Addiction treatment experts from the National Institutes of Health (NIH) discuss the history and development of buprenorphine, and its relevance to us, today, as follows:

“The discovery of buprenorphine in 1966 revolutionized care for opioid use disorder. US government and private industry partnership led to buprenorphine-based medications. Confronting barriers to use these medications is critical to address the opioid crisis.”

Buprenorphine is a core component in an approach to opioid addiction treatment called harm reduction. It’s a primary medication used in medication-assisted treatment (MAT), which is considered the gold-standard treatment for opioid addiction, also known as opioid use disorder (OUD).

When the FDA approved buprenorphine, it joined another medication – methadone – approved for treating opioid use disorder. However, because of a higher risk of diversion for illicit use, federal restrictions around methadone made access difficult. In some cases, these rules prevented people who needed treatment from getting the treatment they needed. Upon approval, the federal government placed fewer restrictions around buprenorphine than around methadone for two reasons:

1. It’s a partial opioid agonist, as opposed to a full opioid agonist – like methadone – which means it creates almost no euphoric effect, thereby decreasing risk of diversion.
2. Pharmaceutical companies designed buprenorphine in specific formulations that precipitate withdrawal when altered from their original form and injected intravenously, i.e. diverted from as directed uses to illicit

Here’s how FDA commissioner, Dr. Robert Califf, describes the approval of this new buprenorphine treatment option, called Brixadi:

“Buprenorphine is an important treatment option for opioid use disorder. Today’s approval expands dosing options and provides people with opioid use disorder a greater opportunity to sustain long-term recovery.”

We’ll now discuss what’s new about Brixadi, and why it makes a difference for people seeking evidence -based treatment for opioid use disorder (OUD).

Reducing Barriers to Care: Harm Reduction and New Buprenorphine Treatment Option

Evidence shows medication-assisted treatment (MAT) with methadone, buprenorphine, and/or naltrexone can significantly improve treatment outcomes for people with opioid use disorder (OUD). People on MAT experience:

• Decreased opioid use
• Decreased overdose fatality
• Increased time-in-treatment
• Improved social and family function
• Improved work and school function
• Reduced relapse rates
• Reduced criminal behavior

That’s why it’s called the gold standard treatment for OUD. It works better than anything else we know about. However, as we mention above, there’s risk of diversion for illicit purposes. That’s why both methadone and buprenorphine treatment are highly regulated, with rules around buprenorphine less restrictive than around methadone.

Before COVID, many of the rules around MAT involved who could prescribe and dispense medication, how treatment initiation could occur, how patients could access medication, and how often patients had to show up in person to either receive medication, engage in counseling and therapy, and submit samples for drug testing.

Because of the various public health measures adopted in 2020 to stop the spread of COVID, the federal government temporarily changed the rules so that at-risk patients with OUD could either initiate or continue MAT without increasing risk of contracting COVID. These new rules also protected health care workers from unnecessary exposure to COVID.

To learn about the changes instituted during 2020, please navigate to the blog section of our website and read this article:

The Mainstreaming Addiction Treatment (MAT) Act: Will We Keep COVID-Era Changes?

The new medication, Brixadi, addresses one of the most difficult problems to overcome, with regards to MAT: the balance between realistic expectations for what we require of people on MAT and the risk of diversion. Before COVID, rules restricted refills and the amount of medication a person could receive at a time. Here’s how Brixadi makes some of those rules obsolete.

Brixadi: New Buprenorphine Treatment for Opioid Addiction

• It’s an extended-release medication, which reduces barriers to care by mitigating access problems such as:
  • Transportation to office visits
  • Getting time off work for office visits
  • Arranging childcare during office visits
• Various weekly doses can accommodate the severity of the OUD, and help patients who don’t tolerate the higher doses of extended-release buprenorphine currently available. Weekly doses or Brixadi include:
  • 8 mg, 16 mg, 24 mg, and 32 mg
• Various monthly doses also accommodate the severity of OUD and help patients who don’t tolerate high doses of extended-release buprenorphine currently available. Monthly doses of Brixadi include:
  • 64 mg, 96 mg, and 128 mg.

The weekly doses are designed to promote treatment adherence for people new to MAT who need a period of stability on the medication. The monthly doses are designed for people who are already stable on MAT, participating in treatment, and at lower risk of relapse, diversion, or other adverse events associated with MAT.

MAT, Counseling, Therapy, and Patient-Centered Treatment

Reducing barriers to care is a priority in the FDA Overdose Prevention Framework. One issue treatment professionals and regulatory officials have gone back and forth about is the role of counseling and therapy for patients on MAT.

To be clear, MAT is about more than medication. It’s about a whole-person approach to recovery that includes medication, therapy, counseling, and peer support. Counseling and therapy are required for participation in MAT. However, for some patients, two things make participating in counseling and therapy difficult for people on MAT:

1. The in-person requirement for therapy sessions can prevent people without transportation from attending all sessions.
2. Early in recovery, some patients are simply trying to get through the day, and are not in a physical, psychological, or emotional condition where participating in counseling or therapy would be beneficial or possible.

Previously, the inability to participate in therapy or counseling sessions was perceived as a requirement for initiating MAT. In a letter accompanying the approval or Brixadi, federal officials addressed this interpretation of the current regulations:

“This letter serves to clarify the importance of counseling and other services as part of a comprehensive treatment plan, but to also reiterate that the provision of medication should not be made contingent upon participation in such services.”

With regards to counseling and therapy, federal regulators indicate that assessing each individual to identify their current and accurate stage of change is what should determine participation in counseling and therapy, rather than a blanket, one-size-fits-all rule applied upon initiation of treatment.

Some patients are ready to engage in therapy and counseling immediately. Others are better served engaging in therapy and counseling after they make progress in treatment and achieve stability on their medication. These decisions should be the result of a shared decision-making process that includes the patient and the provider.

Treatment With MAT Saves Lives

It’s clear – as indicated in the letter above – that opioid use disorder is often accompanied by serious and complex psychological and social issues that medication cannot resolve on its own. That’s why it’s essential to offer these supports when appropriate, which means when they have the best chance of increasing overall treatment success.

At the same time, MAT – without concurrent therapy or counseling – reduces risk of relapse and reduces rates of fatal overdose.

In other words, it saves lives.

That’s why federal regulators clarified their stance. Evidence shows a combination of medication and therapy leads to the best possible overall outcomes. Evidence also shows that patients can benefit from buprenorphine treatment when counseling/therapy is not available right away. Therefore, in the words of the current Assistant Secretary for Mental Health and Substance Use at the Substance Abuse and Mental Health Services Administration (SAMHSA):

“OUD…treatment…can begin with stabilization on medication.”

That’s the guidance from the very top of our federal regulatory system. We think it’s entirely logical, and aligns with our vision of both harm reduction and integrated, person-first treatment.

The post Is There a New Type of Buprenorphine Treatment for Opioid Addiction? appeared first on Pinnacle Treatment Centers.

The crisis continues, and last year we got encouraging news. 2023 was the first year we saw a decrease in overdose fatalities since 2018.

That’s a good step in the right direction, but we need to understand it in context.

The context: rates of opioid use disorder (OUD) and fatal overdose have increased dramatically over the past three decades. The COVID-19 pandemic exacerbated the overdose crisis, which has claimed over two hundred fifty thousand lives since 2019, with three quarters of those overdose fatalities attributed to opioids.

Every overdose death is tragic, and the pain experienced by friends and loved ones is foregrounded by the fact that right now, lifesaving, evidence-based treatment for opioid use disorder exists, and is available in every state in the country.

There are two primary evidence-based interventions that can reduce opioid-involved overdose deaths among patients with OUD:

• Initiation of medication-assisted treatment (MAT) with medication for opioid use disorder (MOUD) approved by the Food and Drug Administration (FDA)
• Retention in MAT program with FDA-approved medication for opioid use disorder (MOUD)

For people with OUD, data shows that current participation in MAT programs that use methadone, buprenorphine, and/or naltrexone reduces overall risk of mortality by close to 75 percent, compared to people with OUD who do not currently participate in MAT programs.

That’s why MAT, using FDA-approved medications for opioid use disorder (MOUD), is considered the gold-standard treatment for opioid use disorder. That’s also why researchers want to learn as much as possible about the factors that promote MOUD initiation and MOUD retention. Previous research shows that at least three factors predict successful treatment, reduction of mortality, and reduction of relapse.

Relapse Prevention, Medication-Assisted Treatment, and Outpatient Treatment

1. Initiating treatment within 14 days of diagnosis reduces overdose and relapse risk
2. Participating in at least two outpatient visits within 30 days of initiating treatment reduces overdose and relapse risk
3. Continuous participation in MAT program using MOUD for a minimum of six months reduces overdose and relapse risk

Treatment professionals who work with people with SUD derive those first two factors from a group of health metrics called the Health Effectiveness and Data Information Set (HEDIS), a resource the Centers for Medicare and Medicaid Services (CMS) use to gauge treatment outcomes, monitor treatment progress, and make decisions about reimbursement for various healthcare treatment services. The third factor comes from an extensive evidence base on the use of MAT for treating OUD, as described by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Those three metrics are important not only because they indicate the effectiveness of MAT for OUD  but also because payors – like CMS and private insurers – use them to make decisions about what types of treatment they’ll cover, and for how long. They’re important, but they haven’t been subject to the same type of scrutiny as the metrics used to gauge treatment success – and determine reimbursement – for non-SUD medical conditions.

Earlier this year, a group of researchers decide to fill that gap in our knowledge, and engage in a thorough review of the first two metrics on the list above.

Medication-Assisted Treatment for Opioid Use Disorder: Verifying Our Metrics

In a publication released in October 2022 called “Performance Measurement for Opioid Use Disorder Medication Treatment and Care Retention,” a group of researchers analyzed the three treatment predictors/metrics to ensure they’re accurate and contribute – in a positive way – to our nationwide efforts to mitigate the harm cause by the overdose crisis.

Here’s what they wanted to verify:

• Whether initiating treatment within two weeks of diagnosis predicted treatment outcomes
• Whether participating in at least two outpatient visits within a month of treatment initiation predicted treatment outcomes
• Among people with OUD who met the first two metrics, whether those metrics would predict participation in MAT programs for at least six months
• Among people with OUD who met the first two metrics, whether those metrics would predict participation in MAT programs for longer durations, such as 12 months or 24 months

Let’s quickly review why this research is important. First – pulling no punches, here – close to 200 people in the U.S. die of opioid overdose every day: that’s something we, as a society, need to fix. Second, evidence-based treatment with MAT can prevent relapse and overdose: that’s something we know, but can use more data to support the increased use of MAT nationwide. Third, CMS uses these metrics to make decisions or reimbursement for past care and approval of ongoing care: without access to care, individuals with OUD may not get the treatment they need.

Therefore, in order to keep people with OUD in the treatment programs that can save their lives, we need to know whether our methods for measuring and predicting treatment outcomes are valid, or need further research.

Let’s take a look at what the researchers found.

Medication-Assisted Treatment for Opioid Use Disorder: The Role of Outpatient Engagement

The first thing the researchers wanted to know was the rate of successful treatment initiation among all individuals in the study. Out of the 19,4867 patient records they analyzed, the data indicated the following:

• 16,063 – that’s 82.4% – successfully engaged in care
• 3,424 – that’s 17.6% – did not successfully engage in care

We’ll note that 82.4 percent is a good rate of engagement – and more than we expected. That’s a positive result. It indicates a majority of patients with OUD demonstrate a willingness to participate in MAT. We’ll also note that while that result is encouraging, what we really want to know is whether this level of engagement persisted for at least six months.

One more thing.

In this context, successful engagement means participants started MAT within 14 days of diagnosis and participated in at least two outpatient visits within 30 days of diagnosis.

Next, we’ll look at the key metric that we’re most curious about:

Eight out of ten individuals in the study successfully initiated treatment, but how long did they stay in treatment?

Let’s see.

Among those successfully engaging in care:

• 47% remained in care for a minimum of 6 months
  • 3% did not meet measurement criteria for successful initial engagement, but remained in care for 6 months
• 33% remained in care for a minimum of 12 months
  • 1.5% did not meet measurement criteria for successful initial engagement, but remained in care for 12 months
• 20% remained in care for a minimum of 24 months
  • 0.01% did not meet measurement criteria for successful initial engagement, but remained in care for 24 months

These results, while not inspiring, are also encouraging. They’re not inspiring because a retention rate of 47 percent is not what we want. We prefer that number to be 100 percent. However, we know that’s not realistic. We also know that when we consider relapse rates for OUD, which hover between 30 percent and 70 percent, 47 percent retention is not ideal. However, it is acceptable – and a sign of progress in our efforts to reduce the harm caused by OUD.

Did Early Engagement Predict Treatment Retention After Six Months?

The original goal of the research we discuss in this article was to confirm and validate metrics used by Medicare and Medicaid – via CMS – to determine approval and reimbursement for individuals in medication-assisted treatment programs (MAT) for opioid use disorder (OUD) using MOUD.

Based on that goal, the research effort was successful: successful treatment engagement predicted a 47 percent retention rate six months after initiation of care.

That’s what the data we share above mean. There’s something else in the numbers we should mention, though. Three percent of individuals who did not initiate MAT within two weeks of diagnosis and did not participate in at least two outpatient visits within 30 days of diagnosis, did, in fact, remain in care for at least six months. What that means is that for some people – 3 percent, at least – early engagement and participation in outpatient treatment did not predict treatment success. This subgroup stayed in treatment for six months. That means they substantially reduced their risk of relapse and overdose while in a medication-assisted treatment program, compared to people with OUD who don’t stay in treatment for at least six months.

That percentage does appear small. It’s not small, though, when you consider the big-picture numbers. In 2021, over 73,453 people died of opioid-related overdose. Three percent of 73,453 is 2,203. That means over 2,000 people – friends, siblings, parents, children – decreased their likelihood of relapse and fatal overdose. Here’s how study co-author Dr. Robin Williams describes this finding:

“This is critically meaningful and could guide intervention development to prioritize stabilization of high-risk patients early in treatment. Without early engagement, the great majority of patients will be lost to relapse and possible death.”

We agree.

We should not give up on those who don’t immediately engage, but rather, make plans to follow up with them. The results show that even if they don’t seek treatment right away, they may engage in their own way – and find their own path towards treatment success.

Outpatient Visits and Treatment Retention

There’s one more finding to report on the relationship between relapse, medication-assisted treatment, and outpatient therapy. People who did engage in treatment right away – meaning within two weeks of diagnosis of OUD, with at least two outpatient visits within one month – were twenty times more likely to stay in treatment for at least six months.

Study co-author Dr. Stephen Crystal makes this observation:

“Engagement in outpatient visits or professional services appears to be a necessary condition for adequate care retention. Monitoring this engagement may help identify and address barriers and disparities in outcomes.”

This finding is the meat and potatoes of this research. It confirms that early engagement increases likelihood of treatment retention, which does two things. First, it confirms the metrics we introduce in the beginning of this article as valid. Second, it teaches us that we need to redouble our efforts to get people diagnosed with OUD into treatment as soon as possible. Early engagement means longer retention. Longer retention means reduced risk relapse. Reduced risk of relapse means reduced risk of mortality for patients in medication-assisted treatment programs.

In short, what this study tells us is something we tell almost anyone who reaches out to us for support. Tthe sooner a person with OUD initiates evidence-based treatment for OUD, the more likely they are to experience treatment success. Or, in other words, early engagement in MAT treatment and outpatient support can save lives.

That’s something anyone with OUD, or anyone with a friend, family member, or loved one with OUD should know. If you read this article – and know someone who needs help – we encourage you to share this information with them as soon as possible.

The post Does Outpatient Treatment Reduce Risk of Relapse for People on Medication-Assisted Treatment? appeared first on Pinnacle Treatment Centers.

This article examines new research on the effectiveness of a substance use disorder-specific acupuncture protocol for people with OUD currently participating in a medication-assisted treatment program. The study we discuss, published in China in August 2021, explored a simple research question:

Can adjunctive acupuncture therapy reduce the amount of medication needed for people participating in an MAT program?

