There have occurred dramatic advances in the treatment of SUD (substance use disorders) in the last decade. Treatment models have evolved from pure abstinence and social context approaches
The essence of this shift in thinking is based upon the fact that addictive disorders, particularly opioid use disorders, are theorized to be chronic relapsing conditions with compulsive
With these concepts in mind, treatment has become more biologically oriented, and medications have risen to
Because these addictive disorders are heterogeneous, clinicians recognize that patients have “psychobiologic illness”, which
There will be relapses, even with the MAT paradigm, but with less frequency and with less severity. The length of time in a state of drug abstinence should be optimized. Less overall substances should be consumed. We are conveying a realistic treatment expectation, as conditions can often be controlled but not cured. The abstinence model resulted in about 80% recidivism (relapses) amongst substance abusers after one year of treatment. This treatment was often spent in detoxification centers, followed by inpatient partial hospitalization (inpatient PHP), then IOP (intensive outpatient treatment). The presumption was that the isolation of the patient in an environment, in which restriction of cell phones, communication with friends and family, and freedom of movement for weeks, would be therapeutic. Many of these patients relapsed during “passes” to the outside environment, and some of them died due to overdoses. They had been successfully detoxified off opiate drugs and “abstinent”. Though their initial motivation for treatment was present, they re-experienced the cravings for opiates, due to their biologic propensity to use drugs. It is “
So, what are the alternatives to the conventional approach currently comprising the majority of addiction treatment
The first alternative is the prescription of low dose buprenorphine/naloxone (Suboxone) following detoxification, so the vulnerable brain is protected by medication which diminishes cravings and allows the damaged neurons to heal. Suboxone is not just an opiate substitute, it also protects brain cells from the deleterious effects of opiate drugs, without inducing any form of “euphoric high”. Abstinence based treatment maintained for years that Suboxone was no different than street drugs. That misconception differs from scientific studies and clinical practice. These patients experience a far lower recidivism rate after one year; i.e. about 30%. There are also medications which benefit alcohol use disorder and this is incorporated into the MAT paradigm, as well.
The second alternative is environmental. It almost sounds counterintuitive to state that patients will adhere to abstinence and surpass the success of conventional model outcomes in an outpatient program. Patients will complete the program for IOP in
This outpatient MAT model will save billions of healthcare dollars, and the maintenance of employment will reduce disability expenditures, and loss of productivity in the economic sector. Inmates can be treated for opiate addiction in diversion programs, in which treatment will replace incarceration. The healthcare results and outcomes will far surpass the current conventional forms of treatment at a much lower “price tag” for the patient, the healthcare industry, and the taxpayer.
Many believe this model is the logical next step in substance abuse treatment and that this will be the paradigm for the future.
Charles A. Buscema, MD is the Medical Director and CEO at Alternatives for You, LLC in Palm Beach Gardens, FL which is a MAT (Medication Assisted Program). (561) 337-8880