The use of Medication-Assisted-Treatment when addressing addiction issues appears to provoke a great deal of attention. There has been no consensus even within the recovering community about the role of use of medication in recovery. There seem to be a general acceptance of medications for the treatment of chronic medical conditions, excluding addiction and psychiatric issues. There appears to be some opposition in terms of use of medication in recovery coming from many different sources including: legal and healthcare professionals, peers, and family members. Additionally, physicians seem to be less educated about the use of medications in recovery, and there are some physicans that appear to be clearly opposed to the idea. Stigma from physicians not only has a negative impact on addictions treatment, but also in the larger context of healthcare, as these perspectives support the myths and misperceptions about addiction, and reduce access to Medication-Assisted Treatment.
Medication-Assisted Treatment and Myth
A main concern echoing through many unfriendly comments was about replacing one drug with another drug, thus undermining the true potential of recovery. It is a common myth about Medication-Assisted Treatment, and a major area in which providers can help. Meeting myth with facts and education can be effective in combating stigma; for example, by understanding and reinforcing the difference between medications and drugs, and physical dependence versus addiction. Providers can also share examples of other chronic illnesses (i.e. diabetes/hearth disease) that are treated with maintenance medications. The more service providers, family members and patients can learn about how medications work, and the research supporting their use, the better they will be able to combat stigma and myths that seem to prevail. A related mythin regards to addiction treatment is that medications are not supposed to be a part of it, where in fact, medications can and are accepted as an effective tool in treatment of many chronic mental and physical conditions, including addictions, aiding in bio-chemistry just as other medications do.
Peer-Support Groups
Another pervasive myth is that the most common and accepted peer support groups Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) do not support the use of medications. Much of the objection from 12-step members is founded in a fear that members will use medications inappropriately. Many members have also relapsed while using prescribed medication, and for many the safest path to sustained recovery becomes “just say no” to all medications. For others, the use of medications is necessary to support their sobriety. Some alcohol or drug dependent clients require medication and it would wrong to deprive any person of medication which can alleviate or control other disabling health problems. The Big Book of AA, itself, says that the world is full of “fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of
them give freely of themselves, that their fellows may enjoy sound minds and bodies…. we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.” [Chapter 9, p. 133]
Medication-Assisted Treatment and Discrimination
Patients using medication in recovery may also face discrimination, particularly in regard to use of addictions medications for opioid treatment. This happens largely due to lack of knowledge about Medication-Assisted Treatment’s significance, effectiveness, and safety. Discrimination is also common because people in Medication-Assisted Treatment frequently do not have the tools necessary to educate employers, landlords, courts, and others about this type of treatment and relevant legal protections.
There are some free publications by SAMHSA and there is The Legal Action Committee (www.lac.org) of both of which are reliable source for useful publications, including information about the legal rights
related to child welfare and/or the criminal justice system.
Medication Support
Supporting clients/patients in continuing to take prescribed medications properly can significantly improve treatment outcomes, as well as treatment for other co-existing conditions, such as HIV
or hepatitis C, or hypertension, or psychiatric conditions such as bipolar disorder, depression or anxiety.
The patient needs to have access to factual information regarding the importance of taking their medications regularly, avoiding potential interactions, keeping to a schedule, thus, they will
experience a greater sense of control, and know what to expect. When discussing mediations it is important to keep in mind that medical decisions must be made by trained and licensed providers, and although addiction counselors cannot make specific recommendations, they can encourage patients to talk to their GPs and they can support the patients’ use of medication as one tool in their recovery process. The counselors, mental health professionals, and nurses are a great resource for providing support and education around the medication assisted treatment to the client and family members. Health
providers should plan to devote about few minutes each time they meet to discuss medication usage and the importance of following their treatment plan. It is important to remind all involved that taking medications as prescribed can help prevent relapse. Also, the treatment providers need to know that the more informed a patient can be about their medications and the reasons for taking them, the greater chance they will follow their treatment plan. Patients and services providers can begin by talking about the use of medications for any chronic condition, such as high blood pressure, or diabetes, and normalize the use of medication for addiction which also is a chronic health condition. As mentioned earlier, understanding potential medication interactions – with food, alcohol, other drugs, other medications, or pregnancy considerations- are also necessary. Some medications may require a routine blood test to monitor for side effects like liver toxicity or blood pressure; while this is something a physician would initiate and monitor, it is a process everyone involved can encourage and support
Medication Adherence
It is important to monitor the following: doses missed, feeling or acting different on days when medication was missed, reasons for missing medication including relapse on other substances (drugs/alcohol), how many doses were missed during a specific period of time. Once a patient provides a specific reason for missing a dose (or doses), it is important to identify a couple concrete strategies to help with medication adherence. Sometimes, when patients first start taking medications, they feel
better than they have in a long time, and consider themselves to be healed which may lead to discontinuing the use of medications or taper the prescribed dose. Negative side effects may be another reason a patient decides to discontinue medication. It may be important for the patient to go back to their
doctor, as many side effects can be managed through dose adjustments, supportive medications, or simply understanding that the effects will diminish with time. People may also worry that if they are taking medication they are not really in recovery, and that they are replacing one drug for another. Once again, this idea may also be coming from peers, support groups or even family members. It is critical to understand this issues and educate oneself about the need and effectiveness of medication as a legitimate treatment tool.
Medication assisted treatment in the Context of Recovery
It is critical that individuals are able to access and be supported in using the tools that are relevant to their recovery, whether they utilize a medication, outpatient treatment program, peer support group, literature, meditation, yoga, acupuncture, and so on. The tools that individuals, families and communities use are just that – tools; they do not define or undermine the quality of recovery. Recovery needs to be understood as a process, that is unique for every individual and a process that needs to be inclusive of medications as a legitimate and effective tool.
”There is also an emerging consensus supporting recovery as a non-linear process, a chronic condition that may involve relapse and other setbacks, but is based on continual growth and improved functioning”. Recovery is a process of building or rebuilding what’s lost, rebuilding relationships, improving quality of their life improving, obtaining education, employment, housing, and being a part of a community. Evaluating recovery in this context is crucial – rather than judging the tools a person is using to get there.
Most addiction professionals know quite well that there is no “one size fits all” approach to recovery, and having a catalogue of options is always the best case scenario; The medication assisted treatment needs to become a normal and accepted part of recovery, and in some cases, medication may be the very tool that helps a person remain clean and sober.
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