Before we share the results of that study, we’ll offer a brief overview of the use of acupuncture in addiction treatment and mainstream medical practice the U.S.

Note: in the context of this article, and in treatment for OUD in general, the words adjunctive and complementary mean in addition to. In other words, acupuncture and other adjunctive or complementary therapies never replace primary, evidence-based modalities, but rather support them and improve outcomes as part of an integrated, holistic approach to treatment.

Now, back to our topic.

Does Acupuncture Really Work?

For most people in the West – meaning Western Europe and the U.S. – that’s the million-dollar question. We know a little about acupuncture, know it’s been used in China for thousands of years, and know it became relatively common here in the second half of the 20^th century.

We know people swear by its effectiveness – but is there a solid clinical evidence base for the use of acupuncture?

Let’s take a look.

Acupuncture in the West: An Overview

• 1970s:
  • Treatment providers at Lincoln Detox Center in New York City developed a protocol to mitigate the symptoms of withdrawal for heroin users
• 1985:
  • The Lincoln Protocol became the National Acupuncture Detoxification Association (NADA) Protocol, was approved for use in addiction treatment, and is now in use in hospitals across the U.K. and U.S.
• 1996:
  • The Food and Drug Administration (FDA) removes barriers to the use of acupuncture for medical treatment
• 1997:
  • The National Institutes of Health (NIH) approve acupuncture as an acceptable complementary therapeutic technique for use alongside Western medicine
• 1997-2005:
  • Evidence indicates acupuncture as an effective complementary treatment for:
    • Chronic pain
    • Fibromyalgia
    • Headaches
    • Parkinson’s disease
    • Schizophrenia
    • Depression
  • 2005-Present
    • A growing body of evidence indicates acupuncture is an effective complementary treatment for mitigating withdrawal symptoms and reducing rates of relapse for people in treatment for:
      • Opioid use
      • Cocaine use
      • Alcohol use
      • Nicotine use

That’s the current state of acupuncture as an official medical treatment in the U.S.

While it’s neither accepted nor recommended as a primary therapeutic technique for medical conditions or mental health disorders, its effectiveness as a complementary, supportive approach – especially during detoxification from substance of misuse – is gaining acceptance by the substance use disorder treatment community.

Now let’s look at the research from China we mention in the introduction to this article, and learn whether acupuncture may also be a practical, effective, complementary treatment for people with OUD on MAT.

Does Acupuncture Help People With Opioid Addiction in Medication-Assisted Treatment?

The study, called “Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data,” examined the effect of adjunctive – a.k.a. complementary – acupuncture on medication dosage for 135 patients in a methadone-based MAT program in the Substance Dependence Department of Guangzhou Huaiai Hospital in Guangzhou, China.

To justify the research, study authors cite several data sources:

• A random control trial in China that showed acupuncture decreased methadone dosage in patient on MAT for OUD
• Another random control trial in China that showed acupuncture reduced opioid cravings for people on MAT for OUD
• A retrospective analysis on U.S. Air Force personnel showed reductions in opioid prescriptions for servicemembers who received acupuncture treatment
• A meta-analysis that identified four trials in which adjunctive acupuncture treatment improved treatment retention and decreased methadone maintenance dosage for people on MAT for OUD

In this study, researchers divided participants into two groups. One group engaged in methadone-based MAT as usual, and the other received acupuncture in addition to MAT. Next, researchers collected data on methadone dosage, drug cravings, sleep quality, and quality of life at baseline, four weeks, and six weeks after the initiation of the experimental protocol.

Here’s what they found.

The Effect of Acupuncture on Methadone Dosage and Quality of Life for People With Opioid Use Disorder in Medication-Assisted Treatment

Compared to the control group, patients on MAT for OUD showed:

• Decreased daily methadone dosage:
  • By week six, daily dosage for the acupuncture group decreased by 17.68 mg
  • By week six, daily dosage for the non-acupuncture group decreased by 1.07 mg
• Decreased drug cravings:
  • By week six, drug cravings for the acupuncture group improved significantly
  • By week six, drug cravings for the non-acupuncture group did not improve
• Improved sleep quality:
  • By week six, sleep quality for the acupuncture group improved significantly
  • By week six, sleep quality for non-acupuncture group did not improve
• Quality of life:
  • Quality of life did not differ at statistically significant levels for the acupuncture group compared to the non-acupuncture group

Those results add to the growing body of evidence confirming the effectiveness of acupuncture as a complementary therapy for people with opioid use disorder on medication-assisted treatment. People in recovery from OUD often cite the intensity of cravings and sleep problems as primary drivers or relapse. This data suggests that acupuncture can improve cravings and sleep quality while simultaneously reducing daily methadone dosage. The combination of those findings tells us that acupuncture fits well with other complementary therapies. Therefore, like yoga, exercise, and meditation, it can improve outcomes across several key recovery metrics.

Complementary, Adjunctive Supports in Practical Application

The evidence base for the use of complementary supports in treatment for substance use disorder grows more robust every day. The study we discuss here addresses acupuncture for people with opioid use disorder in the context of medication-assisted treatment. This is important because of its timeliness. As the opioid crisis continues to have a negative impact on individuals, families, and communities across the U.S., we need to employ every tool at our disposal to mitigate that impact.

This study suggests that acupuncture is one tool treatment professionals can use – in the context of an integrated, comprehensive, holistic approach to treatment – to help improve outcomes for people in recovery from opioid use disorder.

In our effort to mitigate the harm caused by the opioid crisis, that’s good news. It’s an indication that innovation and tradition can work side-by-side to create new, effective therapeutic approaches that promote long-term, sustainable recovery.

The post Can Acupuncture Help People with Opioid Use Disorder (OUD) on Medication-Assisted Treatment (MAT)? appeared first on Pinnacle Treatment Centers.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

With regards to substance use and mental health, that means health is more than the absence of substance use or the absence of mental health symptoms. The Centers for Disease Control (CDC) concurs with this definition, and indicates their goals for all people in the U.S.:

• Help people live fulfilling lives, free from preventable disease, disability, injury, and premature death
• Establish health equity, eliminate disparities and barriers to care, and improve the health of all groups
• Promote quality of life, healthy development, and healthy behavior in all areas of life

Integrated treatment acknowledges these definitions and goals for overall health and includes them in treatment for co-occurring disorders. The general idea is that treatment should address not only the SUD or mental health disorders themselves, but all the factors in the life of an individual that may contribute to the SUD or mental health disorder. Addressing and resolving symptoms is important, but the absence of symptoms is not necessarily synonymous with overall health and wellbeing.

That’s the goal of integrated treatment: total health.

We’ll describe how integrated treatment can help patients achieve total health in a moment. Firsts, we’ll take a moment to define what we mean by co-occurring disorders.

What are Co-Occurring Disorders?

When a person receives a diagnosis for one or more substance use disorders and one or more mental health disorders at the same time, they receive a dual diagnosis and have co-occurring disorders. In the context of SUD treatment, this is always what these terms mean. In other areas of healthcare, dual diagnosis may refer to the presence of two conditions or diseases at the same time, but the more appropriate phrase is comorbidity, while co-occurring disorders or dual diagnosis is the preferred term in mental health and SUD treatment.

Co-occurring disorders are far more prevalent than most people realize. In fact, in the introduction to the 2020 Substance Abuse and Mental Health Services Administration (SAMHSA) publication “SAMHSA TIP 42: Substance Use Disorder Treatment for People With Co-Occurring Disorders,” a leading expert on SUD and mental health treatment observes:

“Comorbidity is important because it is the rule rather than the exception with mental health disorders.”

Two years later, the data still supports this observation. The 2022 National Survey on Drug Use and Health (2022 NSDUH) shows:

• 84 million adults in the U.S. had either SUD or any mental health illness (AMI)
  • 25 million adults had SUD but not AMI
  • 59.3 million adults had AMI
  • 37.7 million adults had AMI but not SUD

21.5 million adults had SUD and AMI

• 3 million adults in the U.S. had either SUD or a serious mental health disorder (SMI)
  • 39.1 million adults had SUD but not SMI
  • 15.4 million adults had SMI
  • 8.0 million adults had SMI but not SUD

7.4 million adults had SUD and SMI

Those are the big-picture facts about co-occurring disorders. Millions of people nationwide have co-occurring disorders, and need effective, evidence-based treatment to achieve the best possible outcome.

Let’s look at how integrated treatment can help people with co-occurring substance use disorder and mental illness.

Integrated Treatment for Co-Occurring Disorders: An Overview

Here are the primary elements of the integrated treatment model, as defined by SAMHSA.

Integrated Treatment: Six Core Components

To meet the criteria established by SAMHSA for a fully integrated SUD/Co-Occurring Disorders treatment program, a treatment center:

1. Provides Access

• Access means the process by which an individual first encounters the treatment experience. There are four main types of access:
  • Routine: individuals who are not in crisis seek treatment independently
  • Emergency: individuals who initiate treatment because of a crisis
  • Outreach: individuals in need but do not seek treatment independently
  • Involuntary: individuals who initiate treatment as mandated by an employer, the criminal justice system, or the child welfare system
• No Wrong Door
  • This concept it crucial: it means that an individual should receive access to treatment no matter how they arrive at, initiate, or encounter the opportunity to engage in treatment. If an individual asks for help, help them.
  • Providers can create the right door through outreach

2. Performs a Comprehensive Assessment

• Providers must screen for SUD and mental health disorders immediately
  • Type of SUD/mental health disorder
  • Severity of SUD/mental health disorder
• Providers must assess background:
  • Family history
  • Trauma history
  • Medical history
  • Work history
  • SUD treatment history
• Providers must assess psychosocial factors:
  • Employment status
  • Housing status
  • Food access status
• Assessments must be followed by treatment evaluations during the treatment process:
  • Determine treatment progress
  • Make changes to treatment plan if necessary

3. Determines an Appropriate Level of Care

• Providers use the Level of Care Utilization System (LOCUS) or similar metric to refer an individual to the appropriate level of care. The LOCUS matrix uses six factors to hep clinicians determine a level of care:
  • Risk of Harm: Is the individual a risk to themselves or others?
  • Functional Status: Is the individual impaired with regards to family, work, and school?
  • Medical or Psychiatric Factors: Are there additional conditions or disorders that will impact treatment?
  • Home Environment: Does the individual have a safe, recovery friendly home or family situation?
  • Treatment History: Has the individual been in treatment before?
  • Engagement/Recovery Status: Does the individual understand their disorder? Is the individual committed to treatment?

4. Achieves Integration of Treatment

• Providers address SUDs and mental health disorders concurrently, based on symptoms and need
• Clinicians receive training in treating individuals with SUD and mental health disorders
• Treatment occurs in phases that match individual readiness for treatment and engagement
  • Providers use motivational strategies such as motivational interviewing (MI) to facilitate readiness and engagement
• Providers offer substance use and alcohol counseling services
• Providers offer:
  • Individual therapy
  • Group therapy
  • Family therapy
  • Peer support, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)
  • Medication-assisted treatment when appropriate

5. Provides Comprehensive Services

• In this context, comprehensive means everything not mentioned above. Comprehensive services for people in treatment for co-occurring disorders may include:
  • Vocational support/access to vocational services
  • Housing support/ access to housing services
  • Food support/access to food support services
  • Language support for non-native English speakers

6. Ensures Continuity of Care

• Continuity of care refers to two things:
  • Transitions between levels of care during formal treatment
  • Ongoing care after the completion of a formal treatment program, which is often called aftercare or alumni support
• The goal of continuity of care between levels of care is to facilitate a smooth transition, capitalize on treatment progress, and communicate all relevant details about treatment from one treatment team to the next
• The goals of an aftercare plan – i.e. a plan an individual receives upon completion of a formal treatment program – include, but are not limited to:
  • Sustaining sobriety
  • Continuing recovery
  • Living independently
  • Resolving relationship and family issues
  • Finding employment
  • Continuing healthy, recovery friendly habits, such as health eating and exercising
  • Ongoing engagement with a peer support/recovery community such as AA or NA

The intentional combination of the treatment components above increases the chance of successful recovery for a person diagnosed with co-occurring substance use and mental health disorders. The idea is to treat both disorders simultaneously, and, while doing so, begin to address the psychosocial factors at play that can either promote or impair the recovery process. When a person receives evidence-based treatment for all the disorders for which they receive a diagnosis, and receives support in all the areas of life that impact recovery, then their chances of achieving sustainable, long-term recovery improve.

Treating the Whole Person

The movement toward integrated treatment often involves components which we never would have considered twenty years ago. Lifestyle changes, exercise, diet, meditation, yoga, and stress management – just 20 years ago – may have been considered radical or woo woo or simply ineffective treatments with no evidence to support them.

There is now evidence to support those complementary approaches, and high-quality treatment centers around the country incorporate these components into treatment programs every day.

In addition, treating substance use and mental health disorders at the same time was not common: that’s a new approach, based on evidence – see our SAMSHA link above – that shows treating one without treating the other can impair treatment progress for both.

The final piece of the puzzle, with regards to integrated treatment, is the widespread recognition of the importance of the psychosocial components of recovery, which align with the WHO definition of health and the CDC goals for a healthy society that we list earlier in this article. Health is more than the absence of disease: health is when a person thrives in all areas of life.

The same is true for recovery from SUD and mental health disorders. Health is not simply abstinence from substances or the absence of mental health symptoms, although those are critical elements of health for a person with SUD and a co-occurring disorder. Health is when a person thrives in recovery, maintains positive relationships, meets personal responsibilities, and achieves overall wellbeing and life satisfaction.

That’s what integrated treatment can do for an individual in recovery: create a foundation for long-term health and happiness. It takes work and commitment – and for people new to treatment, those goals can seem a long way off – but it’s important for anyone in treatment to understand this fact:

Those goals are achievable.

Right now, across the country, millions of people are finding hope in treatment, belief in themselves, and creating a positive vision of a better tomorrow.

The post Mental Health Month: What is Integrated Treatment for Co-Occurring Disorders? appeared first on Pinnacle Treatment Centers.

Read about the grand opening in the Turlock Journal:

Turlock’s First Methadone Clinic Opens on Lander

At our new Turlock location – licensed and accredited by the California State Department of Health Care Services – we offer medication-assisted treatment with methadone and Suboxone (buprenorphine).

Call us today to learn more: (209) 353-4838

The post Aegis Treatment Centers Turlock Opens: Methadone and Suboxone Services in California appeared first on Pinnacle Treatment Centers.

It’s an important question for a variety of reasons.

From a patient perspective, knowing how long drugs stay in their body helps them understand more about the drug they’re taking and why they’re on the dosage schedule they’re on. It also helps them avoid any dangerous interactions with other medications and prevents unwanted side-effects related to missed or incorrect dosages.

Knowing how long drugs stay in the body helps clinicians for the same basic reasons. They need to know how a potential medication might interact with other medications a patient takes and affect other medical conditions the patient might have. For clinicians with patients in treatment for alcohol or substance use disorder (SUD), the information is essential for understanding when withdrawal starts and ends, which has a direct impact on when a patient can participate in various treatment activities.

In addition, for clinicians with patients with opioid use disorder (OUD) or SUD, the length of time an opioid – or alcohol – stays in their system determines when that person can initiate medication-assisted treatment (MAT) with certain medications for opioid use disorder or medications for alcohol use disorder.

What Happens to a Drug Inside Your Body?

When you ingest a drug, your body breaks it down into its constituent parts. Some of those parts serve a purpose, like relieving pain, reducing swelling, or decreasing anxiety, for example. The remaining parts of the drug are treated by the body as waste. These extra waste products are processed through the kidneys, lymphatic system, or liver, and subsequently eliminated through various means. The time it takes for the body to completely eliminate a substance depends on a variety of factors, including:

• The drug itself
• Dosage of the drug
• Presence of other drugs
• Age
• Weight
• Gender
• Liver/kidney function

When discussing how long a drug stays in the body, one term clinicians and scientists use frequently is half-life. The half-life of a drug is the length of time it takes for the concentration of a drug in the body to drop by fifty percent of its original dosage/concentration. Half-life does not refer to how long a drug stays in your body overall: that’s determined by the factors we list above.

