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Medication Assisted Treatment MAT; A New Breed of Drug Addict

Disease Models, and Addiction Treatment for Opiates

Medication assisted treatment MAT in West Palm Beach, FL needs to be addressed. At Whole Health outpatient addiction treatment clinic in West Palm Beach, FL., we see 100’s of patients suffering from drug and alcohol addiction. Many do not have a clear understanding on MAT due to bad information on social media. We see many social media posts giving incorrect information, mainly based on personal experience. MAT must be properly diagnosed by a qualified addiction physician.

As most of us are aware, the opioid and heroin problem in our country is at epidemic proportions, and I would go so far as to state unequivocally that we are dealing with a magnitude and severity of a situation in addiction medicine that is unprecedented in nature. Suddenly, relapse isn’t an “oops let me try again,” it is DEATH.

Too Many Deaths from Opiate Epidemic

A recent CNN article detailed some alarming statistics: “heroin-related deaths increased 439% from 1999 to 2014. As of 2014, heroin-related deaths had more than tripled in five years and quintupled in 10 years. In 2014, opioids were involved in 28,647 deaths, 61% of all US drug overdose deaths and 10,574 were related to heroin, in particular.

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Data from 2014 reflects “two distinct but interrelated trends,” the CDC notes, a long-term increase in overdose deaths due to prescription opioids, and a surge in illicit opioid overdose deaths, mostly related to heroin.” At Whole Health outpatient addiction treatment clinic, 70% or greater of our patients are addicted to heroin. Very clearly, the near-universal mechanism by which we as a country have dealt with substance use disorders to date, namely traditional 12 step rehab, is inadequate in this new and exploding population of opiate use disorder patients.

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There are two prevailing “thought models” which attempt to explain the pathophysiology behind addiction.

Moral Model of Addiction

The first is termed “the moral model,” which asserts that addiction is entirely a choice and secondary to an individual’s moral decision-making (or lack thereof). This model presupposes that, if not for one’s dysfunctional values and choices, he or she would not have an addiction problem.

Disease Model of Addiction

The second model is known as the “disease model”, which categorizes addiction as a chronic disease. ASAM (the American Society of Addiction Medicine) defines addiction as ”a primary, chronic disease of brain reward, motivation, memory and related circuitry”. And as part of a recent landmark statement, the US Surgeon General, Vivek Murthy, distinctly stated that addiction is “a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer”.

Medication Assisted Treatment MAT Supported

Furthermore, President Obama’s 2017 fiscal year budget includes $1.1 billion to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders. All of this did not happen on a whim. These statements and decisions are directly based on clinical evidence that including MAT in the treatment of the chronic disease of addiction increases the likelihood of abstinence from the illicit substance and decreases the probability of overdose and death.

Medication Assisted Treatment (MAT) Education Needed

Accepting addiction as a chronic disease mandates that we, as addiction professionals, view and treat it in the same multi-disciplinary manner in which we treat other chronic diseases. Namely a COMBINATION of medical interventions and behavioral adjustments and modifications. In other words, we as physicians don’t look at an obese diabetic patient and simply say “lose a hundred pounds and your diabetes will go away” and omit insulin therapy.

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Nor do we look at a smoker with emphysema and simply say “stop smoking and you will breathe better” and omit inhalers that improve lung function. Are the insulin and inhalers, respectively, “crutches” for these patients? I suppose one could look at it that way, but mainstream medicine, and our society as a whole, would submit that these medications are imperative to preserve life and improve the quality of one’s life.

So, if the addition of medication is perfectly acceptable, appropriate and the actual standard of care for all these other chronic disease states, why the stigma when discussing medication assisted treatment MAT, as it applies to the chronic disease of addiction? As an addiction medicine Doctor, I feel that it is imperative to at least consider utilizing any and all available tools at our disposal, and this includes MAT (Medication-Assisted Treatment.)

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Having said that, medication assisted treatment MAT should also not be used in a cookie-cutter fashion, and is not appropriate in all forms for all patients. The specifics regarding MAT medications are beyond the scope of this introductory article, but will be detailed in a future editorial. However, suffice to say that, when used responsibly and appropriately, MAT saves lives.

Our national academy and addiction authority, ASAM, our surgeon general, our Country’s President, and addiction medicine physicians in the trenches with these patients concur that that is, indeed, the case. The recovery community cannot continue to treat our current climate of heroin addiction in a rigid, dogmatic fashion, or thousands of more deaths will be left in the wake- guaranteed.

Abstinence, or Die (What’s Really Happening in the Recovery Community)

I would submit this question to the recovery community as a whole: given the REALITY that abstinence is only attainable by approximately 10% of our patients addicted to heroin, what should our answer be to the other 90%? Attain the recovery community’s traditional idea of abstinence, or go die?

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In the course of treating no other disease would that be the sentiment. The logical answer is harm reduction. If a portion of our patients are utilizing some form of medication assisted treatment MAT, yet going to work, having meaningful relationships, and living a fulfilling life devoid of crime and an elevated risk of death and communicable disease, what is wrong with that? If I could actually attach a title to the current arena of mainstream heroin addiction treatment it might be “Abstinence- worth dying for.” The unyielding ideals in the context of the current patient population are at the very least antiquated and simplistic, and at the very most, downright dangerous.

