abuse
When it comes to substance use disorders, recovery from alcohol addiction can be particularly challenging. Alcohol is legally and readily available at bars, liquor stores and clubs, and its consumption is deeply ingrained in daily life in the United States. In addition, alcohol withdrawal can trigger severe symptoms, including delirium tremens (DT) and seizures.
While recovery from alcohol use disorder can be difficult, the process is made significantly easier and safer with MAT. Medication for alcohol abuse can reduce cravings and disincentivize alcohol use. When used in combination with counseling and other evidence-based treatment methods, MAT can lead to healthier outcomes for clients with alcohol use disorders, according to SAMHSA.
Some of the medications most commonly used in MAT for alcohol use disorder are disulfiram, naltrexone and acamprosate.
Disulfiram is most effective for people who have already gone through detox and are in the early stages of recovery. Taken once a day in tablet form, disulfiram deters individuals from consuming alcohol by producing unpleasant side effects when even small amounts of alcohol are ingested, including:
These side effects can set in within 10 minutes after consuming alcohol and may persist for an hour or more. Because these side effects can be uncomfortable or even dangerous, some treatment centers elect not to use this drug for MAT.
Naltrexone is a medication that blocks the euphoric effects and feelings of intoxication that people experience after consuming alcohol. Over time, this diminished effect can help individuals disassociate alcohol from previously pleasurable feelings, and make it easier to stay committed to sobriety in recovery. This medication is most commonly administered in its tablet (ReVia and Depade) and injectable forms (Vivitrol). Like all other medications used in MAT, naltrexone treatment works best when paired with counseling and a comprehensive recovery plan.
Like disulfiram and naltrexone, acamprosate is ideal for people who have already worked through the initial withdrawal symptoms of recovery. Treatment with this medication typically begins on the fifth day of abstinence and reaches its full effectiveness within five to eight days. Acamprosate comes in tablet form and must be taken three times a day.
Acamprosate has been shown to reduce cravings and improve a person’s chances of abstinence when used in conjunction with a comprehensive recovery plan. However, despite its success, there is still no clear answer to the question “How does acamprosate work?”
Success Rates of Medication-Assisted Treatment
There is no one-size-fits-all approach to addressing substance use disorder. While complete abstinence from drugs or alcohol might work for some people, the reality of the situation is that it may not work for everyone. Some people need additional help early on in recovery.
When it comes to evidence-based care, medication-assisted treatment is one of the most useful — and unfortunately, underutilized — methods available today. When compared to non-drug approaches, research suggests that medication-assisted treatment’s effectiveness is significant, improving a client’s chances of sticking with treatment and reducing illicit opioid consumption. For example, one study involving criminal justice offenders showed that extended-release naltrexone use was associated with a significantly lower rate of relapse than traditional treatment methods.
Medication-assisted treatment success rates, in general, are shown to be high, particularly when it comes to decreasing overdose deaths. A study that examined the impact of expanding methadone and buprenorphine treatment in Baltimore, Maryland, found that buprenorphine treatment was associated with a decrease in heroin overdose deaths. Additional research found that buprenorphine and methadone maintenance treatment (MMT) was associated with a reduction in both all-cause and opioid-related mortality.
MAT has no impact on a person’s intelligence, mental capabilities, physical functioning, or employability, according to SAMHSA. MAT for opioid and alcohol addiction has been shown to:
Decrease opioid use.
A decrease in criminal activity.
Improve an individual’s ability to gain and maintain employment.
Improve birth outcomes among pregnant women who have substance use disorders.
Pros and Cons of MAT
Like any treatment method, medication-assisted treatment has its pros and cons. MAT is a harm-reduction approach, which means that it aims to view the problem of addiction in a realistic light and decrease the negative consequences of substance. By reducing the risk of drug abuse, MAT can decrease the chance of overdose, and improve a client’s likelihood of remaining in recovery.