While the half-life of a drug doesn’t define its onset of action – i.e., how long it takes to start working – it does help prescribers determine how frequently a medication should be taken to maintain a consistent therapeutic effect.

Medication and Addiction

In addiction treatment, understanding the half-life of a drug is essential in determining several important things:

• When withdrawal – the reaction of the body to the absence of a drug – will begin and end
• Whether specific physical, psychological, and emotional symptoms are a result of withdrawal, a co-occurring disorder, or something else
• Patients with opioid use disorder (OUD) who want to engage in medication-assisted treatment (MAT) with Vivitrol must completely detoxify from opioids before taking their first dose of medication
• Patients with alcohol use disorder (AUD) who wants to engage in medication-assisted treatment (MAT) with Vivitrol must completely detoxify from alcohol before taking their first dose of medication

Here are the lengths of time the most common substances of misuse stay in your body. We know this information based on how long these drugs are detectable by typical drug tests or screens. Below, we’ll share three things:

1. How long a drug is detectable in urine
2. How long a drug is detectable in blood
3. The basic timeline withdrawal for each drug

Let’s take a look at the facts.

How Long Common Drugs of Misuse Stay in Your Body

(And Withdrawal/Detox Timeline)

• Opioids: For most opioids, withdrawal begins 6-12 hours after the last dose and lasts 4-10 days. Longer acting opioids like methadone may involve withdrawal periods of up to 3 weeks.
  • Codeine: 1 day in urine and up to 12 hours in blood
  • Heroin: 3-4 days in urine and up to 12 hours in blood
  • Methadone: 3-4 days in urine and 24-36 hours in blood
  • Morphine: 2-3 days in urine and 6-8 hours in blood
  • Fentanyl: 2-3 days in urine and 5-48 hours in blood
  • Oxycodone/oxycontin: 4 days in urine and 24 hours in blood
• Cocaine: 3-4 days in urine and 1-2 days in blood. Withdrawal begins quickly and lasts 7-10 days.
• Amphetamine: 1-3 days in urine and around 12 hours in blood. Withdrawal begins 6-12 hours after the last dose and lasts about 7 days.
• Methamphetamine: 3-6 days in urine and 24 – 72 hours in blood. Withdrawal begins 6-12 hours after the last dose and may last as long as a month.
• Marijuana: 7-30 days in urine and up to 2 weeks in blood. Withdrawal from marijuana is nearly as intense as other drugs, but mild psychological and physical discomfort may last for about a week.
• Alcohol: 3-5 days in urine, 10-12 hours in blood. Withdrawal begins about 8 hours after the last drink and lasts 7-10 days.
• Benzodiazepines (Xanax): 3-6 weeks in urine and 2-3 days in blood. Withdrawal typically begins with 1-2 days and may last as long as 6 months to a year.
• MDMA (ecstasy): 3-4 days in urine and 1-2 days in blood. Withdrawal from MDMA has not been studied extensively, but generally follows a timeline similar to amphetamines. Symptoms can begin within 6-12 hours and may last for 3-5 days.
• LSD: 1-3 days in urine and up to 2-3 hours in blood. LSD does not have a withdrawal syndrome like most drugs of misuse. A person who stops taking LSD will lose any tolerance for the drug within 3 days.
• Barbiturates (Seconal, Phenobarbital): 2-4 days in urine and 1-2 days in blood. Withdrawal begins within 24 hours, the most severe symptoms occur within 72 hours, and may last for up to three weeks.

Some drugs – primarily benzodiazepines – cause a withdrawal phenomenon called post-acute withdrawal syndrome (PAWS). PAWS occurs when symptoms of withdrawal may last for several months. In some cases, the symptoms may persist for years. The most common PAWS symptom is insomnia. However, symptoms such as irritability, fatigue, depression, cravings, anhedonia (inability to feel pleasure), decreased libido, impulse control, and problems with memory and/or concentration can persist for months. Or, as mentioned, some of these symptoms may persist for a year or more, in rare cases.

Medication: Use Only as Directed

There are many reasons to use medication only as directed, and no real good reason to use a medication in a way other than directed by a physician. The most important reason to follow directions is your health. The people who research, design, manufacture, and sell medications can’t do any of the above if the medication creates a health or safety risk.

That’s why every medication – especially prescription medication – comes with that extra piece of paper that includes basic dosage guidance, abundant warnings about drug interactions, and an extensive list of dos and don’ts: do take this medication with food, don’t take double if you miss a does, don’t take this medication before driving or operating heavy machinery, do call your doctor if you experience these side effects – all that information is there for one reason: your health and safety.

We provide the information above for the same reason. It’s for the health and safety of our patients, who need to know how long drugs stay in their body in order to understand the potential risks and benefits of any medication they take during recovery, which includes how long a drug might stay in their system.

The post How Long Do Drugs Stay in Your Body? appeared first on Pinnacle Treatment Centers.

We published an article on the topic in July 2023:

Medication-Assisted Treatment for Alcohol Use Disorder (MAT for AUD)

In that article, we identified three medications approved by the Food and Drug Administration (FDA) for AUD treatment. Those medications include:

• Naltrexone
• Acamprosate
• Disulfiram

All three medications are effective. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) publication “Medication-Assisted Treatment for the Treatment of Alcohol Use Disorder: A Brief Guide” confirms the following benefits of MAT for AUD:

• Decreased alcohol consumption
• Improved cognitive function
• Improved ability to initiate and participate in AUD treatment
• Decreased cravings for alcohol
• Prevents alcohol use entirely (disulfiram)
• Facilitates positive lifestyle changes

Of those three medications, clinicians use Naltrexone and Acamprosate as first-line pharmacotherapies and Disulfiram as a second-line pharmacotherapy. Note: pharmacotherapy is a fancy way of saying therapy/treatment with pharmaceutical medication. While Naltrexone and Acamprosate work by affecting neurotransmitters associated with alcohol and alcohol cravings, Disulfiram is different. It makes ingesting alcohol extremely unpleasant: a person who drinks alcohol with Disulfiram in their system will experience sweats, shakes, nausea, anxiety, and vomiting.

It works, but it’s not used as often as the other two medications for alcohol use disorder, which are the topic of a new study that got our attention: “Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis.” The research team organized the project around a simple question:

Which pharmacotherapies are associated with improved outcomes for people with alcohol use disorder?

Their systematic review and meta-analysis included 118 clinical trials with a total of 20,976 participants. They found compelling evidence supporting the use of oral naltrexone and acamprosate for people with alcohol use disorder (AUD).

Why Do We Need Another Study on Medication for Alcohol Use Disorder (AUD)?

This information published by the Centers for Disease Control (CDC) describes the significant need for a greater understanding of alcohol consumption and its consequences:

“Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day).”

With regards to the common cultural trope/idea that moderate alcohol consumption has some positive outcomes, they clarify their point of view:

“Although past studies have indicated that moderate alcohol consumption has protective health benefits… it’s impossible to conclude whether these improved outcomes are due to moderate alcohol consumption or other differences in behaviors or genetics.”

We discuss this new information at length in previous articles. Please navigate to the blog section of our website and read this piece:

Moderate Drinking, Binge Drinking, and Alcohol-Related Problems

That’s one reason we need more research on alcohol: much of what we know about the health effects of alcohol needs revision, especially in the minds of the general public. Another is that alcohol causes significant harm that goes largely unrecognized and underreported. Here’s data published by the CDC, the National Institute on Alcohol Abuse and Alcoholism (NIAA), and the National Highway Traffic Safety Administration (NHTSA) that most people are unaware of:

Harm Caused by Alcohol

• 2015-2019: 140,000 alcohol-related fatalities each year
  • Males: 97,000
  • Females: 43,000
• That’s 75% more than the reported opioid-related fatalities in the same time
• 2008-2017: 10,000 people alcohol-related automobile fatalities
• 2020: 11,654 alcohol-related automobile fatalities
  • That’s 14.3% more than 2019

A study released in 2022 about problems among moderate alcohol drinkers who occasionally binge-drink revealed this surprising set of facts:

Binge Drinking Among Moderate Drinkers: Long-Term Problems

• 85% of alcohol-related problems at 9-year follow-up appeared in moderate drinkers
• Binge and heavy drinking at baseline predicted the presence of alcohol-related problems at 9-year follow-up.
• Moderate drinkers who reported binge drinking episodes reported more alcohol-related problems at 9-year follow-up more than heavy drinkers who reported binge drinking episodes
• Risk of multiple alcohol-related problems at 9-year follow-up increased by 439% for participants who reported moderate drinking with binge drinking episodes at baseline

Next, the 2021 National Survey on Drug Use and Health (2021 NSDUH) contains the most up-to-date information on alcohol use available.

Alcohol Use: Past Month, Binge, and Heavy Drinking, Age 12+

• 133.1 million people reported drinking in the past month
• 60.0 million (45.1%) reported binge drinking
• Binge drinking by age group:
  • 18-25: ~10 million
  • 26+: ~50 million
  • 12-17: ~1 million
• Binge drinking among underage people: ~3 million
• Heavy drinkers: ~16.3 million
• Heavy drinkers by age group:
  • 18-25: ~2.5 million
  • 26+: ~14 million
  • 12-17: ~100,000
• Heavy drinkers under age 18: ~600,000

Alcohol Use Disorder: By Age Group

• 12 + total: ~30 million
• 12-17: ~900,000
• 18-25: ~5 million
• 26+: ~23.5 million

Next, evidence form studies published here and here show AUD is various negative health outcomes, including but not limited to:

• Hypertension
• Heart disease
• Stroke
• Cognitive impairment
• Sleep problems
• Depression
• Anxiety
• Peripheral neuropathy
• gastritis and gastric ulcers
• Liver disease including cirrhosis
• Pancreatitis
• Osteoporosis
• Anemia
• Fetal alcohol spectrum disorders
• Several types of cancer

Finally, evidence from a study published here indicates alcohol consumption is associated with and increase in additional negative outcomes, including:

• Homicide
• Suicide
• Motor vehicle crashes and deaths
• Sexual violence
• Domestic violence
• Drownings

Taken as a whole, that’s a compelling set of facts that leads to one conclusion: alcohol causes more problems than most people realize. That conclusion leads to this realization: we need to know more about how to support people with alcohol use disorder (AUD).

Therefore, scientists conduct more research, and we report it to you here. With all that in mind, let’s take a look at the results of the study we introduce above, “Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis.”

Naltrexone or Acamprosate: Which Medication for Alcohol Use Disorder is More Effective?

The primary metric the research team used to judge the effectiveness of the medications for alcohol use disorder was alcohol use/ consumption over the 30-day study period. Secondary metrics included health and wellness factors, motor vehicle crashes, and mortality. However, the studies reviewed in the meta-analysis didn’t include data sufficient to draw any statistically significant or relevant conclusions on their secondary metrics. Therefore, we’ll report the results of their primary metric: alcohol consumption during the 30-day study period.

The metric they used to assess consumption is interesting. They assessed:

• Return to drinking
• Return to heavy drinking
• Percentage of drinking days
• Percentage of heavy drinking days

To report their findings, they used a construct called number needed to treat (NNT). What that means is the number of people they needed to treat with the medication in question to prevent one (1) person from returning to heavy drinking or drinking. The team identified the most effective dose for patients – 50 mg/d (milligrams per deciliter) – and reported results based on that dosage.

Here’s what they found.

Naltrexone or Acamprosate? The Results

The number of patients needed to treat (NNT) to prevent 1 person from returning to any drinking, at a dose of 50 mg/d:

• Naltrexone: 18
• Acamprosate: 11

Compared with placebo:

• Oral naltrexone was associated with lower rates of return to heavy drinking
• Injectable naltrexone was associated with fewer drinking days over the 30-day treatment period:
  • Average of 5 fewer drinking days
• Injectable naltrexone was associated with greater reduction in percentage of heavy drinking days over the 30-day treatment period:
  • Percentage of heavy drinking days decreased by 5%
• Acamprosate showed no statistically significant improvement in return to heavy drinking
• Adverse effects included:
  • Naltrexone: nausea/vomiting
  • Acamprosate: diarrhea

We’ll summarize this data now. The meta-analysis showed naltrexone reduced:

• Return to any drinking
• Return to heavy drinking
• Percentage of drinking days
• Percentage of heavy drinking days

The meta-analysis showed acamprosate reduced:

• Return to drinking
• Number of drinking days
• Acamprosate was not associated with reduced return to heavy drinking

Here’s how the research team describes their findings:

“Oral naltrexone and acamprosate were each associated with significantly improved alcohol consumption-related outcomes compared with placebo. In conjunction with psychosocial interventions, these findings support the use of oral naltrexone, 50 mg/d, and acamprosate as first-line pharmacotherapies for alcohol use disorder.”

MAT for AUD: How it Works

The most important thing to understand about medication-assisted treatment – whether for alcohol use disorder or opioid use disorder – is that it’s not just about the medication. Please note the summary from research team reads “…in conjunction with psychosocial interventions…” the results support the use of oral naltrexone and acamprosate for AUD.

SAMHSA indicates treatment plan with medication for AUD must include:

• Therapy, counseling, lifestyle changes, peer support, and complementary treatment modes
• Educational workshops on relapse prevention, healthy communication, healthy relationships
• Family participation (biological or chosen family)
• Treatment for co-occurring disorders
• A timeline and criteria for discontinuing MAT
• Timeline and criteria for completing treatment
• An aftercare plan for ongoing support upon discharge from treatment

In other words, MAT programs for AUD should be integrated, comprehensive, and holistic. Integrated means clinicians plan how the various modes of treatment will reinforce one another. Comprehensive means they treat all issues simultaneously: a person with a mental health disorder and a substance use disorder needs treatment for both at the same time. Treating one without treating the other reduces chance of successful recovery from both. Finally, holistic means the program addresses the whole person: biological, social, and physical. We concur with the definition of health espoused by the World Health Organization (WHO):

“Health is a state of completer physical, mental, and social well-being and not merely the absence of disease or infirmity.”

When a patient comes to us for support for alcohol use disorder – or any substance use disorder – that’s why MAT is one option. It helps a person achieve total, holistic health, and puts them on the road to long-term sustainable recovery, and a life without alcohol or drugs.

The post What’s the Best Medication for Alcohol Use Disorder (AUD)? appeared first on Pinnacle Treatment Centers.

MAT and Medicaid: Lifesaving Medication Underused 

1. 500,000 Medicaid recipients with opioid use disorder (OUD) did not receive the best available treatment for OUD, which is medication-assisted treatment (MAT) with medication for opioid use disorder (MOUD). MOUDs include methadone, buprenorphine, and naltrexone.
2. That makes up around 33% of people on Medicaid with OUD.
3. MAT participation varies by state, and by state Medicaid expansion status. For instance:
   • 90% of Medicaid recipients with OUD in Rhode Island received MAT
   • Under 40% of Medicaid recipients with OUD in Mississippi and Illinois received MAT
4. Over 80,000 people died of opioid overdose last year.

That last fact makes the NYT headline all the more disturbing: we have the capacity to address the problem, but we’re not getting the right treatment to the right people in the right places with the kind of consistency that can help reduce rates of overdose.

To read the full NYT article, click this link:

A Third of Medicaid Recipients With Opioid Use Disorder Aren’t Getting Medication to Treat It

To learn about MAT at Pinnacle Treatment Centers, please navigate to our treatment page:

Medication-Assisted Treatment

Finding Help: Pinnacle Treatment Centers

If you or someone you know need support for opioid use disorder, alcohol use disorder, or another addiction, please contact us as soon as possible. We offer a wide range of holistic, integrated treatment programs for SUD, AUD, and co-occurring disorders.

The post MAT and Medicaid: A Third of Medicaid Recipients With Opioid Use Disorder Aren’t Getting Medication to Treat It appeared first on Pinnacle Treatment Centers.

Let’s back up and define methadone and methadone treatment for anyone unfamiliar with either. We’ll elaborate below, but for now, simply understand that methadone is a medication used to treat people with opioid use disorder (OUD) – a.k.a. opioid addiction – and it’s part of an overall approach called medication-assisted treatment (MAT). Treatment specialists recognize MAT as the gold-standard treatment for opioid use disorder.

Back to the question:

Why, in some cases, do families have everything to do with methadone treatment?

