As an addiction medicine physician on the Monument platform, I’m reassured to see a growing interest in medication-assisted treatment. Often referred to as “MAT,” medication-assisted treatment is largely considered the gold standard in treatment for alcohol use disorder by the medical community. Not only is there increased awareness surrounding this life-changing approach, but now, with online alcohol treatment programs like Monument and other AA alternatives, it’s more accessible than ever.
Let’s dive into the details of MAT treatment for alcohol use disorder, and discuss how it can be helpful to anyone looking for a science-backed way to change their relationship with alcohol.
What is medication-assisted treatment for alcohol use disorder?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders,¹ including alcohol use disorder.
If you’re wondering “what is alcohol use disorder?,” or “what’s the difference between alcohol use disorder vs. alcoholism?,” you’re not alone. You may be more familiar with terms such as “alcohol abuse”, “alcoholism”, or “alcohol addiction.” At Monument, we use the term ‘alcohol use disorder’ because it’s recognized by the medical community, and can be diagnosed based on 11 criteria per the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Alcohol use disorder is characterized by drinking more than you want to, for longer than you want to, despite wanting to cut down. Alcohol use disorder can be challenging to navigate, but it can be effectively treated with tools such as therapy and medication-assisted treatment.
While medication alone can effectively help individuals reduce their alcohol consumption or stop drinking, most people benefit from combining medication with counseling and cognitive behavioral therapy. Alcohol use disorder is a complex condition that affects and is affected by multiple aspects of one’s life, and effective treatment requires a whole-person approach.
How does medication-assisted treatment work?
The first step of medication-assisted treatment involves seeing a healthcare provider, whether that’s at Monument or elsewhere.
Speak with a healthcare provider
At Monument, all treatment plans begin with a virtual physician appointment. During your first visit, your provider will ask about your alcohol use and medical history, and determine whether it’s safe for you to start medication-assisted treatment.
Depending on your risk for developing severe alcohol withdrawal symptoms when quitting alcohol cold turkey or significantly cutting back, your provider may recommend that you complete in-person supervised detox to ensure your safety.
Identify the appropriate medication for you
If you’re deemed medically stable to start MAT, you and your provider will decide which MAT medications will work the best for you based on your treatment goals and medical comorbidities. Your provider will explain to you the pros and cons of each medication to make an informed decision.
Although not required, one-on-one therapy and support groups are strongly recommended because they work synergistically with prescribed medication to give you the best chance of success.
Navigating the non-linear treatment journey
Follow up with your provider
After getting started on one of the MAT medications, you’ll follow up with your provider regularly to ensure that it’s safe for you to continue with the medication and determine whether you need any changes to your prescription. Everyone is different in how they respond to the medication, and sometimes you may need to manage side effects, increase or decrease your dose, or try a different medication to stop drinking.
For long-term success, it’s important that you follow up with your provider periodically, even if you’re continuously meeting your goals. The duration of medically assisted treatment is different for everyone, but as long as a treatment program is working for you, it’s reasonable and recommended to stick with it.
Benefits of medication-assisted treatment for alcohol use disorder
Many people are unable to cut down or stop drinking on their own. There is no shame in that. The chemical reactions that occur in the brain after extended alcohol use can cause alcohol cravings and make it hard to cut back. Fighting cravings all day takes up a lot of energy and headspace. You deserve better resources for how to stop alcohol cravings. Additionally, many people use alcohol as a coping mechanism for depression, anxiety, isolation, trauma, or boredom. These underlying issues are challenging to address when you’re fighting against cravings all day.
That’s where medication can play a powerful role. By reducing cravings with medications, you can focus on addressing the underlying issues that influence your alcohol consumption, and work on creating healthier habits. It’s also possible that you don’t experience alcohol cravings, but do find it especially difficult to stop after your first alcoholic beverage. There are medications that make alcohol less pleasurable, which can be especially helpful for those who identify with that drinking pattern.
Common types of medication used in the treatment of AUD
There are two primary medication types used in the treatment of alcohol use disorder.
Medication that reduces the reinforcing effects of alcohol
The first type of medication reduces alcohol cravings by decreasing the reinforcing effects of alcohol that make you want to keep drinking. These medications include naltrexone, Vivitrol, and acamprosate.
