Within the addiction treatment community, factions have coalesced around two seemingly different pathways to recovery: abstinence-based treatment and medication-assisted treatment. These dueling perspectives have even been found in the current administration, with former Health and Human Services Secretary Tom Price seeming to spurn MAT when he said, “If we’re just substituting one opioid for another, we’re not moving the dial much.” On the other hand, Price’s successor, Alex Azar, has actively promoted MAT, even pushing MAT with religiously affiliated recovery providers, which usually embrace an abstinence-only approach.
To understand what’s at the heart of this controversy and whether taking an either/or stance accurately characterizes actual treatment practices, we must first understand what is involved in the two treatment approaches to substance abuse disorder.
Historically, addiction treatment in the U.S. has largely focused on an abstinence-based model. This approach can be traced to the original 12-step programming, which asserts that abstinence — the complete absence of all mind-altering substances — is essential to recovery. “Successful abstinence-based approaches typically integrate community connections — 12-step meetings, alumni programs, and a recovery network — as an important factor in long-term, sustainable recovery,” says Dan Labuda, a counselor and program director at Northpoint Washington in Edmonds.
According to the Substance Abuse and Mental Health Services Administration, MAT is defined as “the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.” MAT treatment is also sometimes referred to as “harm reduction,” as medications are used to limit the harm and/or negative consequences of the addiction. The FDA-approved medications used in MAT help a patient overcome withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. People may take medications — usually treating opioid addiction with methadone, Suboxone (buprenorphine + naloxone), or Vivitrol (naltrexone) — as part of MAT for months, years, several years, or even a lifetime.
Because two of the three federally approved MAT medicines are opioids themselves, some believe taking drugs to quit drugs is not real recovery and may simply be substituting one addiction for another. Others believe that MAT medications administered for the disease of addiction is no different from insulin being administered for disease of Diabetes. Suboxone has proved effective in relieving the symptoms of opiate withdrawal, particularly for those addicted to heroin, as the buprenorphine gives the addict a dose of the effect they miss (mimicking the effect of the opioid). If Suboxone is used in treatment, any decision to taper off the medication should be carefully managed by a team of medical and clinical professionals. Vivitrol is considered equally effective for treatment but is nonaddictive.
For many working in the addiction treatment arena, the debate has underscored the idea that perhaps one size does not fit all — individuals’ addictions all come with unique circumstances that warrant personalized care.
“We use an approach that independent, evidenced-based research confirms works — it is rooted in abstinence and it also allows for selective, strategic use of MAT medication when it can save the life of someone grappling with addiction or put them on the path to recovery,” says Logan Stroud, Vice President of Northpoint Washington. “We have to acknowledge that recovery can look different from person to person and that a multimodal approach increases the chances of long-term success.” Northpoint Recovery’s comprehensive approach to treatment includes group therapy, psychosocial supports, a focus on any co-occurring mental health conditions, community integration activities, the use of medications and more.
Stroud also notes that the conversations within the recovery community shouldn’t be based simply on ideology or a gut feel. Rather, he argues, recovery centers should apply the treatment practices that have proved effective in achieving long-term sobriety. “Data is what drives the continued efficacy of our practice. We track and measure results, so that we can assure our patients and the community that what we’re doing is grounded in actual success,” says Stroud.
Northpoint Recovery provides a safe, therapeutic environment, where those struggling with addiction can build a foundation for recovery. Our affordable, holistic, evidence-based, effective treatment is offered at The Evergreen at Northpoint in Bellevue and in Northgate, and Northpoint Washington in Edmonds.