by Timothy P. Lepak

New medications are changing the addiction treatment modality, because practitioners can now treat addiction disorders in the privacy of their offices. At first glance, treating an addiction to substances with a medication may seem counterintuitive to some. The stigma associated with addiction can prevent us from viewing it as we would other brain disorders. Addiction is a neurobiologic brain disorder that manifests as an uncontrollable compulsive behavior that ruins lives and harms patients and their loved ones. It is not the act of taking a drug that is the problem. Millions of people take medications for many conditions and live better and longer lives as a result. Instead it is the consequences that result from the compulsive behavior of addiction that is dangerous, and that is the focus of treatment.

Understanding that the disorder is “addiction”, not “drugs” allows clinicians to recognize medication-assisted treatment (MAT) as a viable and effective tool in treating the damaging uncontrollable compulsive behaviors, which are the hallmarks of addiction. MAT is not replacing one addiction with another. With successful treatment, the addictive behavior is stopped – not replaced. Ideally, as with any other chronic condition, no medication would be optimal, but this is not realistic for some patients.

Addiction medications are not a panacea or substitute for other treatments, but a tool to be used in conjunction with other evidence-based therapies. Medications simply reduce the distractions of cravings and withdrawal allowing therapy to be more effective.

Buprenorphine

FDA approved in late 2002 Buprenorphine (Suboxone®, Subutex®) is an opioid medication indicated for the treatment of opioid dependence (addiction). It is available by prescription, filled at a pharmacy and taken in the privacy of the patient’s home. The pharmacology of buprenorphine is unique because unlike other opioids it doesn’t provide strong euphoria, it has a ceiling to its effects, and it has the ability to block other opioids. Since approved over 550,000 patients have been treated for opioid addiction with buprenorphine.

DATA-2000 is the law that legalized office-based physicians to prescribe certain medications for opioid dependence (addiction). Lack of counseling referrals has been a limiting factor in how many patients receive proper care. Some physicians have been resistant to refer their patients to a random therapist, fearing s/he may not be of an evidence-based philosophy.

A therapist who doesn’t understand MAT may unwittingly compel a patient to discontinue his/her medication, thus putting the patient at risk of relapse.

MAT counseling differences

With the introduction of medications that virtually stop withdrawal and cravings, counselors and therapists have noticed the need to reverse their treatment approach. In traditional addiction counseling, fighting cravings, avoiding triggers, and dealing with withdrawal take up a major portion of the therapy. Without the distraction of cravings and withdrawal, patients can focus on issues such as rebuilding relationships and self-esteem, reducing stress and anxiety, restoring careers and finances, and exploring the underlying reasons why the addiction occurred. These are topics that are usually postponed due to the immediate treatment requirement to prevent relapse.

Online patient peer support

Sometimes mistaken for therapy, peer support is a separate but essential part of a comprehensive treatment plan. The internet provides a new paradigm in patient peer support. Never before could patients receive the benefits of interacting with a group of peers while maintaining total anonymity. This “anonymous group” allows patients to overcome embarrassment and the initial period of becoming comfortable. Instead, they get right to the issues on their minds. The internet connects many more people than any live support group could, giving patients a higher likelihood of finding others they can relate to with common interests or experiences. Many physicians have identified this as an essential component and now recommend it as part of their treatment protocol. Online community (www.AddictionSurvivors.org).

The National Alliance of Advocates for Buprenorphine Treatment (www.NAABT.org ) is a non-profit organization with the mission to, educate, reduce stigma and connect patients with providers. We provide a number of online tools such as a one-page treatment locator that displays a list of the closest physicians, counselors, pharmacies, treatment centers, clinical studies, state health department resources, local peer support meetings and other support resources. By using geographic web technology only relevant local information is presented to visitors. One-stop Buprenorphine provider’s page (www.naabt.org/local).

When a patient reaches out for help is when they need to be connected to help. Any delay reduces the chance of that patient receiving treatment. An online list of providers is only useful during business hours, when help can be reached, but that only represents 25% of the total time in a week. The decision to get treatment can happen at any time day or night. NAABT’s online Patient-Physician Matching System allows patients to reach out for help 24/7 as soon as they first decide to seek treatment. Patients anonymously submit a 16-question form that is immediately emailed to all participating certified physicians in their area. Some patients receive a response within minutes at any time of the day or night and on weekends and holidays. This is a very easy, fast, and non-intimidating way for patients to reach out for help when they are ready, and has the potential to get patients into treatment sooner. The system also acts to match patients’ insurance coverage with practitioners who accept it. Counselors or advocates can register on behalf of patients who don’t have internet access. Patient Physician Matching System (www.NAABTList.org).

What’s coming?

The need for counselors trained in MAT is about to explode. NAABT is partnering with the National Association for Medication-Assisted Recovery (NAMAR) and other organizations to facilitate training. Later in 2008 there will be a 45-hour training and certification offered that focuses on the recent developments in the science of addiction medicine and its impact on the field. Physicians will soon be able to confidently make referrals from a database of these trained and/or certified counselors allowing them to treat more patients, thus expanding treatment. Counselors/therapists already familiar with MAT can register now for the online evidence-based counselor locator at: Counselors locator registration page (www.CounselorList.org)

Stigma remains the biggest barrier to treatment for patients. Old views of addiction as a moral deficiency or willpower problem still persist despite overwhelming scientific evidence to the contrary. We can all contribute to dismantling the damaging stigma with the words we use. By using medical terms when appropriate or otherwise respectful language while avoiding street terms, we can change how addictive disorders are perceived. Changing the stigma associated with opioid addiction treatment will benefit everyone. It will allow patients to more easily regain their self esteem, allow lawmakers to appropriate funding, allow doctors to treat without disapproval of their peers, and help the public understand that addiction is a medical condition as real as any other. The Words We Use Matter (www.NAABT.org/Language).

Free resource kits available at: www.naabt.org/resource_kit

Bulk printed materials are available upon request from MakeContact@naabt.org

Timothy Lepak is President and co-founder of NAABT, Inc. (National Alliance of Advocates for Buprenorphine Treatment) (www.naabt.org)