- Naltrexone blocks opioid receptors in the brain, which in turn decreases the pleasure you feel when drinking alcohol, and ultimately helps reduce alcohol cravings. Because naltrexone is an opioid antagonist, it’s also commonly used as part of an opioid treatment program. Naltrexone’s chemical properties can help curb alcohol cravings and opioid cravings. Some doctors use naltrexone in order to follow The Sinclair Method.
- Vivitrol is a monthly injectable form of naltrexone. This method of taking naltrexone benefits people who have difficulty with having a daily medication.
- Although the medical community does not fully understand how Acamprosate works, it interacts with GABA and glutamate neurotransmission and decreases cravings.
As noted above, naltrexone is also FDA-approved for the treatment of opioid use disorder. However, besides naltrexone, the medications used to treat opioid dependence differ from those to treat alcohol use disorder. Other FDA-approved medications to treat opioid use disorder include buprenorphine, suboxone, and methadone. You may have also heard about naloxone, a medication that treats opioid overdose. These medications are not available via the Monument platform. To learn more about MAT for opioid use, visit SAMHSA.gov to browse resources for opioid use disorder, opioid overdose, and opioid withdrawal.
Medication that makes you sick from alcohol
The second type of medication to treat alcohol use disorder is called disulfiram, or ‘Antabuse.’ Unlike naltrexone, which helps to reduce your alcohol cravings, disulfiram is an alcohol sensitizing agent that makes you sick if you drink alcohol. So, how does disulfiram work? It inhibits the enzyme aldehyde dehydrogenase and causes the elevation of acetaldehyde. Disulfiram doesn’t help with cravings, but acts as a psychological deterrent that prevents you from drinking alcohol. Like naltrexone, you can receive a prescription for disulfiram online if your physician deems it safe and appropriate for you.
Why isn’t medication-assisted treatment more common?
When discussing holistic treatment with my patients I’m often asked “why was I never told about MAT before? ” Unfortunately, the use of medications to treat alcohol use disorder is not widespread. In 2019, only 7.6 % of people with alcohol use disorder received medication-assisted treatment.²
Despite alcohol being one of the most commonly used substances, few community treatment programs offer prescribed medication for alcohol use disorder.³ One of the reasons is because many physicians lack training and feel unprepared to use MAT to address alcohol use disorder with their patients.⁴ As a result, the FDA approved medication that’s proven to reduce heavy alcohol consumption is often underutilized. Fortunately, with Monument, physicians are prepared to discuss these options and empower members to begin a medication assisted treatment program if safe and appropriate for them.
Finding holistic treatment with Monument
According to the 2019 National Survey on Drug Use and Health, the most common reasons for not receiving treatment were not being ready to stop using a substance, not knowing where to go for treatment, and not having healthcare coverage or being able to afford the cost of treatment.²
Monument breaks down these barriers by providing convenient, affordable access to the most critical aspects of treatment: medication, alcohol therapy, and alcohol support groups. Whether your goal is complete abstinence or moderation, Monument can help you determine if a medication assisted treatment program is right for you.
Sources:
- SAMHSA. “MAT Medications, Counseling, and Related Conditions, https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions.” Accessed October 22, 2021.
- SAMHSA. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health, https://www.opioidlibrary.org/document/key-substance-use-and-mental-health-indicators-in-the-united-states-results-from-the-2019-national-survey-on-drug-use-and-health/.” Accessed October 22, 2021.
- The ASAM Principles of Addiction Medicine. Accessed October 22, 2021.
- Acad Psychiatry. “The Time is Now: Improving Substance Abuse Training in Medical Schools, https://pubmed.ncbi.nlm.nih.gov/25749922/.” Accessed October 22, 2021.
About the Author
Dr. Jiseung David Yoon, MD, MPH, is a distinguished physician specializing in addiction medicine and preventive health. He graduated from Loma Linda University with a Medical Doctorate and a Master of Arts in Bioethics and holds a Bachelor of Science in Biology from Andrews University. Dr. Yoon completed his Addiction Medicine fellowship and Preventive Medicine residency at Loma Linda University.
His professional journey includes pivotal roles as the Medical Director at Aegis Treatment Centers and a Telemedicine Provider at Monument, focusing on alcohol use disorder treatments. Dr. Yoon has also been a Physician for Veteran Evaluations, conducting disability exams for veterans.
Dedicated to community health and global medical outreach, Dr. Yoon has volunteered extensively in Africa and on medical mission trips to Peru. His involvement in educational projects like the ATTAIN Pilot Project at Kaiser Permanente highlights his commitment to innovative health solutions.