Additionally, MAT has shown to be particularly beneficial for clients struggling with co-occurring conditions like depression. Dr. Roger Weiss, of McLean Hospital and Harvard Medical School who co-led a study on the effectiveness of MAT, reported that “Patients with a lifetime history of major depressive disorder were nearly twice as likely as patients without such a history to have a good outcome during the 12-week Bp/Nx treatment.”
While the benefits of medication-assisted treatment are many, this method does come with its share of challenges:
MAT must be used as part of a wider treatment program to be effective.
Most methods of MAT require daily dosing.
Clients may face stigma for partaking in MAT.
Medications used in MAT can cause medical complications in some cases.
Some medications utilized in the MAT can be abused if use is not carefully monitored.
Depending on the individual’s needs, outpatient treatment can be an excellent means of obtaining substance abuse recovery help.
Substance abuse is a complicated issue, potentially impacting all areas of one’s life, including work, health, and interpersonal relationships. Hopefully, at some point, a person in the grips of drug or alcohol addiction will reach out for help. Thankfully, there are many settings and levels of addiction treatment available to provide recovery assistance.1 After an assessment from a doctor or other qualified addiction medicine professional, outpatient treatment may be recommended. Usually, it is reserved for those whose addictions are less severe, who don’t have other mental health disorders, and who have a supportive home environment.1
What is Outpatient Treatment?
There are a number of treatment options for those struggling with substance abuse. One option is an outpatient treatment center.
These centers are an excellent option for those who know they need help for drug abuse or alcoholism but are unable to stop working or attending school to get it.
Programs for outpatient treatment do vary but essentially provide assistance a few times a week for a limited amount of hours.1 Outpatient treatment centers provide a level of flexibility that many individuals require, but its effectiveness can be limited, especially for those who need medical as well as psychological recovery services—the National Institute on Drug Abuse (NIDA) notes that some low-intensity outpatient programs don’t offer much more than drug education.2
Benefits of Outpatient Treatment
Depending on the individual’s needs, outpatient treatment can be a good means of obtaining substance abuse recovery help.
Outpatient treatment is appropriate for those whose condition is sufficiently stable, whose symptoms are mild, and are willing to participate in the treatment plan.1
With that in mind, there are many potential benefits to seeking treatment on an outpatient basis.
For one, outpatient treatment can be delivered through various settings:3,7
In a hospital clinic.
In a community mental health clinic.
At a local health department.
At a therapist’s office.
Additionally, the daily schedule can be adjusted in many outpatient programs to allow sufficient time for school and/or work commitments.3
It should be emphasized that it is of utmost importance to first receive a thorough evaluation and detailed examination of your specific drug abuse issues from someone qualified to make the recommendation for outpatient treatment.
Intensive Outpatient Substance Abuse Treatment
Intensive outpatient treatment may more closely match the services and effectiveness of inpatient programs. Those with more severe addictions may fare better in an IOP than in a lower-intensity program. IOPs tend to have more and longer therapeutic visits per week. These programs tend to cost more than regular outpatient programs, though this cost varies by program.4,5
Partial Hospitalization or Day Treatment
Slightly farther up the scale on a continuum of treatment levels in terms of intensity is partial hospitalization.1 While it might not sound like it, this is still considered an outpatient level of treatment, albeit a”very intensive outpatient” level of therapy. Also called “day treatment,” partial hospitalization level treatment is appropriate for those requiring more intensive blocks of therapy based on the seriousness of their addiction history and is an alternative to inpatient treatment.6
Those who meet the criteria for partial hospitalization are seen as able to make progress on their treatment goals when they return to home, school or work, but still require more frequent, or concentrated periods of access to medical care and/monitoring by treatment professionals or other addiction treatment staff to maintain recovery momentum.7,8
Partial hospitalization is sometimes reserved for those who have been through an inpatient or residential treatment program, but who need to continue a relatively intensive course of treatment to avoid relapse. It may also be appropriate for those who need medication or other medical services or treatment for co-occurring mental health disorders.7,8 Day treatment, expectedly, requires more of a time commitment than other outpatient treatment levels—it varies depending on individual situations, but it can exceed 20 hours per week.7 What it has in common with the other, less intensive levels of outpatient treatment is the fact that patients continue to live at home for the duration of treatment.6
Inpatient vs. Outpatient Treatment
Of course the most important consideration in determining the need for inpatient or outpatient care is dependent upon the severity of your condition.