The answer:

Because a robust support system of loving, concerned individuals create conditions within which a person in recovery from OUD can grow and thrive.

It’s not just families. Evidence shows that for people in recovery from alcohol use disorder (AUD), adding just one non-drinking friend to their social network dramatically increases the likelihood of sustained recovery. A similar thing is true for people with OUD: the stronger and wider the support system, the more likely the chances of a full and successful recovery.

And in this context, a committed and fully engaged family can form the first and most powerful base of support available to a person in treatment. In other words, they’re the foundation of the support system, and can play a vital role in the success or failure of any treatment plan.

The lion’s share of the work, of course, belongs to the person in recovery. However, with the full support of a loving family, a person in treatment can meet the challenge of that work with the knowledge their family has their back and is invested in their success.

Before we go any further, we’ll take a moment to define family therapy.

Family Therapy: The Basics

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers this definition of family counseling/therapy:

“Family counseling or therapy is a collection of treatment approaches and techniques founded on the understanding that if change occurs with one person, it affects everyone else in the family and creates a change reaction.”

In the context of substance use disorder treatment, including medication-assisted treatment (MAT) with methadone or another medication for opioid use disorder (MOUD), any friend or loved one concerned with the successful recovery of the individual in treatment can help the treatment and recovery process, if the person in treatment wants them to participate in the process.

In the publication “Treatment Improvement Protocol 39: Substance Use Disorder Treatment and Family Therapy,” SAMHSA outlines the principles of family participation in the SUD process, which applies to recovery from all substances of misuse or disordered use, including alcohol:

Families and SUD Treatment: Seven Core Principles

1. Recognize the importance of family participation in treatment and recovery
2. Emphasize collaboration and mutuality in treatment
3. Recognize the value of harm reduction in OUD treatment
4. Realize a successful treatment means improving quality of life for the whole family, not only the person in treatment
5. Understand family support and a robust social network are crucial components of recovery
6. Any family therapy plan must honor the cultural traditions of the family involved in treatment
7. Recognize that SUD is a complex, multilayered disease, and families can play a pivotal role in helping an individual in treatment achieve long-term, sustainable recovery

Family therapy is based on a concept from developmental psychology called family systems theory. Here’s a simple way of understanding  family systems theory:

1. We all grow up in a system of human relationships defined as a family
2. Family dynamics play a pivotal role in individual development
3. Families have a direct impact on any behaviors an individual develops

In the context of family systems theory, family members include spouses, children, parents, grandparents, adoptive parents/grandparents, aunts and uncles, cousins, other relatives, close friends, and chosen family.

Those are the initial facts about methadone, family participation in SUD treatment, and family participation in MAT treatment.

But why is all this important now, in 2023?

The Drug Overdose Crisis: Opioid Overdose

We just emerged from a worldwide pandemic that claimed over a million lives in the U.S. What many of us don’t realize is that the opioid crisis – which many call the opioid epidemic or the overdose epidemic – has claimed over a million lives since 1999.

Let’s take a look at the most relevant data on the opioid crisis. We’ll start with the overall statistics on drug addiction, which we now call substance use disorder (SUD).

SUD by Substance in 2021

Source: 2021 National Survey on Drug Use and Health (2021 NSDUH)

• Alcohol use disorder: 29.5 million
• Illicit drug use disorder: 24.0 million
• Marijuana use disorder: 16.3 million
• Opioid use disorder: 5.6 million
• Pain reliever use disorder: 5.0 million
• Methamphetamine use disorder: 1.6 million
• Stimulant use disorder: 1.5 million
• Cocaine use disorder: 1.4 million
• Heroin use disorder: 1.0 million

Now let’s look at opioid overdose fatalities over the past six years.

Opioid Overdose Deaths: 2017-2022

Source: CDC National Vital Statistics System (NVSS)

• 2017: 42,249
• 2018: 46,802
• 2019: 49,860
• 2020: 68,630
• 2021: 80,411
• 2022: 82,797

Those statistics tell us why this topic – families and methadone treatment – is important right now, in this moment. Millions of people have opioid use disorder (OUD), tens of thousands of people die every year from opioid overdose, medication-assisted treatment with methadone is an effective, evidence-based treatment, and family participation in any form of SUD treatment improves outcomes: that’s our current situation.

Now let’s define exactly what we mean by medication-assisted treatment (MAT).

What Is Medication-Assisted Treatment (MAT)?

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as follows:

“Medication-assisted treatment (MAT) for opioid use disorder combines counseling and other recovery supports with prescribed medications. These medications help reduce cravings and withdrawal symptoms that come from stopping opioid use. The medications approved for MAT are methadone, buprenorphine, and naltrexone.”

In this article, we focus on methadone. To learn more about buprenorphine – a.k.a. Suboxone – please navigate to the blog section of our website and read this article:

Suboxone Treatment for Opioid Use Disorder

That article will tell you what you need to know about Suboxone. Now let’s get back to methadone with these basic methadone facts:

• Methadone is an FDA-approved medication for opioid use disorder (MOUD)
• Methadone mitigates opioid cravings and reduced opioid withdrawal symptoms.
• It’s typically dispensed in liquid form
• Methadone is dispensed daily, in single doses – with some exceptions – at FDA-certified opioir treatment programs (OTPs).

The benefits of methadone, confirmed by fifty years of research, include:

• Increased treatment retention
• Reduced withdrawal symptoms
• Reduced opioid use
• Decreased relapse rates
• Decreased involvement with criminal justice system
• Reduced rates of fatal overdose
• Reduced spread of infectious disease
• Improved family function, work, and academic functioning
• Decreased overall premature mortality
• Decreased risk taking/risky behavior

While methadone treatment is not always long-term, evidence indicates methadone treatment lasting less than 90 days is not more effective than other approaches to treatment. However, evidence also indicates people who engage in methadone treatment for over a year have the best likelihood of achieving long-term, sustainable recovery. Patients on methadone should not stop taking methadone without medical supervision. The best way to discontinue methadone treatment – the last phase of MAT, called tapering or medically supervised withdrawal – is slowly, over time, in collaboration with a substance use counselor and physician.

It’s clear MAT works, and of the medications for opioid use disorder approved by the FDA, methadone is particularly effective. An outside observer could safely assume that with this knowledge – and medication – available, every person with opioid use disorder would choose some form of medication-assisted treatment.

Let’s see if that’s the case.

Medication-Assisted Treatment for OUD in 2021

Source: 2021 National Survey on Drug Use and Health (2021 NSDUH)

• 5.6 million people had opioid use disorder. This figure includes those with the disordered use of:
  • Heroin
  • Prescription opioids
  • Illicit prescription opioids
• 1.2 million received treatment
• 533,000 with OUD received MAT with MOUD
• 1.1 million overall engaged in MAT for opioid use, regardless of OUD status
• 887,000 with opioid misuse received MAT with MOUD

Unfortunately, the facts tell us that’s not the case.

That data shows us what we call the treatment gap, which is the difference between the number of people who need a specific treatment and the number of people who get that treatment. In the U.S. in 2021, none out of every ten people diagnosed with opioid use disorder did not receive the MAT, which – as we’ve said again and again in this article – treatment professionals consider the best available treatment for OUD.

The treatment gap is something we can rectify – but we need everyone’s help. That means people in treatment, people with friends in treatment, and family members of people in treatment. We need everyone’s help in three areas:

1. Reducing stigma around MAT
2. Increasing awareness of the effectiveness of MAT
3. Raising awareness about the role families can play in methadone treatment

We’ll discuss that last item now: the role and benefits of family participation in SUD treatment, which applies directly to family participation in MAT with methadone.

Families, Methadone Treatment, and Recovery

If we check the definition of MAT, we find a key phrase: “…combines counseling and other recovery supports with prescribed medications…” What that means is that MAT is not only about medication. It’s a holistic approach to recovery that leverages all possible avenues of support to maximize the likelihood of a positive result. Those avenues include individual therapy, group therapy, and family therapy. We define and explain family therapy above.

Now let’s look at the positive outcomes associated with family therapy during MAT with MOUD.

Family Participation in SUD Treatment: Core Benefits

Source: Treatment Improvement Protocol 39: Substance Use Disorder Treatment and Family Therapy (SAMHSA)

Family participation in the context of SUD treatment is associated with:

• More enthusiastic participation in treatment
• Longer treatment retention
• Prevention of substance use in other family members
• Individual benefits:
  • Decreased drug use
  • Decreased relapse to drug use
  • Improvement in mental health symptoms
  • Improved social, family, school, and work functioning
• Family benefits:
  • Reduced conflict
  • Stable interactions/interpersonal dynamic
  • Improved overall communication
  • Reduced risk of negative impact on children

Research indicates several treatment approaches involving families can increase the likelihood of successful recovery.

Family Therapy: Evidence-Based Therapeutic Techniques

Source: Treatment Improvement Protocol 39: Substance Use Disorder Treatment and Family Therapy (SAMHSA)

Multi-Dimensional Family Therapy (MDFT):

• MDFT operates on the assumption that change occurs in three primary places: home, school, and in the community
• MDFT-trained providers tailor therapy to unique client need in these three places, or life domains, which creates an effective web, or system, of support for each person in treatment

Behavioral Family Therapy (BFT):

• BFT is rooted in the concept that the disordered use of substances use is learned behavior
• In some cases, family members model this negative behavior, which reinforces the behavior
• BFT counselors help families learn to reinforce positive, alternative behavior, such as decreased drug use and /or abstinence
• BFT is indicated for any family involved in the SUD recovery process

Solution Focused Brief Therapy (SFBT):

• SBFT counselors prioritize practical solutions to acute challenges in order to create a template for solving subsequent problems.
• Counselors help patients and family identify the circumstances when the patient does not use drugs, and families help reinforce/create those circumstances to promote the desired behavior

Community Reinforcement and Family Training (CRAFT)

• CRAFT helps families with a loved one with SUD who refuses/strongly resists treatment
• Family members learn to reinforce desired behaviors, i.e. not using drugs
• Family members learn not to interrupt the natural consequences of drug use

Psychoeducation Workshops

• Psychoeducation classes teach families and individuals the important facts about treatment, addiction, and recovery
• Family education may include workshops on healthy communication, resolving conflict, boundary setting, codependency, and others.

It may come as a surprise that a medication-based treatment includes family therapy that covers topics and issues like psychoeducation, conflict resolution, and communication skills. Upon reflection, this combination of medication and behavioral therapy reflects trends across the medical field. We now regularly include lifestyle changes in treating chronic diseases like diabetes, hypertension, obesity, and others. Family support helps in those instances, too: family members help keep the person in treatment on track to total health.

The Power of Family

In that way, treatment for OUD with methadone in an MAT program is no different than treatment for chronic physical disease: family support can make all the difference. As we mention above, the person in treatment does the heavy lifting. It’s their life, their recovery, and their personal success ultimately depends on them. With that said, when a family unites around the concept of recovery and understands how they can support their loved one without enabling them, then their chances of achieving sustainable, long-term recovery increase.

In short, when families engage in the therapeutic process, outcomes improve. And when outcomes improve for one person, those positive outcomes ripple outward and benefit the family, and by extension, benefit the community.

That’s how we move toward a holistic vision of total health. One person at a time, one family at a time, and one community at a time.

The post Families and Methadone Treatment appeared first on Pinnacle Treatment Centers.

The crisis: the opioid overdose epidemic.

In recent years, media attention to the opioid crisis faded because of another public health crisis: the COVID-19 pandemic.

Now that we’ve discovered a new normal with regards to the COVID-19 pandemic, with boosters addressing new variants and an increasing understanding of long COVID, we can return our attention to the opioid crisis. It’s critical that we return our attention to this public health crisis, because during the pandemic, it didn’t go away.

It got worse.

In 2022, the Centers for Disease Control (CDC) reported an increase in overdose deaths over 2021. In fact, the last time drug overdose deaths decreased in the U.S. was between 2018 and 2019. Since then, despite our best efforts, rates have increased each year. That means we need to redouble our efforts to help people with opioid use disorder in all areas of our society, including among individuals incarcerated in prisons and jails. That population is particularly vulnerable, because data shows high rates of opioid use disorder (OUD), and limited access to the gold-standard treatment for OUD, in the form of medication-assisted treatment (MAT) with medications for opioid use disorder (MOUD).

Trends in Overdose Death, 2001-2022

2001-2006:

• 2001: 19,394
• 2006: 34,425 drug overdose deaths
• 5-year increase: 77%

2006-2011:

• 2006: 34,415
• 2011: 41,340
• 10-year increase: 113%

2011-2016:

• • 2011: 41,340
  • 2016: 63,632
  • 15-year increase: 228% increase

2016-2021:

• • 2016: 63,632
  • 2021: 106,699
  • 20-year increase: 450%

2022:

• • Overdose deaths: 108,388
  • Total increase, 2001-2022: 458%

That’s the big-picture situation in the U.S. right now. The crisis is real, it’s reached every corner of our society. Both the Trump and Biden presidential administrations allocated billions of dollars of federal funding to mitigate the harm caused by the opioid crisis. To learn about those efforts, please navigate to the blog section of our website and read these articles:

Trump Administration Response: The Politics of Addiction: How a Group of Cities and Counties Shaped the Federal Response to the Opioid Crisis

Biden Administration Response: The Opioid Crisis: A New National Strategy

Both aid packages included comprehensive, all-of-the-above, all-hands-on-deck approach to the opioid crisis, including provisions to enhance law enforcement prevention, increase access to treatment and support, monitor opioid prescriptions, reduce regulations around MAT with MOUD for OUD, and expand harm reduction programs nationwide.

In addition, both plans included funding for OUD treatment in prisons and jails. But in 2019, between the first and second responses, harm reduction advocates made arguments before the Supreme Court of the United States (SCOTUS) that changed the ways we approach SUD treatment – particularly OUD treatment – in prisons and jails.

MAT in Prisons and Jails: The Department of Justice Position

The advocates cited SCOTUS precedent in a simple and effective manner. In 1976, they argued, the Supreme Court of the United States (SCOTUS) issued a decision in a case called Estelle v. Gamble that addressed medical care for incarcerated individuals. The decision stated:

“Deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment.”

They argued this decision implies, therefore, that adequate medical care – which, for people with OUD, includes MAT with MOUD – is a constitutionally protected right. Then, in 2022, the Department of Justice (DOJ) issued further guidance, indication incarcerated individuals have protections provided by the Americans with Disabilities Act (ADA).

Here’s the text of the DOJ guidance:

“People who have stopped illegally using drugs should not face discrimination when accessing evidence-based treatment or continuing on their path of recovery. The Justice Department is committed to using federal civil rights laws such as the ADA to safeguard people with opioid use disorder from facing discriminatory barriers as they move forward with their lives.”

– Assistant Attorney General Kristen Clarke, Civil Rights Division, U.S. DOJ

What that means is that people in recovery should not only have access to the gold-standard care for their medical condition, but that care is protected by law. This presents an immediate quandary in our prisons and jails, because the latest data indicates that a very small percentage of incarcerated individuals with OUD receive support in the form of MAT with MOUDs. With that in mind, let’s take a look at a recent study published by Johns Hopkins University called “How the Drug Enforcement Administration Can Improve Access to Methadone in Correctional Facilities and Save Lives.”

MAT and Methadone in Prisons and Jails

Before we go any further, we should encourage anyone unfamiliar with MAT or MOUD to learn the basic facts on our treatment pages:

Medication-Assisted Treatment

Office-Based Opioid Treatment

Also, please read this article by our Chief Medical Officer, Dr. Chris Johnston, published in the online magazine Medium in 2021:

The Case for Medication-Assisted Treatment (MAT) in Prisons and Jails

Now, back to the topic at hand, which is how to improve our support for incarcerated individuals with OUD. The Johns Hopkins publication lays out a blueprint for change in four areas:

1. Regulations regarding medications for opioid use disorder (OUD)
2. The threshold for initiating treatment for OUD
3. Collaboration between corrections officers and medical staff
4. How to support incarcerated individuals upon release

We’ll review their recommendations in all four of these areas below. First, however, we’ll provide information about the use of MAT in prisons and jails for people with OUD.

