Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies to treat alcohol and other drug addiction. It is recognized as one of the best practices in substance abuse treatment supported by federal and state agencies. Scientific evidence shows that a combination of medication and behavioral therapies is most successful to achieve sobriety. At Avance Psychiatry, medication management is supervised by a licensed physician and is a part of our multidisciplinary approach. It is designed to control distressing symptoms and to improve the quality of life.
Medications are generally used with the following goals:
- to achieve abstinence or reduction in the use of alcohol and other drugs
- to reduce relapse into alcohol or other drug use
- for acute and maintenance treatment of co-occurring psychiatric disorders
- for symptom-specific improvement (e.g. treatment of insomnia)
Medications are prescribed after a comprehensive evaluation and properly monitored. For individuals who come to Avance Psychiatry with pre-existing medication regimens, we communicate with the prescribing physician to determine the most appropriate medication regime for patients. We offer a variety of medication assisted treatments with proven effectiveness to help individuals with alcohol or drug problems.
Avance Psychiatry offers outpatient buprenorphine-naloxone maintenance for opioid addiction. The three phases of maintenance are (1) induction, (2) stabilization, and (3) maintenance. All phases are combined with counseling and behavioral treatments and urine toxicology monitoring. Different formulations of buprenorphine-naloxone or buprenorphine (Suboxone®, Subutex®, Bunavail®, Zubsolv®) are used for maintenance.
Induction is the first phase of treatment and involves the patient switching from illicit opioids to buprenorphine. The goal of induction is to find the minimum dose of buprenorphine at which the patient stops use of other opioids and experiences no withdrawal symptoms or cravings. Induction is initiated after a comprehensive medical evaluation that determines whether the patients is a suitable candidate for buprenorphine treatment. The usual duration to complete induction is approximately 1 week and requires multiple office visits. Induction can be performed in the office (more common) or at home (less common). Office based induction involves the patient being given 2-4 mg of buprenorphine at a time and monitored for 2-4 hours in the medical office to evaluate adequacy of dose. Home based induction involves patients provided buprenorphine to take home with clear dosing and monitoring instructions. Induction buprenorphine dose is usually 4-12 mg/day.
Stabilization phase begins after induction is complete and patient is free of withdrawal symptoms and tolerating the buprenorphine well. The goal of stabilization phase is to adjust the dose of buprenorphine to produce desired benefits of opioid receptor blockade and laboratory indices (negative urine toxicology) while minimizing side effects. Engagement in counseling and compliance with treatment are other goals. The duration of stabilization is 4-8 weeks and may involve weekly to biweekly contact with the provider. Stabilization doses of buprenorphine range between 8-24 mg/day.
Maintenance phase of treatment is started after patient is sufficiently stable on buprenorphine and no longer experiences uncontrollable cravings or withdrawal symptoms, has negative urine toxicology and has minimal side effects to buprenorphine. The goal of maintenance is abstinence from illicit drug use, improvement in work and family life and relapse prevention. Counseling is an important aspect of maintenance and patient must demonstrate responsible handling of prescribed buprenorphine. There is no recommended duration of maintenance. It can be relatively short-term (e.g. <12 months) or medium term (1-3 years) or long term (> 3 years) process. Following successful maintenance, decisions to decrease or discontinue buprenorphine are based on a patient’s desires and commitment to becoming medication-free, and on the physician’s confidence that tapering would be successful.