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Information for patients who are chemically dependent

Addiction touches the life of every American. Whether you yourself are chemically dependent or whether it is someone you love, chances are that you have been affected. Traditional treatment has not been as effective as hoped and so a new approach is needed. We call this new approach harm reduction. Harm reduction means that the life of the addicted person stabilizes and they become a functioning member of society. Then, with time and continued treatment, they are able to slowly free themselves completely from their dependency upon medication. Medication Assisted Treatment (MAT) has a proven record of reducing harm. MAT is available for Opioid dependency and for a subset of those afflicted with Alcohol dependency. Medication helps to control the cravings and allow the addicted individual to focus on their recovery. When their life is back on track then we can begin the gentle process of freeing them completely from all addictive substances. 

"Cold Turkey" approaches have a greater than 90 % failure rate and an unacceptably high death rate. Relapses can be deadly because the brief period of abstinence causes the individual to lose their tolerance for their drug of choice. MAT has a success rate well over 50% and, in the case of opioid addiction, the medication used for treatment has a very high likelihood of preventing a relapse from having much effect at all. If an addicted individual remains in treatment for three to five years, their chances of becoming completely free of addictive substances is very high. 


There are two primary medications used in the treatment of opioid dependency. The first is naltrexone, an opioid blocker that prevents opioids from reaching the opioid receptors in the brain. The use of this medication does require that the individual go through withdrawal or "detox" before the medication can be started. There are other medications that can be used temporarily to reduce the symptoms of withdrawal and increase the chances of successfully starting the treatment medication. Naltrexone is administered as a shot once every four weeks. Patients receiving Naltrexone will additionally receive counseling which may consist of either group or individual therapy, or both. 

The second medication for opioid dependency, the one used more frequently, is buprenorphine. Buprenorphine is an opioid that has a very long duration of action and that binds strongly to the opioid receptor in the brain but only partially activates the receptor. This means that it blocks the opioid receptor from responding to other opioids, but doesn't itself cause the "high" that the abused opioid causes. It is taken under the tongue once or twice daily and can completely remove cravings for other opioids. Buprenorphine can be abused, especially by those early in their addiction, and so careful monitoring is required. Prescriptions are issued every two to four weeks and counseling, either group or individual or both, is required in order to remain in the program. 


It is much less widely appreciated that there is MAT available for alcohol dependency. Unlike with opioid dependency, the medications used do not block the full effect of alcohol nor do they prevent withdrawal. But, with the right individual, detox is not required and it is not even necessary to stop drinking immediately. The right individual would be someone who cannot stop alcohol on their own but who has not yet suffered the end stage consequences of alcoholism. They would be someone who is functioning well in life but is starting to see that they are on a path that leads only to misery and they want off this path. They want to have control over alcohol instead of the alcohol controlling them. 

There are about 10 different medications that can be used as MAT for alcohol dependency. The choice of medication is dependent upon several different factors but there is also, unfortunately, a "trial and error" approach at times. This is necessary because the individuals response to a medication is as of yet unpredictable. Sometimes more than one medication is used, sometimes as many as three. Counseling is at a frequency of only once weekly. The initial treatment phase can last a year or more, with much less intensive care required once the individual has control over their drinking. Abstinence is the preferred goal, but some are able to reach the point where they can still consume some alcohol as long as they remain consistent with what they learned during treatment. 

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