Facts to Know, Ideas to Understand: MAT in Prisons and Jails

Prison, Jail, and OUD

• It’s common for people with opioid use disorder (OUD) to experience incarceration.
• Over 40% of people who use heroin report recent contact with the criminal justice system
• Almost 20% of people with a prescription opioid use disorder (OUD) report recent contact with the criminal legal system.
• 20% of people in jails and prisons reported regular heroin or opioid use before incarceration
• Current data estimates show there are roughly 2 million people in prisons and jails at any given time in the U.S.
• Fewer than 1% of jails and prisons in the U.S. offer MAT with MOUD for OUD

The next to last figure means that at any given time, there’s an opportunity to help close to half a million people (400,000) initiate MAT with MOUD, and that last figure shows that we’re falling woefully short, with lifesaving treatment absent in 99% of prisons and jails in the U.S.

Increased Overdose Risk

• Evidence shows incarceration significantly increases risk of fatal overdose
• From 2013-2014, 40% of deaths among people released from incarceration were caused by overdose
• Within 2 weeks of release:
  • People with OUD are 40 times more likely to die of an overdose than people in the general population
• Within 3 months of release:
  • 75% of people with OUD relapsed
• Within 1 year of release:
  • 45% of people with OUD are arrested for a new offense

This data shows us that initiating MAT during incarceration could reduce relapse, save lives, and prevent new offenses.

Decreased Recidivism (Repeat Offending/Reoffending)

• Treating people for addiction in jails reduces recidivism.
• For example, a study in Rhode Island showed a 60% decrease in overdose deaths, upon release, after participating in MAT in jail
• Experts estimate that initiating MAT in prisons and jails could prevent 2,000 overdose deaths per year

This data shows that MAT in prisons and jails has a dual effect: it reduces repeat offenses and decrease overdose deaths upon release.

Comprehensive Access to MOUD Recommended

• Major stakeholders endorse all three medications for opioid use disorder (MOUD), including:
  • National Commission on Correctional Health Care
  • National Governors Association
  • American Society for Addiction Medicine
  • National Academy of Medicine
• Availability of methadone in prisons and jails is inadequate, compared to buprenorphine
• Naltrexone is the most common MOUD used in prisons and jails, but it’s the least favored among people with OUD, and associated with shorter duration of treatment adherence

This information shows us that important stakeholders support MAT in prisons and jails, including those typically cautious and averse to change, such as National Commission on Correctional Health Care.

Next, let’s look at the recommendations they make in each of these four areas.

How to Expand Access to MAT in Prisons and Jails

We’ll review these Johns Hopkins recommendations one item at a time, beginning with their position on current rules and regulations. The details on these recommendations appear in the publication “Medications for Opioid Use Disorder in Jails and Prisons: Moving Toward Universal Access.”

Toward Universal Access for MAT

Changing Rules and Regulations

• The problem(s):
  • Under current regulations, patients can only receive methadone through licensed opioid treatment programs (OTPs), and must visit their provider daily to receive medication. For an incarcerated person, this is impossible.
  • Before the pandemic, patients could only initiate buprenorphine treatment with a provider with an X-waiver. The X-waiver is no longer necessary, but rules prevent providers from dispensing buprenorphine to more than 30 patients, which creates problems for patients in prisons and jails.
• The possible solutions:
  • Reduce barriers to methadone access in prisons and jail by increasing allowable take-home doses
  • Expand regulations to allow mobile methadone units to support patients in prisons and jails
  • Expand regulations to allow medical personnel to prescribe buprenorphine to more than 30 patients per provider
  • Expand the existing 72-hour rule to allow prison and jail medical personnel to distribute MOUDs to patients past the existing 72 hour maximum
  • Lobby the Drug Enforcement Agency (DEA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Commission on Correctional Health Care (NCCHC) to publish a set of best practices for MAT in prisons and jails

Lower the Threshold for OUD Diagnosis and Treatment.

• The problem(s):
  • Jails and prisons have stringent criteria for diagnosis and treatment of OUD
  • They place arbitrary limits on dosage and treatment duration
  • They make participation in peer support groups mandatory for receiving medication
  • When incarcerated individuals break rules, consequences are punitive, and may include withholding medication
• The possible solutions:
  • Lower the threshold for diagnosis and treatment. The idea is that it should not be hard for a person to get an accurate diagnosis and appropriate medication for a well-known, well-established, well-defined medical condition
  • Facilitate “warm-handoff” programs for patients both entering and exiting incarceration
  • Allow patients access to medication, even when they don’t participate in peer support groups or counseling
  • Institute non-punitive practices for breaking program rules: denying lifesaving medication should never be a consequence
  • Create appropriate dosage regimens for methadone and buprenorphine for patients in prisons and jails

Collaboration Between Corrections Officers and Medical Staff

• The problem(s):
  • Stigma from prison and jail personnel prevent adequate access to evidence-based treatment with MOUD
  • Officers and medical staff may think they have conflicting goals: one the one hand, officers want to ensure safety and security, while on the other hand, medical staff want to provide evidence-based treatment
  • Officers are more accustomed to confiscating methadone and buprenorphine than assisting in distributing methadone and buprenorphine as medication
• The possible solutions:
  • Educate corrections officers on the science of addiction
  • Education corrections on the science of addiction treatment
  • Teach prison staff about the benefits of MAT with MOUD for people with OUD
  • Communicate with other facilities, in other locations – different counties or states – to learn about the benefits of MAT programs
  • Enlist an advocate in a position of leadership who understands the pressing need for MAT in prisons and jails

Supporting Patients Upon Release

• The problem(s):
  • Currently, federal law terminates Medicaid for incarcerated individuals
  • Infrastructure for reenrolling incarcerated individuals upon release is inconsistent and prevents many incarcerated individuals from accessing medical care upon release from incarceration
  • Rules vary state to state, county to county, jail to jail, and prison to prison, which creates confusion for everyone involved, and often results in treatment gaps for incarcerated individuals upon release
  • Significant barriers to accessing social support exist for formerly incarcerated individuals, including access to support for housing, food, employment, and medical care
• The solutions:
  • Expand Medicaid coverage for low-income adults upon release from prisons or jails
  • Create technology infrastructure for automatic enrollment in Medicaid upon release from incarceration
  • Create programs to establish continuity of care between incarceration and release
  • Distribute Naloxone to patients with OUD upon release
  • Invest in specific reentry clinics for patients with OUD upon release
  • Eliminate the Medicaid inmate exclusion policy
  • Pass the Medicaid Reentry Act, which allows Medicaid services for patients to begin 30 days before release

If we can implement those recommendations, then we’d make considerable progress in addressing the gap between the number of incarcerated people with OUD who need treatment with MAT and the number of incarcerated people with OUD who receive MAT.

MAT in Prisons and Jails: Underlying Priorities

The first priority is, of course, the health and safety of our population as a whole. It’s important for people out in the world to understand that helping people with OUD heal and grow not only helps them, it helps everyone. Individuals benefit, families benefit, and communities benefit. To learn more about MAT in prisons and jails, please refer to these resources, which explain both where we are and where we want to go:

Current Policies on MAT in Prisons and Jails

1. SAMHSA: Use of Medication-Assisted Treatment for Opioid Use Disorder (OUD) in Criminal Justice Settings
2. Model Access to Medication for Addiction Treatment in Correctional Settings Act
3. Expanding Access To Medications For Opioid Use Disorder In Corrections And Community Settings
4. Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit

We’ll end this article with a list of core values, as determined by the study team at Johns Hopkins University, for implementing future MAT programs in prisons and jails.

Core Values: Priorities for MAT in Incarcerated Populations

Patient-Driven Support

The foundation of effective treatment for substance use disorder is personal agency. This is as true for people in prisons and jails as it is for people in the general public. People should have the right to choose treatment, and have both voice and choice in what treatment they receive and how they receive it.

Racial Equality:

Rates of incarceration among Black, Latinx, and American Indian/Alaska Native/Native Hawaiian people are higher than for people in non-minority demographic groups. This impacts access to evidence-based treatment and support. It’s essential to create programs for OUD treatment that eliminate the potential for institutional racism, systemic bias, or discrimination of any sort.

Follow the Evidence

The evidence speaks: the gold-standard treatment for opioid use disorder is medication-assisted treatment (MAT) with medication for opioid use disorder (MOUD). That’s true wherever a person is: incarcerated or not incarcerated. Therefore, it’s time to recognize this fact, and scale up our MAT program in prisons and jails, in order to follow the evidence, and give everyone with OUD a chance at making a full recovery – whether they’re incarcerated or not.

Holistic, Integrated Treatment

Health is when a person thrives on all levels: physical, emotional, psychological, and relational. SUD treatment in prisons and jails needs to address the complete person in order to keep them healthy. Granted, the fact of incarceration creates challenges. However, we have a duty to provide incarcerated individuals with complete care that maximizes total health, and create systems that allow a person to engage in continuous, uninterrupted care before, during, and after incarceration.

Moving Forward: Treatment Improves Lives

When we implement these policies and practices in places where patients need them the most, we know we can improve lives. As a society, this is an achievable goal: we can help incarcerated people turn their lives around, and prepare them to live, thrive, and grow in recovery upon release. It’s not only achievable, it’s the right thing to do, and will help improve our world, one person at a time.

The post Methadone and MAT in Prisons and Jails appeared first on Pinnacle Treatment Centers.

HealthQwest Canton | 230 Riverstone Parkway Suite C | Canton, GA 30114

September is National Recovery Month, which is an appropriate time to honor the privilege of expanding our recovery services to a new location that will allow us to reach more individuals in need, help more families heal, and give another community the resources it needs to mitigate the ongoing harm caused by the opioid overdose crisis.

To learn more about Recovery Month, please visit the blog section of our website and read this article:

Recovery Month 2023: Recovery is for Every Person, Every Family, and Every Community

HealthQwest Canton joins our six existing treatment centers in the state of Georgia. We offer integrated, holistic, individualized treatment for substance use disorders (SUD), including alcohol use disorder (AUD), opioid use disorder (OUD), and polysubstance use disorder. By opening this location, we’re responding to an increased need for evidence-based treatment for SUD, and OUD in particular, in Georgia.

HealhtQwest Canton is accredited by the National Association of Addiction Treatment Providers (NAATP).

PLEASE JOIN US AT OUR OPEN HOUSE ON OCTOBER 10^th 2023 TO MEET OUR STAFF, SEE OUR LOCATION, AND LEARN ABOUT HOW WE WORK TO IMPROVE THE LIVES OF INDIVIDUALS, FAMILIES, AND COMMUNITIES WITH THE LATEST EVIDENCE-BASED ADDICTION CARE AVAILABLE.

About HealthQwest Canton

At HealthQwest Canton, we offer the following services:

• General Outpatient Treatment (GOP) for people with substance use disorder
• Medication-Assisted Treatment (MAT) for people with opioid use disorder (OUD):
  • Buprenorphine (Suboxone)
  • Methadone
  • Vivitrol
• Medication-Assisted Treatment (MAT) for people with alcohol use disorder (OUD):
  • Vivitrol
• Medication Management
• Essential Treatment Services, including:
  • Comprehensive clinical evaluation
  • Custom-designed, personalized treatment plans
  • Patient-driven one-on-one counseling
  • Group counseling
• Trauma-Informed care
• Evidence-Based Therapeutic Techniques:
  • Acceptance and Commitment Therapy (ACT)
  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavior Therapy (DBT)
• Educational Programs and Workshops, including:
  • Family Dynamics
  • Relationship Maintenance
  • Relapse Prevention
  • Stages of Change

There has never been a more important time to expand treatment for opioid use disorder – and other addictions – in the state of Georgia. According to CDC data, nationwide rates of fatal overdose increased over 350 percent between 1999 and 2020.

In Georgia, rates of opioid overdose mirrored those national increases. That’s why we’re expanding our treatment services in Georgia. We understand people need the high-quality, evidence-based support and care we can offer.

The Opioid Crisis in Georgia

In October 2017, The White House declared the opioid overdose crisis a national emergency. That declaration included $6 billion in funding for initiatives to reduce demand, increase access to treatment, reduce the flow of illicit opioids into the country, and expand harm reduction initiatives in community health centers and rural health centers nationwide.

In Georgia, the State Department of Health used their funds to engage over 200 stakeholders to form a comprehensive statewide plan to reduce the harm caused by the opioid epidemic and overdose crisis. Initially, the plan they formulated involved the creation of The Opioid and Substance Misuse Response Program as part of the Division of Health Protection in the Georgia Department of Public Health. Subsequently, the plan included increased funding for prevention, data collection and reporting, prescription drug monitoring, control and enforcement, and treatment and recovery.

Here’s the latest data on the opioid crisis in Georgia, as reported in the Georgia Department of Public Health Opioid and Substance Misuse Response publication, “The Georgia Opioid Strategic Planning, Multi-Cultural Needs Assessment.”

Opioid Overdose in Georgia: Facts and Figures

• From 2010 to 2020, the total number of opioid-related overdose deaths in Georgia increased by 207%
• From 2019-2021, opioid-related overdose deaths in Georgia increased by 101%:
  • 2019: 853
  • 2021: 1,718
• From 2019 to 2021, fentanyl-related drug overdose deaths increased 124%
  • 2019: 614
  • 2021: 1379
• Total drug overdose deaths in 2021: 2,390
  • Opioid related: 71%
  • Fentanyl-related: 57%

In addition, between 2019 and 2021 in Georgia:

• Total non-fatal drug overdoses increased
• Emergency department visits and hospitalizations for drug overdoses increased
• Presence of fentanyl in seized cocaine, heroin, and counterfeit pills increased

Now let’s look at the data for Cherokee County, where HealthQwest Canton operates:

Cherokee County Opioid Overdose Deaths: Annual Surveillance, 2018-2021

• 2018: 37 fatalities
• 2019: 114 fatalities
• 2020: 42 fatalities
• 2021: 43 fatalities

This data gives us one clear message: the people of Cherokee County need help and support addressing the opioid crisis. Professional treatment and support is the best way to address this crisis, and we want the people of Cherokee County to know we’re here for them in this time of need. Let’s take a look at how Georgia plans to meet these needs, based on data collected for the Multi-Cultural Needs Assessment we mention above.

Moving Forward: Georgia Responds to the Opioid Crisis

To determine the best path forward to address the drug use and opioid overdose crisis in Georgia, public health officials conducted a lengthy interview and survey process. Throughout the interview process, participants noted the presence of judgment, stigma, and prejudice while seeking support services, accessing resources, or inquiring about treatment. Therefore, they stressed that across the board, they think counselors/therapists can and should be more compassionate and empathetic, and offer culturally appropriate care that’s responsive to their unique needs. In addition, they noted two things many people in Georgia need to understand:

• Emotional pain is a primary trigger for misusing substances
• Spirituality is an important component in the SUD recovery process

Participants in the interviews and surveys recommended the State of Georgia and the Georgia Department of Public Health work make a wide variety of structural, relational, and transformational changes. These include:

Structural Changes:

• Address poly-substance misuse in treatment programs
• Legalize and promote syringe exchange for intravenous drug users
• Provide ongoing medical services to groups in need
• Reduce barriers to treatment
• Streamline intake process for various populations
• Provide Narcan more to all first responders
• Make Narcan affordable for at-risk populations
• Legalize and implement syringe exchange programs
• Reduce barriers to housing access due to prior convictions, lack of employment, federal policies, and stigma

Relational Changes:

• Increase availability of linguistically and culturally appropriate support
• Individualize treatment to match the needs of each person
• Discuss SUD in all areas – media, public speech, otherwise – without judgment, in a way that demonstrates compassion and understanding
• Increase support non-English speaking immigrants
• Increase peer support for all cultural and demographic groups

Transformational Changes:

• Eliminate stigma surrounding substance use and opioid use disorder (OUD), which prevent substance users from seeking treatment.
• Reduce overprescribing in older adults
• Adopt a holistic approach to treating substance use disorders
• Increase harm reduction efforts to mitigate suffering caused by substance use
• Train physicians to make accurate and appropriate diagnoses and referrals for SUD care and treatment

The opioid crisis in the U.S. happened in three waves. The first resulted from increases in prescription opioids, a trend which began in the 1990s. The second resulted from an increase in heroin use, as people with opioid prescriptions developed opioid use disorder (OUD) and turned to illicit opioids, such as heroin, when new prescribing rules reduced access to legal opioids. The third began around 2016, with an influx of fentanyl into the illicit drug supply in the U.S.