Studies show that outpatient treatment can be quite successful for those in recovery.8 The advantages of outpatient treatment vs. inpatient treatment lie in the patient’s living situation.
Some argue that there are distinct benefits to allowing a patient to continue to live (and in some cases, work and attend school) in a home environment—in this case, whatever it is they might call home. While inpatient treatment removes those struggling with substance abuse from an environment that may have contributed to the development of drug or alcohol addiction to begin with, outpatient treatment provides the recovering person a way to more accurately test the efficacy of ongoing treatment and practice newly developed skills while remaining amidst those very triggers.8 PHPs provide intensive support during the day but then lets the patient take what the learned home at night and practice them in the “real world.”
In addition, outpatient treatment challenges a patient to seek out and utilize sources of support in their home environment, such as in finding local self-help groups or other recovery mentors in the neighborhood that can help guide someone down the path of recovery.3 Given that the transition from inpatient to outpatient treatment can be jarring, the addict in recovery will need the support of the community where he lives, works, and belongs to welcome him back to wellness and to a life without the bondage of addiction.
There is a flip-side to these arguments, however. Those struggling with an addiction might face a much greater challenge of abstinence in an outpatient treatment center, especially in the early stages of recovery. Since their environment is not changing, they can easily access the addictive substance and are faced with temptation on a regular basis.
In addition, outpatient treatment does not always mandate follow-up or aftercare treatment after the period of outpatient treatment ends, so it is important to find a facility that can direct you to another service that provides it, to help ensure continuity of care and continued recovery.
The cost of outpatient also tends to be lower than that of inpatient services. Outpatient programs of various types tend to cost anywhere between $100 and $500 per treatment session,9 and this cost varies by length and frequency of treatment. Inpatient treatment, on the other hand, costs around $200 to $900 per day,9 though the level of medical and psychological care in these programs may be higher.
Of course the most important consideration in determining the need for inpatient or outpatient care is dependent upon the severity of your condition. If substance abuse is interfering with your life, your relationships, your job, or your medical or mental health, inpatient programs frequently will prove a better option.
What to Prepare Before Seeking Help
Before seeking out a treatment program for yourself or a loved one, do some basic leg work to ensure you have the necessary information. Try to find out:
How long the substance use has been going on.
How much of the substance is being used consistently.
If any other drugs are being abused at the same time.
If there are known medical issues/diseases.
If other mental health disorders are present.
You should also have some financial information at hand, especially your insurance information. When you call a hotline or a specific treatment center, whether outpatient or inpatient, you may be asked to provide specific details about your coverage, so have your or your loved one’s card handy. Also remember that you can ask about payment options like loans, financing, and scholarships.
National Institute on Drug Abuse. (2014). Treatment Settings.
National Institute on Drug Abuse. (2018). Types of Treatment Programs.
CIGNA. (2017). Inpatient and Outpatient Treatment for Substance Use Problems.
Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 4. Services in Intensive Outpatient Treatment Programs.
Broome, K. M., Knight, D. K., Joe, G. W., & Flynn, P. M. (2012). Treatment Program Operations and Costs. Journal of Substance Abuse Treatment, 42(2), 125–133.
Medicare.gov. (n.d.). Mental health care (partial hospitalization).
California Department of Health Care Services. (2016). Partial Hospitalization Services.
McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services (Washington, D.C.), 65(6), 718–726.
American Addiction Centers. 2017.