Medication Assisted Treatment MAT Saves Lives

In summary, we have an absolute epidemic of opioid/heroin abuse in this country of a never-before-seen magnitude, and our current historic methods of dealing with alcoholism and other addictions are NOT WORKING. Traditional 12-step, “abstinence-based”, one-size fits all programs are simply NOT acceptable as a uniform approach to this new and evolving segment of addicts, and these patients are DYING IN RECORD NUMBERS.

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One More Time, Could Be Your Last.

The primary difference between heroin and alcohol, or other drugs of abuse, is that with ANY relapse, just ONE use or momentary lapse in judgment, the heroin addict has a significant rate of sudden death. Perhaps being dogmatic about traditional, Big Book, 12 step programs are more acceptable when the risk of relapse does not include the very high likelihood of immediate death. But, because of the totally unknown mixture of drugs in each purchased “bag” or “cap,” including the most potent opioids known to man, namely fentanyl and carfentanil, a relapse is not necessarily an invitation to “try again,” but is a game of Russian roulette often ending in death.

Harm Reduction – Medication Assisted Treatment MAT

In my time treating patients with substance use disorders, I have often heard the statement “the definition of insanity is doing the same thing over and over again and expecting a different result,” I think the way we are currently treating our heroin-addicted patients accurately, albeit ironically, fits that definition.  It’s time that we as a recovery community stop preaching and demanding that our idea of “abstinence” in the course of addiction treatment is the ONLY acceptable goal. We must embrace harm reduction.

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We can continue jumping up and down screaming abstinence-based rhetoric while our patients continue to die, or we can think more pragmatically about the issue and consider the non-judgmental addition and acceptance of appropriate medically-based therapies to the paradigm of addiction treatment. Our patients’ lives truly depend on our willingness in the recovery community to adapt to this uncharted territory by implementing the same treatment paradigm that we use as a society in any other chronic disease.

For more information on Medication Assisted Treatment MAT, or outpatient addiction treatment options in West Palm Beach, Fort Lauderdale, and Miami please visit our website HERE or call 855.365.1626 (majority of medical insurance plans and Medicare, excluding HMOs. Flexible financial arrangements are available to patients unable to afford their entire deductible or who are without insurance and are paying cash.)

More Addiction and Behavioral Health Treatment Options

 

Addiction Treatment Ft Lauderdale Whole Health Facebook Group Addiction and Behavioral Health Options

CLICK HERE to join.

Addiction and Behavioral Health Options

This group is designed to provide a resource for addiction and behavioral health professionals and individuals seeking addiction help, and individuals in recovery. In this group, you can network with professional peers and individuals seeking information on treatment from the specialists, strengthen your position in the treatment field and forge valuable new relationships. This is a place to get information on treatment, search for help, network, give and receive referrals from addiction centers, psychiatrists, psychotherapists, occupational health physicians, practitioners, health counselors, psychologists, social workers, nurses, front-line practitioners, and many other sources. Share current information, interact with each other, meet leaders in the field, and be exposed to the latest research and clinical methods and techniques. Group members can post information on treatment, info about their services, share information about addiction, recovery, holistic treatments, mental health, marketing, social media and business strategies. Group members are encouraged to network and refer each other.
Brett Lieberman
Brett Lieberman2 days ago
MAT Windsong Wellness now accepting clients for MAT treatment
Corey Cohen
Corey Cohen shared a link to the group: Addiction and Behavioral Health Options.2 days ago
Jon Heller
Jon Heller3 days ago
Heartbreaking phone call with a Father this morning; his family desperately needs ideas. Their daughter is 23 years-old, Bipolar 1 (recent meds), ED (not active), chronic pain from childhood injury (no meds), ETOH. Currently homeless in Austin, TX after AMA from an RTC there. Family is in Berkeley, CA. Family describes her as treatment resistant, 12-step resistant. Needs emphasis on MH with CD balance, as well as strong community. Employer-based CIGNA PPO. Please, no 12-step or "tough love" suggestions. Outside of the lines recommendations welcome. Thank you in advance...
Mateja Petje
Mateja Petje shared a link to the group: Addiction and Behavioral Health Options.3 days ago
Fernando Meisenhalter
Fernando Meisenhalter3 days ago
Disclosure Card Game is a fun way to share feelings in groups or one-on-one. The “happy” card, for instance, is a cue to start a sentence by saying “I feel happy when…” and then finishing it by saying, for instance: “…when I walk my dog.” Ideal as an ice-breaker for counselors, psychologists, faith leaders, and others, it can be played as “crazy eight” or other types of games. One deck contains 60 cards printed in four vivid colors. For ages 16+ but can be adapted for younger players by simply eliminating cards with complex ideas.
https://www.amazon.com/dp/B071RNKJ7B

You may also be interested in some of our other articles on addiction treatment; “Unchecked Addiction Treatment Diseases“, “What Does (MAT) Medication Assisted Therapy Mean for Generation Z?“, and “Narcan Education by Opiate Detox West Palm Doctor“.