Polysubstance Misuse and Co-Occurring Disorders

Although public health officials have yet to label a Fourth Wave of the opioid crisis, the COVID-19 pandemic altered its contours. In 2023, we face an increase in overdoses caused by the presence of the illicit opioid, fentanyl, in drugs like cocaine, methamphetamine, and illicit benzodiazepines. In addition, treatment providers report a drastic increase in the amount of co-occurring disorders among people with SUD.

When a person has a mental health disorder at the same time as a substance use disorder, they receive a dual diagnosis for co-occurring disorders. For people with OUD and a mental health disorder, evidence shows the gold-standard treatment is a combination of:

• Medication-assisted treatment (MAT) with medications for opioid use disorder (MOUD), including buprenorphine, methadone, or naltrexone
• Counseling, therapy, and social support
• Lifestyle changes
• Peer support

At Pinnacle Treatment, MAT programs include all of the above: our MAT programs are about more than medication. They’re about helping people with OUD rebuild their lives, and learn to live, grow, and thrive in recovery. Evidence shows the following benefits of holistic, individualized MAT programs:

• Reduced opioid use
• Decreased risk of relapse to opioid use
• Reduced involvement with the criminal justice system
• Increased social, school, and family function
• Increased ability to find work and stay employed
• Decreased opioid related mortality

To learn more about MAT, please read these articles about MAT on our blog:

Medication-Assisted Treatment for Opioid Addiction

Suboxone Treatment for Opioid Use Disorder

Medication-Assisted Treatment: Methadone Treatment for Opioid Use Disorder (OUD)

Who Received Medication-Assisted Treatment (MAT) in 2021?

If you or someone you love needs treatment and support for OUD or another addiction, please reach out to us today. If you live in the North Metro Atlanta area or North Georgia, please consider seeking treatment close to home at HealthQwest Canton.

The sooner a person who needs OUD treatment gets the treatment they need, the better the outcome for the individual, the family, and the community. Treatment works! Please reach out to us today if you have any questions.

The post Pinnacle Treatment Centers: HealthQwest Location in Canton, GA Now Open appeared first on Pinnacle Treatment Centers.

At the time, addiction professionals predicted negative consequences for people in substance use disorder (SUD) treatment if the more restrictive rules and regulations around treatment receipt and delivery were changed or eased to accommodate the new, default status quo. They were particularly concerned about people with opioid use disorder (OUD) in medication-assisted treatment (MAT) programs required to access medication for opioid use disorder (MOUD) and treatment in-person. The emergency public health guidelines created a situation where some patients would be unable to access medication and treatment, which, experts predicted, could increase chances of relapse and fatal overdose.

Thankfully, the authorities listened. They changed important rules and regulations in order to keep people in treatment and remove barriers to treatment with new SUD diagnoses, and specifically eased rules on initiating and accessing MOUD for people with OUD in MAT programs.

Changes included:

• Expanding telehealth services
• Changing prescribing rules for MOUD
• Allowing more take-home doses of MOUDs
• Allowing initiation of MAT via virtual/telehealth

To read more about the federal response to COVID-19 with regards to MAT and MOUD for people with OUD, please navigate to the blog section of our website and read this article:

The Mainstreaming Addiction Treatment (MAT) Act: Will We Keep COVID-Era Changes?

Critics of these changes argued that increased access to MOUDs would increase diversion of MOUDs for illicit purposes, and drive up misuse and overdose fatalities. However, this didn’t happen. We document this in an article here:

Does Increasing Access to Buprenorphine Increase Risk of Overdose?

Spoiler alert: increasing access to buprenorphine did not result in an increase in buprenorphine-related overdose or overdose fatalities. On the contrary, increasing access to MOUD for people in MAT programs saves lives, rather than puts them at risk, and increases overall community safety by reducing criminal behavior associated with OUD.

To learn more about the benefits of medication-assisted treatment (MAT) with medications for opioid use disorder (MOUD), please read our MAT treatment page here:

Medication-Assisted Treatment

That article will tell you how we approach MAT for OUD in our nationwide network of treatment centers. This article will discuss findings published in a recent study that examined the impact of the COVID-19 era rules on treatment with medications for opioid use disorder (MOUD).

Substance Use Disorder (SUD), Opioid Use Disorder (OUD), and MAT with MOUD in 2021

Released in August 2023, the paper “Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021” used data from the 2021 National Survey on Drug Use and Health (2021 NSDUH) to assess the use of MOUDs in the context of the regulations in place at the time. That year – 2021 – was novel because it included the period during the pandemic but before the release of the vaccine.

Since most of 2021 occurred during the height of the crisis, researchers wanted to know – given the special circumstances – how many people engaged in treatment with MOUD, and what factors may have impacted their treatment during that time of heightened anxiety, uncertainty, and worry over the ultimate outcome and resolution of the pandemic.

To that end, they analyzed data from 47,291 adults age 18+ with opioid use disorder (OUD) to determine:

• Receipt of MOUD/MAT for opioid use disorder
• Impact of substance use
• Impact of mental health/mental illness variables
• Effect of sociodemographic characteristics

Before we look at that data, let’s look at the big-picture numbers for 2021, in order to understand where MAT and MOUD fit in the general, nationwide SUD and SUD treatment situation.

SUD in 2021: Adults 18+

• SUD, past-year diagnosis: 1 million
• Needed SUD treatment: 41 million
• Received any SUD Treatment: 4.03 million
• The treatment gap for SUD: 91% of people with SUD did not get SUD treatment

That’s the big picture for adults 18+. Note the significant treatment gap, or the difference between the number of people who needed SUD treatment and the number of people who received SUD treatment. Data shows an enormous gap of 91 percent: that’s a problem we need to address.

Now let’s look at opioid use disorder (OUD) and treatment for OUD among people age 12+ and learn whether there’s a similar treatment gap for people with OUD.

Medication-Assisted Treatment for OUD, Total Age 12+

• Past-year OUD diagnosis: 5.6 million
• Receipt of any OUD treatment: 1.2 million (21%)
• Received MAT for OUD: 533,000 (9%)
• Received MAT for opioid use, with no OUD diagnosis: 1.1 million (19.6%)
• Receipt of MAT for opioid misuse: 887,000 (15%)

Those figures reveal another significant – and troubling – treatment gap: close to 80-85 percent for people with OUD for treatment overall and over 90 percent for people with OUD for MAT with MOUD. That sets the scenario for the information we’ll share below, from the study we introduce above.

MAT with MOUD Among Adults 18+

First, let’s look at the data researchers collected on adults with opioid use disorder (OUD):

• 5 million adults reported OUD in the past year
  • Gender:
    • 52% male
    • 48% female
  • Age groups:
    • 67% age 35+
  • Race/Ethnicity:
    • 61% White
    • 39% Non-White Hispanic or Black
  • Environment:
    • 58% large metropolitan areas
    • 42% rural/small metropolitan areas

Now let’s look at the rates of treatment for OUD among adults with past-year OUD:

• Any past-year SUD treatment: 35.6%
• Past year MOUD treatment: 22.3%
• Among those who received MOUD:
  • Males: 58.5%
  • Age 35+: 61.7%
  • Race/Ethnicity:
    • 1% White
    • 9% Non-White Hispanic or Black
  • Environment: 57.7% large metropolitan areas

Next, let’s look at factors the researchers identified as either increasing or decreasing likelihood of receiving MOUD for OUD in MAT programs:

• Severe OUD diagnosis: 29% increased likelihood of receiving MOUD compared to mild OUD
• Moderate OUD diagnosis: 445% increased likelihood of receiving MOUD compared to mild OUD
• Past-year co-occurring cannabis use disorder and past year co-occurring alcohol use disorder: decreased likelihood of receiving MOUD for OUD by 76% and 83%, respectively
• Past-year other illicit drug use disorder: 48% increased likelihood of receiving MOUD
• Female gender: 83% decreased likelihood of receiving MOUD
• Non-Hispanic Black: 93% decreased likelihood of receiving MOUD
• Employment status: compared to people with full employment, data showed a 93% decreased likelihood for unemployed people and a 78% decreased likelihood for people employed part-time
• Environment: compared to people living in large metropolitan areas, data showed a 38% decreased likelihood for people living in small metropolitan areas, and a 69% decreased likelihood for people living in a rural/non-metropolitan area

We saved one finding for last:

Patients with OUD who engaged in SUD treatment via telehealth showed a 3,678% increased likelihood of receiving MOUD, compared to people who did not receive SUD treatment via telehealth.

We interpret that as a positive: expanded telehealth use during COVID-19 was associated with a significantly higher rate of treatment with MOUD.

How This Data Helps Us Help Our Patients With OUD

The study authors state the primary takeaway from this research clearly:

“Despite the well-documented effectiveness of MOUD, our findings suggest that MOUD remains substantially underused.”

By “well-documented effectiveness,” they mean decades of evidence show medication-assisted treatment (MAT) with MOUDs is the gold standard treatment for opioid use disorder (OUD). The benefits of MAT with MOUD include:

• Decreased opioid use
• Increased time-in-treatment
• Decreased risk of relapse
• Increased psychosocial functioning
• Decreased risk of fatal overdose
• Increased ability to seek and secure employment
• Decreased criminal behavior associated with opioid seeking/opioid use
• Decreased premature mortality

We’ve known about these benefits for literally decades, yet these medications still go underused. To reiterate, this study showed that close to 80 percent of adults over age 18 received MOUD for MAT. That treatment gap is unacceptable when we know about the benefits, especially the benefit we identify in the final bullet point above: people with OUD who engage in MAT with MOUD are more likely to stay alive than people who don’t.

That’s why experts call MAT and MOUD lifesaving approaches to OUD treatment.

In addition to the large treatment gap, we’ll also note that several groups are at decreased risk of receiving MOUD:

• Women receive MOUD at lower rates than men
• Black and Hispanic people receive MOUD at lower rates White people
• Unemployed people receive MOUD at lower rates employed people
• People in rural areas receive MOUD at lower rates than people in large metropolitan areas

We’ll close this article with more insight from the study authors:

“Addressing disparities in MOUD uptake should be prioritized in program, policy, and clinical initiatives… Future research should examine whether removal of the X-waiver in the US in 2023, along with other efforts to expand MOUD, will help close the treatment gap.”

We can add one more thing. This data teaches us that we, as clinicians and treatment providers, should redouble our efforts to examine any unconscious or implicit bias in our OUD treatment efforts. We work every day to ensure we treat everyone equitably. We hope to lead the way for other treatment providers, and demonstrate that it’s possible to meet people where they are, offer the treatment they need in the way they’ll accept it, and provide the gold-standard treatment – MAT with MOUD – to anyone with OUD who decides to commit to long-term, sustainable recovery.

The post Who Received Medication-Assisted Treatment (MAT) in 2021? appeared first on Pinnacle Treatment Centers.

What You Need to Know About Thorazine (Chlorpromazine)

Thorazine is the brand name of a psychiatric medication called chlorpromazine. It’s considered a first-generation antipsychotic medication. It’s part of a class of medication called typical antipsychotics. Thorazine was the first antipsychotic medication approved by the Food and Drug Administration (FDA) and the first prescription psychiatric medication for psychosis used in the U.S. and around the world. Thorazine was developed in 1950 and is considered by experts as one of the most important advances in the history of mental health treatment. It’s the first medicine in the psychiatric section of the Model List of Essential Medications published by the World Health Organization (WHO).

In the rest of this article, we’ll discuss the uses of Thorazine (chlorpromazine), its effectiveness, and its side effects. We’ll also offer information on the size and scope of the need for medications like Thorazine, by sharing the latest prevalence data on the disorders for which Thorazine (chlorpromazine) is most effective.

What is Thorazine Used For?

Thorazine (chlorpromazine) is prescribed for:

• Schizophrenia
• Acute mania in patients with bipolar 1 disorder (BD-1)
• Aggressive, hyperexcitable, and explosive behavior in children under age 12
• Nausea/vomiting
• Chronic hiccups
• Tetanus
• Preoperative anxiety

Thorazine was the first medication to help patients with the symptoms above manage those symptoms successfully, leave institutions, and begin reintegration into mainstream society. The arrival of Thorazine led to what historians refer to as deinstitutionalization, a phenomenon wherein the patient population in mental institutions dropped from over 500,000 in 1955 to around 70,000 in 1994. This trend is not without controversy. To learn more about deinstitutionalization in mental health, please read these helpful articles here and here.

Now let’s answer the next logical question on this topic.

Does Thorazine Work?

Yes.

Research shows Thorazine (chlorpromazine) is an effective medication that can reduce the frequency and severity of the symptoms of schizophrenia and the manic phases of bipolar 1 disorder. Symptoms Thorazine can improve include:

Schizophrenia:

• Hallucinations: visual
• Hallucinations: auditory
• Delusions: thoughts and/or beliefs
• Thoughts: improved disorganized thinking

Bipolar 1 (BD-1):

• Mania: high energy, racing thoughts, feelings of power/importance, risky behavior
• Agitation
• Aggression
• Impulsivity

It’s worth repeating that Thorazine was the first medication that helped reduce symptoms in patients with schizophrenia. Before medications like Thorazine, the prognosis for patients diagnosed with schizophrenia was rarely positive. The advent of Thorazine ushered in a new era: patients with schizophrenia could look forward to relief. And finally, providers could tell patients, “We have a medication that can help you.”

The same is true for people experiencing the manic phases of bipolar disorder 1 (BD-1). For the first time, a medication could control the extremes of mania associated with BD-1. And like schizophrenia, the introduction of Thorazine improved the prognosis for people diagnosed with BD-1.

The medication helps, but there’s a good reason – aside from finding better, more effective medications – researchers continuously search for new, alternative medications to treat mental health disorders: the side effects.

Does Thorazine Have Serious Side Effects?

In some cases, yes.

Thorazine (chlorpromazine) is highly effective in managing the most problematic symptoms of schizophrenia. However, the side effects can be serious. Known side-effects include, but are not limited to:

• Dizziness
• Balance problems
• Blank facial expression (the mask)
• Shuffling/disrupted walking
• Restlessness
• Agitation
• Unusual/involuntary movements (tardive dyskinesia)
• Sleep problems
• High appetite/weight gain
• Menstrual/lactation issues
• Impaired sexual ability/libido
• Swelling of breasts
• Atypical lactation
• Skin problems

This list of side-effects associated with Thorazine – some of which are serious – puts patients and providers in a difficult position. The medication works, but there are risks. Ultimately, the decision to consent to treatment with Thorazine must happen only after an open and honest discussion of the risks and benefits of the medication between patient and provider.

That’s the basic information on Thorazine. We’ve shared what it is, what it’s used for, and the serious side effects it may cause. Now let’s transition, and learn about size and scope of the challenge Thorazine helps patients and treatment providers face: the prevalence of schizophrenia and bipolar disorder in the U.S.

We’ll start with schizophrenia.

Prevalence of Schizophrenia: Facts and Figures

The National Institute of Mental Health (NIMH) indicates that accurate prevalence rates for schizophrenia are difficult to obtain, for a variety of reasons. Here’s how they describe the challenges:

“Precise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses.”

However, experts collect data and verify prevalence rates to the best of their ability, which helps give treatment providers and policymakers an idea of the scope of the problem. Here’s the latest data published by the NIMH and the WHO.

Schizophrenia in the U.S. and World

• Clinical diagnosis of schizophrenia and/or related psychotic disorders:
  • Between 0.25% and 0.64%
  • That’s between 525,000 and 1,344,000 people
• Worldwide prevalence of schizophrenia and/or related psychotic disorders:
  • Between 0.33% and 0.75%
  • That’s between 19,800,000 and 45,000,000 people

Next, we’ll share the data on schizophrenia and co-occurring alcohol use disorder (AUD) and substance use disorder (SUD), as published in the peer-reviewed meta-analysis “The Link Between Schizophrenia and Substance Use Disorder: A Unifying Hypothesis.”

