Medication Assisted Treatment: An Introduction Deborah A. Orr,
Ph.D., RN Remington College School of Nursing
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Why is it difficult to stop taking some drugs?
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What causes the cigarette (non) smoker to relapse?
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How does the unsuccessful treatment client feel after relapse?
How does relapse impact the likelihood of attempting to stop drugs
again?
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Goal of Medication Assisted Treatment (MAT) 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. Research shows that when treating
substance-use disorders, a combination of medication and behavioral
therapies is most successful. Medication assisted treatment (MAT)
is clinically driven with a focus on individualized patient care.
http://www.dpt.samhsa.gov/
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Collaborative Treatment Approach client/family Medical care
counseling Community self-help groups
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Addiction is a Brain Disease Receptor changes Neurotransmitter
changes
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Addiction and the Brain 1.Drug attaches to receptors in brain
-> PLEASURE 2.Repeated drug use -> TOLERANCE 3.Absence of
drug after prolonged use: -> WITHDRAWAL What drugs? Cigarettes,
alcohol, benzodiazepines, opioids
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Other drugs target neurotransmitters Examples: cocaine, crack
cocaine, amphetamines, methamphetamine
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Stimulants alter brain function by blocking reuptake of
dopamine, so effects of dopamine are intensified.
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Cant you just taper the drugs on your own?
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Withdrawal What is the relationship between discomfort from
physical withdrawal symptoms and the ability to successfully
tolerate detoxification? The ability to retain, process, and apply
information? To benefit from counseling?
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Substance: Nicotine Withdrawal symptoms: Irritability
Restlessness Sleep disturbance Decreased concentration Increased
appetite Nicotine cravings Depression Anxiety Treatment Nicotine
replacement medication (patch, gum, etc.) BUPROPION (Zyban):
reduces cravings and may help with depression
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Alcohol Chronic, heavy alcohol consumptions depresses the
neurotransmitters GABA and glutamate Withdrawal creates a rebound
of these neurotransmitters brain hyperexcitability Withdrawal
symptoms: anxiety, irritability, agitation, tremors, seizures, and
DTs Alcohol withdrawal can be fatal.
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Alcohol Treatment Detoxification: medically supervised Main
problems: seizures, hypertension, DTs Replacement therapy with a
chemically similar medication (phenobarbital, valium, librium or
ativan) + treatment of withdrawal symptoms Maintenance: antabuse,
vivitrol (naltrexone)
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Benzodiazepines valium, librium, ativan, xanax Withdrawal can
be fatal Withdrawal symptoms depend on amount, frequency, duration,
and half-life of the specific drug
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Benzodiazepine Withdrawal Symptoms Severe sleep disturbance
Irritability Anxiety Hand tremor Sweating Difficulty in
concentration, confusion and cognitive difficulty, memory problems
Dry retching and nausea, weight loss Palpitations, headache
Hallucinations, seizures, psychosis, and possible suicide
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Benzodiazepine Detoxification Medications Medically managed
detoxification Usually a benzodiazepine taper + treatment of
withdrawal symptoms Anti-seizure medications sometimes used when
there is a history of seizures
Medically-Assisted Withdrawal from Opioids Relieves withdrawal
symptoms while patients adjust to a drug-free state Can occur in an
inpatient or outpatient setting Typically occurs under the care of
a physician or medical provider Serves as a precursor to behavioral
treatment, because it is designed to treat acute withdrawal
symptoms SOURCE: Principles of Drug Addiction Treatment: A
Research-Based Guide, NIDA, 2000.
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Replacement Medication: Methadone Must be dispensed from a
licensed opioid treatment center (methadone program). Pros + Cons
Only approved treatment for pregnant opioid dependent women
(prevent fetal withdrawal)
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Suboxone (buprenorphine/naloxone) Must be prescribed by MD May
be inpatient or office based May be for detoxification or
maintenance Administer the drug sublingually for a sustained period
at a dosage sufficient to prevent opioid withdrawal, block the
effect of illicit opiate use, and decrease opioid craving
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Better social functioning Less risk for illegal behaviors Less
HIV risk behavior Better able to participate in substance abuse
treatment (the brain works better!) Benefits of Opioid Replacement
Medications for Opioid Addiction SOURCE: Principles of Drug
Addiction Treatment: A Research-Based Guide, NIDA, 2000.
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Treatment Regimen Concomitant behavioral counseling (relapse
prevention, managing triggers, increased coping skills, etc.) Detox
versus prolonged detox versus maintenance Vivitrol (naltrexone)
once opioid-free to minimize cravings
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Contraindications to Opioid replacement therapy Benzodiazepine
use, in particular Alcohol dependence Serious untreated
de-stabilizing psychiatric disorders Inability to safely store or
take medication Repeated non-adherence to prescribed dosing
regimen
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Stimulants cocaine, crack cocaine, amphetamines,
methamphetamine Chronic use depletes the reward neurotransmitter,
dopamine
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Stimulant Withdrawal Symptoms Fatigue, but insomnia
Restlessness, irritability Loss of motivation Depression Difficulty
concentrating Sinus problems, headache Cravings
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Stimulants and Other Drugs Withdrawal danger: often used with
alcohol or benzodiazepines (which need medically supervised
withdrawal) No replacement medication available for stimulant
detoxification treatment of withdrawal symptoms Monitor for
depression and treat as needed
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Medical Stabilization Begins Treatment MAT makes the person
less physically uncomfortable Cognitive impairment caused by
withdrawal is minimized, so counseling can start sooner and be more
effective Counselors, client, and medical provider plan treatment
course Counselors support medication adherence behavior by actively
exploring barriers.
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Counseling Initial counseling addresses highest risk situations
for safety, and relapse Ongoing counseling addresses triggers, as
well as the residue of addiction in the clients current life.
Counseling addresses psychological issues. Counselors alert medical
providers to problems discovered in counseling. TEAM.
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Resources http://store.samhsa.gov/list/series?name=TIP-
Series-Treatment-Improvement-Protocols-TIPS TIP 45: Detoxification
and Substance Abuse Treatment TIP 43: Medication-Assisted Treatment
for Opioid Addiction in Opioid Treatment Programs TIP 42: Substance
Abuse Treatment for Persons With Co-Occurring Disorders