The place of medications in addictions treatment…

Conversations about “medication-assisted treatment” or MAT as it has come to be known, can foster much debate, and in the minds of many, continues to be a controversial topic. Opinions vary. There is the stereotypical old-school position that “a drug is a drug is a drug,” which considers the inclusion of any pharmacological agent in an individual’s addictions treatment/recovery efforts as something contrary to, and an automatic violation of that individual’s sobriety. On the other extreme is what I call the brave-new-world position that believes that pharmacology is the sole or primary solution to the problem of addiction. As with many extreme positions in many arguments, neither is defensible at the present time based upon what research has made known to us, and yet both extreme positions carry some grain of truth. Is it possible that someone who has made their addictive drug-of-choice their sole/primary go-to solution for every problem in life, to transfer that maladaptive belief to a medication that is being prescribed to help them with cravings, or to ease the distress of other post-acute withdrawal symptoms? Based on observations of individuals in early treatment/recovery, honest practitioners must answer in the affirmative. However, is it also possible that medications can be one of a number of effective tools in the addicted individual’s treatment/recovery toolbox that, properly understood and utilized, can assist them in making progress toward their treatment/recovery goals? Again, based on research that accurately reflects practice-based evidence, the answer is in the affirmative. Therein lies the tension. If prescription medication were the sole or primary solution to the problem of addiction, or many other problems, then the residents of the United States would be the healthiest population on the planet, as we are, by far, the most heavily medicated country in the world. And yet the Bloomberg Global Health Index doesn’t even have the USA in the top 25 healthiest countries in 2018, which should give us pause, in an even broader manner, in considering the place of medications in overall wellness. But back to our primary topic. A balanced view that takes the involved tensions into account may start with considering that, by simple definition, medication-assisted treatment is treatment — that is, something other than the involved medication — that is assisted by one or another pharmacological agent. And that the treatment that medication may be able to assist with — if properly utilized and understood by the client within a larger context of treatment/recovery — often ideally involves group and individual therapies, recovery community/peer support, targeted case management assistance, and other psychosocial interventions that continue to be the primary focus of addictions treatment, and which best position individuals for a sustainable solution to their addiction problem. Can various medications assist addictions treatment? Of course. Are stand-alone medication interventions the same thing as medication-assisted treatment, or likely to solve the complex problem of addiction by themselves? Of course not.

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