Here’s the data:

Schizophrenia and Substance Use Disorder

• 47% of people with schizophrenia meet criteria for SUD
• 64% of people with schizophrenia meet criteria for AUD (average prevalence from a meta-analysis)
• 50% of people with schizophrenia report chronic cannabis use disorder (average prevalence from ten studies)
• 32.5% of people with schizophrenia report cocaine use disorder (average prevalence from ten studies)

These figures illustrate the need for effective medications for schizophrenia. Among the many consequences of untreated schizophrenia, self-medication with alcohol and/or substances creates more problems than it solves. A medication that can alleviate this need improves outcomes and allows patients to engage in supportive therapy that promotes recovery.

Now let’s look at the data on bipolar disorder.

Prevalence of Bipolar Disorder: Facts and Figures

Reports published by the National Institute of Mental Health (NIMH) and the World Health Organization (WHO) shows the following prevalence rates for bipolar disorder (BD).

Bipolar Disorder in the U.S. and World: Adults 18+

• United States:
  • 2.8% had BD in the past year (7.2 million)
  • 4.4% had BD in their lifetime (11.3 million)
  • 82.9% of those with BD had severe impairment (5.9 million)
  • 17.1% of those with BD had moderate impairment (1.2 million)
• World:
  • 0.5% of the adult population (40 million)

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows the prevalence of co-occurring alcohol/substance use disorder among people with BD:

Bipolar Disorder and Substance Use Disorder

• 14% of people with BD had SUD/AUD in the past year
• 40% of people with BD had SUD/AUD in their lifetime
• Alcohol use disorder (AUD) is the most common SUD among people with BD
• AUD in people with BD decreases treatment engagement
• AUD in people with BD increases risk of suicidality

Like the facts and figures we shared for schizophrenia, and schizophrenia and co-occurring disorders, the prevalence rates of bipolar disorder and co-occurring BD-1 and SUD illustrate the need for effective medication for BD-1. Effective medication can mitigate symptom frequency and severity, which can reduce the need for self-medication. This, in turn, can decrease the risk of AUD in people with BD-1. That’s important, because the negative consequences of co-occurring BD-1 and AUD – decreased treatment engagement and increased risk of suicidality – are severe.

Thorazine: A Summary

Thorazine and its derivatives are incredibly powerful antipsychotic medications that changed mental health treatment in the 1950s. The introduction of Thorazine allowed patients to manage the more intense, severe, and disruptive psychotic symptoms associated with schizophrenia and BD-1. For the first time, patients with delusions and/or hallucinations were able to leave mental health institutions and begin reintegration into mainstream society. We encourage everyone to read the articles on deinstitutionalization we link to above. They’re informative and give full context to a major trend in mental health treatment that occurred between the late 1950s and mid-1990s in the U.S.

In 2023, Thorazine – meaning the various forms of chlorpromazine available – is an effective initial medication for psychotic symptoms in schizophrenia and bipolar disorder. However, because of the significant side effect profile, many patients consent to treatment with second-generation antipsychotics instead of first-generation like Thorazine.

The post What is Thorazine? appeared first on Pinnacle Treatment Centers.

The Opioid Crisis in the United States

The opioid crisis in the U.S. continues to claim lives at an alarming rate.

In 2022, a total of 109,680 people died of drug overdose, with 74 percent – or 81,045 – of those death attributed to opioids. That’s 300 drug overdose deaths overall per day, and 222 opioid overdose deaths per day.

Each of those deaths – whether from opioids or another drug – leaves friends, families, and loved ones behind, in mourning, wondering they could’ve done to help. In many cases, loved ones did everything they could, but it wasn’t enough. They had to face the fact that only one person can create real change in the life of a person with a substance use disorder: the person with the disorder themselves.

The National Institute on Drug Abuse (NIDA) reports the following data about prescription opioids:

• 21% to 29% of people prescribed opioids misuse them
• 8% to 12% will develop an opioid use disorder (OUD)
• 4% to 6% will initiate illicit heroin use

These percentages translate into millions of people with a life-threatening medical condition, which we call opioid use disorder (OUD).

• Opioid misuse in the past year:
  • Total: 9.2 million
• Opioid prescription misuse:
  • Total: 8.7 million
• Opioid use disorder: 5.6 million
• Heroin use: 1.1 million
• Heroin use disorder: 1.0 million

That’s the data: millions of people need help, because the disordered use of opioids and/or heroin leads to severe, and sometimes life-threatening problems, such as overdose.

The Consequences of Opioid Addiction/Opioid Use Disorder (OUD)

For many people who experience chronic drug use and develop a substance use disorder, the future can feel bleak and even hopeless. In most cases, people with opioid or heroin use disorder spend their days preoccupied with seeking, finding, and using opioids or heroin. This can disrupt relationships, impair academic achievement, and degrade work performance. In extreme cases, opioid and heroin use can lead to unemployment and homelessness. But let’s be clear. Doctors, CEOs, and lawyers experience opioid and heroin use disorder as well. However, they may not end up unemployed or on the street, because they have a more substantial financial safety net than others.

In any case, people engaging in active, chronic opioid use often feel that their happiness, joy, and ability to participate in the healthy parts of life are all but gone.

Many people give up hope completely. And every single person with opioid use disorder faces the risk of fatal overdose, which has increased in recent years due the influx of dangerous additives in the illicit drug supply in the U.S., such as fentanyl and xylazine.

If you or someone you love is living with the disordered use of any substance, whether opioids, alcohol, or something else, there is hope – and it’s just a call away.

Treatment for Opioid Use Disorder: The Role of Methadone Clinics

There are millions of people who need help and support for opioid use disorder/opioid addiction. Thousands of those people seek that treatment and support every day – and among those, there are millions around the world in recovery. They’ve made a proactive decision to choose health and wellness and give themselves the opportunity to celebrate the joy of life every day.

At Pinnacle Treatment Center, we understand how difficult the recovery journey can be. Our knowledgeable, experienced, compassionate staff help people across the nation 24/7/365. Medical conditions like opioid use disorder don’t take days off – and neither do we.

As we mention in the introduction of this article, evidence shows the best available treatment for opioid use disorder is medication-assisted treatment (MAT) with one of the three medications for opioid use disorder (MOUD). In fact, experts call MAT the gold standard treatment for opioid use disorder (OUD). There are three medications approved by the FDA for OUD treatment: methadone, buprenorphine, and naltrexone.

Here’s the latest data on MAT treatment, published in the 2021 National Survey on Drug Use and Health (2021 NSDUH):

Medication-Assisted Treatment for OUD

Among the 5.6 million people diagnoses with OUD in 2021:

• 2 million people received treatment for OUD
• 533,000 people received MAT for OUD
• 1 million people received MAT for opioid use, with or without OUD diagnosis
• 887,000 who misused opioids, without OUD diagnosis, received MAT for OUD

This article will discuss the oldest of the MOUDs approved for MAT: methadone.

Methadone is considered a full opioid agonist. That means it completely occupies the same receptors in the brain as both prescription and illicit opioids. However, due to its slightly different chemical structure, methadone does not include the same euphoria associated with other opioids – but it’s similar enough that it can significantly reduce withdrawal symptoms associated with stopping opioids, and also significantly reduce cravings for opioids. These aspects of methadone have been studied extensively since the 1950s, when methadone was first used to treat heroin use, and since the 1970s, when the first methadone clinic in New York City.

Treatment professionals also use methadone for the misuse/disordered use of other opioids, including prescription opioids like oxycodone and illicit opioids like fentanyl.

Methadone is a medication that can only be prescribed by a licensed medical provider in an Opioid Treatment Program (OTP) that’s certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA). Patients receive methadone in either a tablet or liquid form.

Many OTPS, such as those at Pinnacle Treatment Centers, administer an initial medical assessment, create an individualized treatment program, dispense the first dose, and provide daily dosing according to the treatment plan and federal guidelines. That’s a very basic idea of how methadone clinics – i.e. OTPSs – work for most patients.

Let’s take a closer look at treatment at a federally licensed Opioid Treatment Program (OTP) at Pinnacle Treatment Centers.

Understanding How Methadone Clinics Work

Methadone clinics exist for the purpose of dispensing medications used in medically assisted drug therapy treatments. In many cases, treatment locations called methadone clinics provide other medications for opioid use disorder (MOUDs) such as Suboxone and naltrexone.

As we mention above, the first step in engaging in MAT with methadone is a comprehensive assessment – called a biopsychosocial assessment – administered by a licensed and qualified healthcare professional. Once the assessment is complete, patient and provider collaborate on a treatment plan. This is when most patients learn something critical about MAT:

The medication is only part of the treatment.

Federal guidelines require methadone clinics to offer the following services:

Counseling/Therapy/Professional support.

• Rules require methadone clinics to offer addiction counseling provided by an experienced addiction treatment provider.

Educational Workshops/Classes:

Rules require methadone clinics OTPs to provide education about addiction, relapse prevention, and other topics that promote long-term recovery.

Community Support/Peer Self-Help Meetings:

Rules require methadone clinics to offer the support required to connect MAT patients to community resources, vocational assistance, and other social services that support and promote health, wellness, and recovery.

Treatment Plan:

Rules require clinicians at methadone clinics to create a treatment plan that includes:

• Relapse prevention
• Stress management
• Lifestyle changes, such as healthy eating, exercise, and recovery-friendly activities

Before the COVID-19 pandemic, rules required close monitoring for the first week to ten days of treatment, and required patients to visit the methadone clinic every day to receive their medication. Most patients were required to receive their medication in person on a daily basis for at least six months. Then, after the first six months – if a patient complied with the rules, regulations, and expectations of the clinic and their individual treatment plan –  they were allowed to take home a limited supply of medication.

However, during the COVID-19 pandemic, the federal government allowed states to ease these rules around take-home doses of methadone. These new rules were in effect until May 2023. Clinics were allowed to continue to operate under these new rules if they applied for exceptions by May 10^th, 2023:

• For stable patients in treatment for less than two weeks, new rules permitted providers to dispense up to 7 take-home doses
• For stable patients in treatment for 15-30 days, new rules permitted providers to dispense up to 14 take-home doses
• Finally, for patient in treatment for 31 or more , new rules permitted providers to dispense up to 28 take-home doses

Note: Patients should contact their potential provider/methadone clinic to learn whether they’ve applied for continued exceptions to take-home dose rules established during the COVID-19 public health crisis. If they haven’t, some version of the original guidelines apply. If they have, the new rules may apply. In any case, patients should contact their methadone clinic directly to find out about their current take-home dosage policies.

The Benefits of Treatment at Methadone Clinics

Here’s what we want anyone reading this article to take away: MAT with methadone can be lifesaving and lifesaving.

However, it’s not as simple as taking medication and calling oneself cured. As we mention above, the only person that can create real change in the life of a person with opioid use disorder is that person themselves.

They have to show up and do the hard work of recovery – otherwise they have very little chance of creating real change.

We’ll say it this way:

The medication is not magic.

Patients have to commit to recovery and follow their treatment plan closely.

It’s essential for patients engaging in MAT with methadone to stay on the prescribed amount of methadone consistently and adhere to all the protocols established by their methadone clinic. This is how methadone clinics work, and their successful track record reinforces the importance of the protocols. This is also how a patient can meet the criteria for stability that allows them to request take-home doses.

In the context of MAT treatment at a methadone clinic, a.k.a. a federally licensed OTP, a patient must meet the following criteria to be considered stable:

• No additional active substance use disorders
• No physical or behavioral health conditions that increase the risk of harm
• Regular attendance for medication distribution
• No serious behavioral problems that increase risk of harm to themselves or others
• No diversion of methadone for illicit purposes
• Ability to safely store and transport medication

In addition, patients must meet any further criteria their supervising physicians, clinicians, or providers deem essential for the safety of the patient and the safety of the patient’s family and community.

Research has shown that when a person adheres to a methadone treatment program, their lives can change for the better. Positive outcomes include:

• Decreased opioid-related mortality (death)
• Increased time-in-treatment, which increases likelihood of long-term recovery
• Decreased opioid use
• Decreased criminal behavior related to opioid use
• Reduced transmission of infectious disease
• Increased ability to seek and maintain employment
• Improved outcomes for pregnant women with OUD, for both mother and child

That’s why it’s important to follow the protocols in a treatment plan. When a patient adheres to a treatment plan with methadone, they can experience all those lifechanging, and in some cases, lifesaving benefits.

Treatment and Support is Available Now

If you or someone you love needs professional support for opioid use disorder (OUD), we want you to know help is available. There are kind, caring, compassionate providers who understand addiction: some of our providers are in recovery, themselves, and bring their wealth of experiential knowledge to the Pinnacle Treatment Centers experience. We understand that taking the first step – making that first phone call – can often be the hardest step in the entire treatment journey.

At Pinnacle, we promise to be there for you every step of the way – not just during your official treatment program, but for your entire recovery journey.

Methadone Treatment at Pinnacle Treatment Centers

In our medication-assisted treatment programs, we use every tool available to help as many people as possible achieve sustainable recovery. MAT helps patients build a full, vibrant, purpose-driven life, free from opioids and opioid use disorder.

The post What is a Methadone Clinic? appeared first on Pinnacle Treatment Centers.

However, recent research suggests even moderate alcohol use can lead to significant health problems. To learn more about the new research on alcohol use, please navigate to the blog section of our website and read these articles:

National Alcohol Awareness Month: April 2023

Medication-Assisted Treatment for Alcohol Use Disorder (MAT for AUD)

Study Examines Novel Ways of Treating Alcohol Use Disorder

One thing you’ll learn from those articles is the scope of the harm caused by alcohol use and excess alcohol use in the U.S. Between 2015 and 2019, over 700,000 people died of alcohol-related causes: that’s far greater than the number of people who died from opioid overdose during the same five-year span.

That’s why it’s important for scientists and addiction researchers to find new ways to support people with alcohol use disorder (AUD) who want to quit drinking: the harms caused by alcohol on an individual, community, and national level are significant.

A primary challenge for people seeking to abstain from alcohol is relapse to alcohol use. People relapse for a variety of reasons, including:

• Stress: Challenging life events can cause people to seek relief from alcohol
• Environment: Cues that remind people of drinking can precipitate relapse
• Emotions: Feelings triggered by stress and the environment can lead to patterns of behavior that lead to relapse

There’s another problem, common to many people early in recovery from AUD, that can exacerbate all of the potential causes of relapse we list above: insomnia. A study published in June 2023 addresses the problem of insomnia in a group of veterans early in recovery from AUD, and examines the use of cognitive behavioral therapy – insomnia (CBT-I) in reducing sleep problems that may precipitate relapse and/or contribute to the harm caused by ongoing alcohol use.

CBT-I for Insomnia During AUD Treatment

In the study “Effect of Cognitive Behavioral Therapy for Insomnia on Alcohol Treatment Outcomes Among US Veterans” researchers designed a random control trial with the following objective:

“To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes.”

The research team cites research indicating a large percentage of people in treatment for AUD report symptoms of insomnia, but a technique widely accepted as the first-line treatment for insomnia – CBT-I – is not frequently used in the early stages of AUD treatment of recovery from AUD.

CBT-I is a derivative of cognitive behavioral therapy (CBT) designed to treat symptoms of insomnia. Evidence shows CBT-I can reduce insomnia symptoms in 70-80 precent of patients. The goal of CBT is to help patients identify how their thoughts and feelings affect behavior. The of CBT-I is to help patients identify how their thoughts and feeling affect their sleep.

CBT-I therapists use a wide range of techniques during treatment session, including but not limited to:

• Cognitive restructuring
• Breathing exercises
• Relaxation techniques
• Mindfulness
• Meditation

To determine whether CBT-I improves sleep in veterans with AUD early in AUD treatment, researchers recruited 67 patients with AUD and divided them into two groups. The experimental group participated in five weekly sessions of CBT-I, while the treatment-as-usual group participated in one single educational session about sleep hygiene. Researchers directed all participants to keep a sleep journal for the duration of the experimental period.

To examine outcomes, researchers used three metrics:

1. The Insomnia Severity Index
2. Short Inventory of Alcohol Problems
3. Self-Reported Alcohol Intake

They collected data at the beginning of the experimental period, at the end of the experimental period (which they call post-treatment), and at 6-weeks follow up after the end of the experimental period.

