The undocumented and unmeasurable reality of M.A.T compared to abstinence and twelve step recovery.
M.A.T: What is it and how does it work?
M.A.T stands for medication assisted treatment and is prescribed for patients suffering from addiction most frequently for opiate dependence but sometimes for alcohol cravings as well. Buprenorphine, methadone, and naltrexone are examples of common medications used in this type of treatment for addiction.
M.A.T is commonly utilized in the following ways:
- Replacement therapy – a method where the opiate/opioid of the addicts choice is replaced with a prescribed alternative that is also the same or similar type of drug.
- Medical Detox – a method where an addict in withdrawal under medical supervision is administered a dose of a medication that is lowered often called a “Taper” and it usually occurs over a period of time between 7-14 days.
- Antagonist treatment – a method where an antagonist medication such as Antabuse or naltrexone is prescribed in order to block the effects of a substance or make it less desirable to the user. This method is sometimes combined with replacement therapy medications like Buprenorphine. The name brand Suboxone
®is buprenorphine combined to the opioid antagonist drug Naloxone. This medication is designed to prevent the use of additional opioid/opiate medication while also replacing the substance to curb cravings and relieve detox or “Dope sickness”.
What is Twelve Step Recovery?
Twelve Step Recovery is the most common type of abstinence based recovery. The programs are based on behavior modification using twelve steps to accomplish it. Alcoholics Anonymous and Narcotics Anonymous are twelve step programs. The Twelve Steps originated in 1935 with the founding of Alcoholics Anonymous by Bill Wilson and Dr. Robert Smith. The programs believe addiction is incurable, and abstinence is required for treatment.
Core components of Twelve Step Programs:
- Spirituality and God
- Fellowship (often takes place at recovery clubs before and after meetings)
- Personal reflection
- Service (volunteer work provided to other members, meeting places or addicts in need)
- Free of charge
The Truth About Effectiveness of Methods
It is my experience that Replacement Therapy does not work, Medical Detox sometimes works, and Antagonist Treatment can be effective but has major draw backs. I have been in recovery for 9 years and I have watched many people attempt to use Replacement Therapy or a combination and I have meet less than 5 people who did not return to there drug of choice after an extended period of time.
Tyson Carpenter, who has been sober for 3 years and a long term member of the E-Z Duz It Recovery Center in Louisville, KY Says “I’ve been on Methadone, Suboxone
® and even Kratom. None of it ever worked for me. At first things would be good I could hold a job and function externally, but I wasn’t ever actually happy and eventually returned to my drug of choice”. Medical detox is sometimes an applicable solution but isn’t always easier and might prolong the inevitable according to Dr. Evan Massey a retired physician who has had struggles with addiction. “On the matter of Medical Detox with M.A.T its a question of how you want the pain of withdrawal. Do you want lots of pain over a short time? Or less pain over a longer time?”
Why have I been told that M.A.T is more successful than the alternatives ?
The problem is biased metrics and difficulty measuring the success of twelve step programs because they are anonymous and data is self reported. According to samhsa.gov the goal of M.A.T is full recovery, however they use the following metrics to define it:
- Improve patient survival.
- Increase retention in treatment.
- Decrease illicit opiate use and other criminal activity among people with substance use disorders.
- Increase patients ability to gain and maintain employment.
- Improve birth outcomes among women who have substance use disorders and are pregnant.
Being alive, employed and not in prison are not enough! The metrics used to define successful recovery set the bar extremely low compared to what can actually be obtained when working a twelve step program. While the claims of twelve step program members may not be able to verified there is a reason programs like A.A have such a large membership. AA.org estimates membership at 1,967,613 in 2021. Something has to be working right? Personally being happy is a huge forgotten metric that is not measurable and twelve step programs make that a top priority.
Not all recovery is created equal. Is M.A.T effective? I guess it depends on what your looking for. If you seek a fulfilled life without the desire to use a substance my experience and many others indicates that you can obtain that in a Twelve Step program and there are many treatment centers that recognize there methods and use them successfully every day.