Medication-Assisted Treatment vs. Abstinence-Based Recovery

Every day, 128 people in the United States die from an opioid overdose.

The misuse of opioids, such as prescription pain relievers, heroin, and fentanyl—a synthetic opioid—is a national crisis. This crisis affects not only public health but social and economic welfare, as well.

The Center for Disease Control and Prevention (CDC) estimates that the economic burden of addiction is $78.5 billion a year in the US alone. The costs are healthcare, addiction treatment, lost productivity, and criminal justice involvement.

In the past, recovery meant that a person sustained from drug and alcohol use using abstinence-based recovery. Today, things have changed. Now, what makes up “recovery” in many rehabilitation centers is a plan with a medication regimen.

So, which method is more effective—medication-assisted treatment or abstinence-based recovery?

Keep reading for an overview of the two treatment methods, and why abstinence is the better way to go.

What Is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) refers to using medications to treat substance abuse. It is combined with counseling and behavioral therapies. At this time, MAT is only an option for treating addiction to opioids, alcohol, and tobacco.

Many agencies, including the National Institute on Drug Abuse (NIDA) and the CDC, recommend the use of MAT. However, they don’t provide much guidance on what the recovery process using medications should look like.

These agencies believe in compliance with a regimen of medications versus continued abstinence. Studies show that this approach offers some reduction in issues related to opioid misuse. However, it does little to provide someone a stable path out of addiction.

In some cases, these medications are used only in detox or for an immediate overdose-reversing intervention to save someone’s life. And for those reasons, medications do have their place in the treatment of addiction. Especially if someone cannot detox without them, and that’s a potential barrier to entering a treatment program.

With the use of medication, withdrawal symptoms can be eased. This situation allows those with medical conditions or fears of withdrawal the ability to become abstinent. They do so without the additional risk of waiting until they hit “rock bottom” or overdose. However, even in these situations, the ultimate goal should be abstinence-based recovery.

MAT for Opioid Addiction

Medications used to treat opioid dependence include methadone, buprenorphine, and naltrexone. They also treat short-acting opioids such as heroin, morphine, and codeine, and others such as oxycodone and hydrocodone.

Methadone

The administration of methadone for opioid addiction has been a practice for more than fifty years. It is a synthetic opioid that replaces the heroin or painkiller an addict was previously consuming. Taking methadone, given in the liquid form, prevents the person from experiencing withdrawal sickness.

To receive a dose, an individual must show up to a methadone clinic every day. Having to be present in this way severely limits their movements and ability to travel. Treatment can continue for years. Trusted people often receive permission to take a few doses home after consistently visiting the clinic.

Buprenorphine Formulas

Like methadone, oxycodone, or hydrocodone, buprenorphine is a painkiller. In MAT, it’s formulated into a pill that is dissolved under a person’s tongue or inside the cheek. It’s also given as an injection or an implantable device.

The most common form of buprenorphine is Suboxone. In this formula, it’s combined with naloxone to help prevent the abuse of the drug.

These medications are still opioids. While they prevent an addicted person from withdrawing, they also affect their mental state and physical health. For example, both drugs can cause euphoria and respiratory depression. This side effect is shared with heroin, fentanyl, and other drugs.

Methadone and buprenorphine are also traded illicitly. While some individuals abuse them, others save their doses for days when they don’t have access to their preferred drugs. Others trade their doses for other drugs they’d rather have. While it’s easier to overdose on methadone than buprenorphine, overdosing on buprenorphine is possible.

MAT for Alcoholism

There are several drugs used in the course of alcoholism recovery, but three drugs are considered MAT for alcoholism. These are disulfiram, acamprosate, and naltrexone.

Disulfiram

The brand name for disulfiram is Antabuse. It works by preventing the body from fully breaking down alcohol and the individual’s body eliminates the alcohol. When alcohol has been broken down into acetaldehyde, a toxic chemical that makes people sick, the metabolic process starts.

Alcohol with Antabuse can cause headaches, nausea, vomiting, chest pains, and difficulty breathing. Rather than avoidance of symptoms, the goal of Antabuse is deterrence. While it may prevent an alcoholic from consuming alcohol, it does not treat the underlying issues attributed to the addiction.

Acamprosate

Acamprosate, known by the brand name Capral, is thought to help some individuals abstain from alcohol. However, it comes with an increased risk of suicidal thoughts and attempts.

Side effects also include dizziness, diarrhea, depression, anxiety, nausea, vomiting, and headaches.

Naltrexone

Naltrexone is administered to alcoholics to help reduce their desire to drink. It also blocks the effects of opioid drugs during addiction treatment. Its side effects also include nausea, headaches, fatigue, dizziness, and insomnia.

Potential Problems with MAT

Medication-assisted treatment involves a risk that doesn’t come with abstinence-based recovery. As we mentioned, the drugs used for substitution are abused themselves. In fact, there’s an entire black market for them.

At high enough quantities, the drugs can get users high and can be addictive in their own right. Withdrawal from these medications is as severe as withdrawal from morphine or heroin. In some cases, withdrawal can be worse.

Finally, some individuals continue using while on these medications. This use increases the risk of overdose.

Agencies continue to write prescriptions for MAT drugs in non-abstinence based recovery treatment. And it seems that many have forgotten that it’s possible for individuals to recover from addiction without the use of medications. The concept of abstinence-based recovery has lost popularity, but addicts can still stay abstinent and enjoy a productive, 100% sober existence.

What Is Abstinence-Based Recovery?

Other rehabilitation organizations support the idea of full abstinence from drug or alcohol use.

When it comes to addiction treatment, abstinence is defined as the complete cessation of substance abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) says abstinence is the safest approach in treating substance use disorders. It remains the most common form of addiction treatment in the US.

In their view, the safest way to prevent a substance abuse relapse is to avoid abusing the substance entirely. This approach is based on the disease model of addiction and assumes that people suffering from addiction are always at risk of a relapse. Abstinence-based recovery removes any unnecessary temptations from an individual’s life.

History of Abstinence

Alcoholics Anonymous (AA) was created in 1935, and it was followed by its primary text, “The Big Book.” This and several medical advances slowly led to society and the medical community accepting alcoholism as a disease.

In the late 1940s, alcoholics were often jailed or put in institutions for the mentally ill—if they weren’t left to face the fate of their addictions. Society know how to handle this population, however, AA’s membership grew over 90,000 during this time.

The idea of abstinence grew from Alcoholics Ananymous.

The Court’s Case for Abstinence

Abstinence is the only solution to individuals suffering from existence in “chemical jail.” Many drug courts attempt to divert addicts with drug charges away from incarceration. They do so by requiring them to meet certain requirements and submit to drug tests.

In some cases, an individual may have to find a steady income and have a stable living situation to avoid incarceration. Then, after a certain probationary period, they no longer have to live under supervision.

Some courts don’t permit those under their supervision to go to treatment programs that rely on MAT drugs. Their emphasis is on achieving and maintaining abstinence.

We’re Here to Help You Take the Next Step

Some people don’t realize that abstinence is a viable way to recover from drug addiction. They are led to believe that their only option out of addiction is to rely on synthetic addictive or toxic substances that got them there. Abstinence-based recovery can be the ticket to a healthier lifestyle.

Have you reached a point in your recovery where you recognize that you need support beyond residential therapy?

Our 12-step program is a clinical extended care service open to adult men and women in the greater Tucson, Arizona area. Whether it’s your first time facing substance abuse or you’ve been through treatment before, reach out to us and let’s talk about how we can help.