MEDICATION ASSISTED TREATMENT

MEDICATION ASSISTED TREATMENT

Addiction is defined as:

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.” (Amercian Society Of Addiction Medication, 2020)

The American Society of Addiction Medicine (ASAM) is an organization  “founded in 1954, is a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine.” (Amercian Society Of Addiction Medication, 2020) One of the main goals of ASAM is to educate medical professionals and the public about addiction. Another goal of ASAM is increasing access to and providing better quality of addiction treatment.

ASAM has developed a diagnostic tool that is used to determine the level of care an individual need may need for proper treatment. In my current role as a Licensed Clinical Addiction Specialist Associate (LCAS-A), the ASAM is the best tool that I have at the time of assessment. Currently I have a caseload that consist of two separate Substance Abuse Regular Outpatient (SAROP) groups with 10-12 clients and three times a week I provide Comprehensive Clinical Assessments (CCA).

There are six dimensions that are used to determine the level of care. Each dimension scoring ranges from 0-4.  The first dimension is withdrawal potential. In this dimension the person’s substance abuse history is given. For example,  if the person has an extensive history of Heroin or Opiate use then their withdrawal potential could be scored at a 1 or 2. If a person reports an extensive history of Alcohol use or Benzodiazepines their withdrawal potential would be higher between a 2-4. The scoring increases if the person has had withdrawal induced seizures. The second dimension is for biomedical conditions. Information in this dimension would include primary care physician and any medical conditions and daily medications. The dimension would be scored higher if the person has neglected medical conditions. The third dimension is behavioral or mental health concerns. In this dimension any mental health diagnosis would be included, current mental health symptoms, medications and mental health providers as well as any suicide attempts or history of abuse. Unmedicated mental health or current severe mental health symptoms would increase the scoring. The fourth dimension is related to the person’s resistance level to treatment and identification of triggers or coping skills. Also included would be supports and engagement in AA or NA. The fifth dimension is the most important. In this dimension previous inpatient or outpatient treatment history is discussed, longest length of sobriety, as well as risk factors that would lead to continued use or relapse potential.  Lastly dimension six is related to social environment. It is also a summary of demographics and supports. Information included would be who the person lives with, best support and their social circle. ASAM levels of treatment begin with 0.5 which is the prevention level up to 4.0. ASAM scores of 3.2-4.0 indicate that the person would need to be in residential medically monitored treatment.  All of the previous information was designed to provide a basic understanding of levels of care and establish the difference between inpatient and outpatient facilities.

Medication Assisted Treatment -Methadone

Medication Assisted Treatment (MAT) programs are a very controversial topic in the addiction world. “Medicated-Assisted Treatment (MAT) is the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.” (US Dept of Health and Human Services, 2020) When most people hear MAT programs they automatically think of Methadone Clinics. Methadone was one of the first FDA approved medication for MAT. Methadone clinics have become pretty common. Most cities have at least one. The way methadone clinics work is quite simple. The person or client comes in for an assessment and meets the requirements of an opiate use disorder. At that point the client would meet with medical staff to have a Urine Drug Screen. After the urine drug screen results the client meets with staff who will help determine their daily dose of medication.

One of the most common disagreements that I have with methadone clinics is there does not seem to be a timetable in which they work to help client establish sobriety. It seems because they are a cash-based system, they want the client to keep coming back on a daily basis. Most methadone clinics have levels of treatment. Once a client establishes a period of time with clean urine drug screens, they are given a month of medication at a time and no longer have to be at the clinic daily.

Methadone itself is highly addictive and can be abused. On more than one occasion I have seen clients come in for assessment and they are nodding off and say they have just left the clinic. I think that the methadone clinics should monitor more closely the dosages that are given to clients. There should be no reason for a client to be on 200mg plus daily of methadone. It is my opinion the clinics continue to give individual high doses to keep them there longer.

Suboxone and Enhanced Treatment

I currently work for an outpatient treatment facility, Cognitive Connection. The facility located in Hickory, offers a MAT program as well as enhanced and regular level group sessions.