CleanSlate Blog

MAT Facts: Why is There Any Stigma Against Medication-Assisted Treatment?

by Tracey Cohen, M.D. | Apr 2, 2019

MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).

Stigma

Since it was first developed 50 years ago, medication-assisted treatment (MAT) has become the gold standard for opioid use disorder (OUD). The combination of behavioral therapy and medications to treat OUD has been shown to be the most effective intervention for people with OUD. The longer that people stay in treatment with medication, evidence proves, the better their health and functioning.

MAT decreases cravings and symptoms of withdrawal while preventing patients from getting high; reduces the chance of overdose; is cost-effective and convenient; and allows people to resume their normal functioning so that they’re able to address the full scope of their recovery. That’s why MAT is increasingly recommended by leading healthcare organizations, public policy experts, and community stakeholders across the country.

So why is MAT still stigmatized by some within the addiction treatment field?

Addiction treatment grew up outside of mainstream healthcare

To answer this question, we need to go back a bit.

The treatment model for addiction in America grew up not through the mainstream healthcare system but through a 12-step model that emphasizes abstinence from all drugs and alcohol. This model works for many people, but there is limited data on recovery rates. Even so, the 12-step model has continued to serve as the primary model within most healthcare settings, even as MAT has proven to be more effective at treating the disease of addiction than behavioral therapy alone.

Related blog: MAT Facts: What Is Medication-Assisted Treatment?

Because two of the three FDA-approved medications contain small amounts of opioids to reduce cravings and limit withdrawal symptoms, some purists within the addiction treatment field dismiss MAT as “trading one addiction for another.” This perspective doesn’t account for the fact that addiction is a chronic relapsing brain disease, not a lapse of character. All other chronic diseases, such as diabetes or asthma, are treated with medication and without judgment that medication isn’t “real recovery.”

Those who stigmatize MAT also miss a key distinction: there’s a difference between dependence and addiction.

Related blog: MAT Facts: How Does Buprenorphine Work?

Medication for addiction is something that people become dependent on to sustain recovery. Sometimes medications need to be continued for years, sometimes forever. But here’s the key: physical dependence is not the same as addiction.  

Dependence is a physiological state where a person develops a physical tolerance (taking more to get the same response) or experiences physical withdrawal when the substance is not supplied.

Drug addiction, on the other hand, is a chronic brain disease which looks like a person who is losing control of their drug use and losing control of their lives because of that drug use. Addiction medications may trigger physical dependence, but not addiction.

Related blog: MAT Facts: How Does Naltrexone Work?

Medically, we manage all chronic diseases with a biological, psychological, and social approach. The goal of treating chronic diseases is to stay alive, stay healthy, stay out of the hospital and get back to work. We manage chronic diseases as long as necessary.

Biases fading

As the opioid epidemic continues and the success of MAT is more pronounced, many traditional rehabilitation centers are beginning to shift their thinking around medication.

For example, the Hazelden Betty Ford Foundation, one of the household names around residential 12-step addiction treatment, have begun to embrace MAT as an option for their patients.

FDA Commissioner Dr. Scott Gottlieb has stated that MAT is critical to breaking the cycle of opioid dependence and that the stigma associated with these medications must be overcome.

Experts like Gottlieb assert that patients can be in full recovery and still require medication to treat their illness, craving and withdrawal symptoms. “We must confront the reality of what recovery means,” Gottlieb said in a press announcement. “Is complete abstinence the only clinical endpoint appropriate to assess whether these medications are working?”

Related blog: Stigma Against Addiction Medication Fading, Ringing In Hopeful Signs For Opioid Epidemic In 2019

Gottlieb is committed to increasing the number of patients who are offered an adequate chance for treatment that uses medications. “More widespread adoption of MAT, coupled with relevant social, medical and psychological services, has the highest probability of being the most effective of all available treatments for OUD,” he states.

“Improving access to prevention, treatment and recovery services, including the full range of MAT, is a focus of the FDA’s ongoing work to reduce the scope of the opioid crisis.”

 

CleanSlate treats patients suffering from opioid or alcohol addiction with medications and a continuum of care to support each individual's journey to recovery. If you or someone you love needs help, contact us at 833-505-HOPE, or visit our website at www.cleanslatecenters.com to find the center nearest you.

 


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Picture of Tracey Cohen, M.D.

Tracey Cohen, M.D.

Dr. Cohen, Chief Clinical Officer of CleanSlate, is responsible for the clinical and quality oversight of CleanSlate’s services as well as continuous improvement and development of CleanSlate’s model of care. A part-time clinical provider at CleanSlate since 2010, Dr. Cohen joined the CleanSlate leadership team full-time in the summer of 2018, bringing over seventeen years’ experience of leadership in direct care, managed care, and public policy. Board certified in Addiction Medicine and Family Medicine, Dr. Cohen is widely recognized as a leader in substance use disorder care, health care integration, primary care, and chronic pain management. In her previous roles as Medical Director of Neighborhood Health Plan of Rhode Island and as Medical Director of Behavioral Health and Quality at BCBS Rhode Island, Dr. Cohen led initiatives that expanded access to addiction treatment across the state and served as regional and national models. Dr. Cohen earned a Bachelor of Arts degree in psychology from Barnard College and a Doctorate in Medicine from University of Pennsylvania School of Medicine where she was one of the six inaugural Twenty-First Century Scholars.

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If you or someone you know suffers from the disease of addiction, please call 833-505-HOPE to speak with a professional.

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