Let’s see what they found.

CBT-I and Sleep Hygiene During Early AUD Treatment: The Results

We described the basic components of CBT-I above. Therapists use those techniques to help patients identify the thoughts and emotions that may cause insomnia, which in turn can increase risk of relapse. Patients in the treatment-as-usual group participated in one session on sleep hygiene. Sleep hygiene is a general term describing the latest ideas about improving sleep that everyone can use.

Sleep hygiene sessions – unlike CBT-I sessions – do not focus on thoughts or emotions, but rather, practical tips about getting better sleep. Common sleep hygiene tips include:

• Consistent wake time: get up at the same time every morning.
• Consistent bed time: go to bed in time to get at least 7-8 hours of sleep.
• Create a relaxing evening routine.
• Only use the bed for sleeping or sex.
• Only go to bed when sleepy.
• Keep the bedroom as cool and dark as possible.
• Turn off electronic devices 30 minutes before bedtime.
• No electronic device in bed.
• Avoid large meals before bedtime.
• Avoid alcohol and caffeine before bedtime.

We mention these foundational concepts of sleep hygiene for two reasons. First, they can help anyone learn how to improve their sleep. Second, they’re also part of what any CBT-I therapist would include as part of treatment with CBT-I. Therefore, a person engaging in CBT-I would learn all of those sleep hygiene tips, which a CBT-I therapist would augment with patient-specific techniques – in this case, related to AUD recovery – to support the general tips common to sleep hygiene.

Here are the results.

Sleep Hygiene or CBT-I for AUD-Related Insomnia

Metric 1: Insomnia Severity Index

Experimental group

• Post-treatment: Showed significantly superior improvement in insomnia symptoms, compared to treatment-as-usual group
• 6-week follow-up: Improvement persisted through follow-up

Treatment-as-usual group

• Post-treatment: Showed significantly inferior improvement in insomnia symptoms, compared to experimental group
• 6-week follow-up: Inferior improvements persisted through follow-up

Metric 2: Short Inventory of Alcohol Problems

Experimental group

• Post-treatment: Showed significantly greater decreases in alcohol-related problems at post-treatment
• 6-week follow-up: Decreases in harm persisted through follow-up

Treatment-as-usual group

• Post-treatment: Showed significantly inferior decreases in alcohol problems, compared to experimental group
• 6-week follow-up: Inferior decreases persisted through follow-up

Metric 2: Effect on Heavy Drinking

Experimental group

• Post-treatment: No significant differences between groups
• 6-week follow-up: n/a

Treatment-as-usual group

• Post-treatment: No significant differences between groups
• 6-week follow-up: n/a

We’ll discuss these results below.

AUD Treatment: How CBT-I Can Help Patients Seeking Support

In this study, researchers learned something new: CBT-I can improve sleep and problems related to alcohol in patients early in AUD treatment regardless of whether patients maintain abstinence. Ceasing alcohol intake and full abstinence are the ultimate goals of most people in treatment for AUD. However, in the big picture, reducing harm and problems related to alcohol is an important part of recovery, even for patients who relapse or do not achieve full abstinence.

We’ll repeat: abstinence from alcohol is the ultimate goal for a vast majority of people seeking support for AUD, but reducing alcohol-related harm and alcohol-related problems is a positive outcome that can help patients work toward long-term, sustainable abstinence. This aligns with the most recent studies on what it means to be in recovery. For decades, clinicians and people viewed recovery as binary, defined by abstinence: if you’re abstinent, you’re in recovery, if you’re not abstinent, you’re not in recovery.

Now, experts view recovery differently. Here’s the latest definition, as determined by a group of researchers and experts in the paper “Defining and operationalizing the phenomena of recovery: a working definition from the recovery science research collaborative”:

“Recovery is an individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.”

Experts now see recovery as a process that includes – but does not require – complete abstinence at all phases of the recovery journey. Recovery is a process that involves efforts to achieve abstinence with the overall goal of improving wellness and total health. For people with AUD, total health most often means total abstinence. We support patients seeking total abstinence every day. For others, total health may mean drastically reducing alcohol intake and eliminating the harms caused by alcohol, without the singular goal of total abstinence.

Overcoming Insomnia Helps AUD Recovery

For both groups of people, this new study shows that CBT-I is a valuable and effective tool in reducing insomnia and alcohol-related problems in people early in AUD treatment. Based on these results, we can conclude that when combined with lifestyle changes, community support, and counseling, CBT-I may be effective in helping people achieve abstinence, if that’s their goal. Overcoming insomnia can reduce stress, improve cognition, boost mood, and improve overall wellbeing. While CBT-I did not show superiority to sleep hygiene in reducing heavy drinking days for patients in the study we discuss above, it did help patients improve in areas that facilitate recovery. This is a promising finding, and gives us hope that in the future, clinicians can view CBT-I as an effective, valuable component in an integrated, holistic approach to AUD treatment and recovery.

The post Cognitive Behavioral Therapy, Insomnia, and Alcohol Use Disorder (AUD) appeared first on Pinnacle Treatment Centers.

To learn more about MAT for OUD, please read our treatment page here:

Medication-Assisted Treatment

What many people may not know is that evidence shows medication-assisted treatment can help people with alcohol use disorder (AUD), also. The medications are different, of course, and MAT for AUD always includes an integrated treatment approach, like MAT for OUD. Integrated means that treatment involves more than one modality – counseling/therapy combined with medication, for instance – and addresses all factors that can contribute to the disordered use of alcohol.

To learn about our approach to AUD treatment, please read our page here:

Alcohol Use Disorders

We’re raising awareness about MAT for AUD in this article in response to recent data that shows that consuming alcohol at levels previously considered moderate is associated with significant negative physical outcomes. To learn more about this recent research, and about new information on alcohol and alcohol use in general, please navigate to the blog section of our website and read these articles:

National Alcohol Awareness Month: April 2023

Moderate Drinking, Binge Drinking, and Alcohol-Related Problems

The new view of alcohol use in the medical community is that any level of alcohol use can increase risk of various physical diseases, including cancer. This reverses decades of misunderstanding about alcohol: most people remember hearing that a glass or two of wine with dinner is healthy. While research shows a minor benefit from consuming small amounts of alcohol, increased cancer risk eclipses those benefits.

In light of this new information, it’s important for people who want to reduce their alcohol intake to understand the broad range of treatment options available, including medication-assisted treatment for alcohol use disorder (MAT for AUD).

The Benefits of Medication-Assisted Treatment for Alcohol Use Disorder (MAT for AUD)

The Substance Abuse and Mental Health Services Administration (SAMHSA) published a resource called “Medication-Assisted Treatment for the Treatment of Alcohol Use Disorder: A Brief Guide” that offers in-depth information and creates guidelines for MAT for AUD.

The benefits of MAT for AUD include:

• Reduced alcohol use: evidence shows MAT for AUD can significantly reduce alcohol intake and reduce symptoms of AUD
• Increased mental clarity: MAT for AUD allows patients to rediscover a balanced state of thought and emotion, free from the ups and downs of chronic alcohol use
• Increased ability to participate in counseling and therapy: MAT for AUD can help prepare people for the internal work associated with addiction therapy and counseling
• Reduced cravings: two of the three medications minimize alcohol cravings
• Prevent alcohol use: one of the three medications makes ingesting any alcohol psychologically unpleasant and physically uncomfortable
• Increased ability to make lifestyle changes: MAT for AUD can help patients in recovery make positive changes to their daily routines that promote sustainable recovery

Those benefits make it clear: for people who want to reduce their alcohol intake or stop drinking alcohol altogether, MAT can help. Next, with that in mind, we’ll share the latest data on alcohol use in the U.S., including overall rates of treatment and treatment with MAT.

Alcohol Use in the U.S.: Facts and Figures

It’s true: alcohol is everywhere in our society and culture. People serve and consume alcohol on formal occasions, at informal events, and virtually every type of situation in between those two extremes. Consuming alcohol is a socially acceptable way to relax, socialize, and pass the time. However, for millions of people, casual use can lead to chronic, excessive use. In some cases, it leads to disordered use, which we understand as addiction, or alcohol use disorder.

We retrieved the latest data on alcohol use and alcohol use disorder (AUD) from the 2021 National Survey on Drug Use and Health (2021 NSDUH). Let’s take a look at the real numbers to understand the scope of the alcohol use problem in the U.S.

Here’s the data:

Alcohol Use: Current, Heavy, Binge Drinking, and Alcohol Use Disorder, Age 12+

• Current use: 133.1 million (45%)
• Binge drinkers: 60.0 million (21.5%)
• Binge drinkers by age group:
  • 18-25: 29.2%
  • 26+: 22.4%
  • 12-17: 3.8%
• Binge drinking among underage people: 8.3%
• Heavy alcohol use among underage people: 1.6%
• Alcohol use disorder by age group:
  • 12 + total: 10.6%
  • 12-17: 3.4%
  • 18-25: 15.0%
  • 26+: 10.7%
• Classified as needing treatment for alcohol use: 10.7%

That last bullet point gives us a critical fact. By clinical standards, 32.1 million people each year need treatment for alcohol use. That’s far more than most people realize.

Let’s see how many people who needed treatment received the treatment they needed.

Received Treatment for Alcohol Use

• Received any type of treatment: 0.9% of total
• Location/level of treatment (patients may engage in more than one):
  • Hospital Inpatient: 24.5%
  • SUD/AUD facility inpatient: 31.4%
  • SUD/AUD facility outpatient: 34.5%
  • Behavioral health facility outpatient: 27.5%
  • Emergency room: 14.8%
  • Private doctor: 21.1%
  • Self-help group: 49.3%
  • Virtual treatment: 42.8%
  • While incarcerated: 4.9%
• Received treatment among those classified as needing treatment:
  • Any treatment: 10.7%
  • At specialty facility: 4.7%
• Received medication-assisted treatment for alcohol use:
  • Total: 0.1%
  • Among those with AUD: 0.9%

Those figures tell us that MAT for AUD is dramatically underused. Less than one percent of people who need treatment for AUD engage in MAT for AUD. That means that out of the 32.1 million people who need treatment for alcohol use, around 32,100 engage in MAT for AUD.

That’s a treatment gap – with regards to MAT – of 99.9 percent. That’s far too large. We encourage anyone who knows someone trying to reduce or stop drinking to consider medication-assisted treatment, which we’ll discuss in detail below.

What Are the Medications for Alcohol Use Disorder?

There are three medications approved by the Food and Drug Administration (FDA) for the treatment of alcohol use disorder: Naltrexone, Acamprosate, and Disulfiram. We’ll describe each of these medications below, beginning with Naltrexone.

Naltrexone

How it works:

• Blocks brain receptors associated with alcohol reward
• Blocks brain receptors associated with alcohol craving

Method of delivery:

• Oral, daily, or as directed
• Extended-release injection, monthly

Initiation:

• Requires abstinence from opioids
• Abstinence from alcohol preferred – evidence shows Naltrexone is not effective in patients who are drinking upon initiation

Side effects:

• Common: nausea, sleepiness, headache
• Uncommon: Anxiety, vomiting, liver problems, confusion
• Contraindicated for people on long-term opioid treatment for chronic pain

Acamprosate

How it works:

• Affects brain receptors associated with alcohol craving
• Restores balance to brain receptor systems associated with reward
• Does not prevent action of alcohol in brain
• May reduce severity of withdrawal symptoms, but doesn’t prevent withdrawal

Method of delivery:

• Oral, three times per day
• Extended-release injection, monthly

Initiation:

• Requires full detoxification and abstinence from alcohol

Side effects:

• Common: diarrhea
• Uncommon: Anxiety, insomnia, muscle weakness
• Contraindicated for people with kidney problems

Disulfiram

How it works:

• Makes drinking alcohol unpleasant. Causes:
  • Shaking
  • Sweating
  • Anxiety
  • Nausea
  • Vomiting
• Does not prevent withdrawal, reduce cravings, or affect reward systems in brain, but the severe effects listed above are effective in deterring people from drinking alcohol

Method of delivery:

• Oral, once daily
• Extended-release injection, monthly

Initiation:

• Requires full detoxification/abstinence from alcohol

Side effects:

• Common: drowsiness, metallic taste in mouth, headache
• Uncommon: fatigue, weakness, yellowing of skin/eyes, vomiting
• Contraindicated for people with myocardial disease, hypothyroidism, epilepsy, hepatitis, people with high levels of impulsivity or suicidality, and people over age 60.

Medication-Assisted Treatment for Alcohol Use Disorder: How Assessment and Initiation Work

The process for starting MAT for AUD is similar to starting any alcohol or substance use treatment program. The first thing that happens – after an initial contact call/meeting with a potential provider – is a comprehensive biopsychosocial assessment.

During a biopsychosocial assessment, a licensed and qualified provider collects information in the following areas:

Biological:

• Complete medical history
• Family history of medical and mental illness
• Substance Use/Misuse history
• Developmental history
• Current level of physical function and abilities

Psychological:

• Current psychiatric symptoms or illnesses
• Past psychiatric symptoms or illnesses
• Current mental/psychological status
• Family history of mental illness
• Current psychiatric medication/treatment
• Past psychiatric medication/treatment
• Current psychological stressors
• History of trauma or traumatic experiences

Social:

• Current level of social function
• Current home situation
• Status of family, peer, and other relationships
• Gender identity and sexuality
• Family history
• History of trauma
• Educational background
• Legal history
• Work history

Once a qualified provider completes an assessment and confirms the need for treatment, one treatment they offer may be medication-assisted treatment (MAT) with one of the three medications we describe above. If a patient agrees to MAT for AUD, then the provider and patient collaborate to create an individualized treatment plan.

Treatment Plans for MAT with AUD: Essential Components

SAMHSA clearly outlines the guidelines for medication-assisted treatment for alcohol use disorder. The most important thing to understand is that in any MAT program – whether for alcohol or opioids – the medication is one part of a complete treatment plan.

SAMSHA indicates treatment plans using MAT for AUD should include:

• Detailed information about the medication, including:
  • The need to inform all medical providers about the medication
  • Any symptoms or side effects that should be reported to a doctor immediately
  • Clear dosage/use instructions
• Detailed information on additional treatment components, including:
  • Therapy
  • Counseling
  • Lifestyle changes, including healthy eating, activity/exercise, sleep hygiene
  • Community/peer support
  • Complementary support, such as yoga, mindfulness, and stress management
• The purpose and importance of the non-medication components of treatment
• Educational workshops on the following:
  • The science of addiction and AUD
  • Relapse prevention
  • Relationship repair
  • Practical recovery tips
• A schedule for follow-up office visits and tests to monitor progress and assess any side effects related the medication in use
• Participation of family or significant other, when possible and deemed beneficial
• A plan for treating any co-occurring psychiatric conditions
• A plan for treating any other substance use disorders or issues
• Clear benchmarks and criteria for:
  • Discontinuing the use of medication
  • Discharge from treatment
  • Referral to a more immersive level of care, if needed

We would add one component to this list: a robust aftercare plan that stresses the value of community support, relapse prevention plans, and what to do in case of relapse. An aftercare plan includes medical resources, psychiatric resources, substance use treatment resources, and information on community support groups like Alcoholics Anonymous (AA) and others.

Ongoing Support for AUD: What Happens After Discharge?

A patient who engages MAT for AUD may continue to take medication for a long period of time after their formal treatment program ends. However, they still need to engage in an active recovery plan and refine their stress management and recovery skills over time. That’s another – and perhaps the most important – component of an aftercare plan: a list of all the things that worked for each patient during treatment. What works for one person may not work for another. That’s why each aftercare plan is unique, like each treatment plan.

For instance, some patients may love exercise, and find that for them, daily activity keeps them on track and helps them maintain sustainable, long-term recovery. On the other hand, some patients may feel the same way about yoga, mindfulness, and meditation: it works and keeps them on track. In addition, still others may find daily community support meetings keep them on their program: accountability and frequent contact with recovery peers makes all the difference.

What we want people seeking treatment and support for alcohol use for themselves or for a friend or loved one to know is that MAT is a safe, effective option that can help reduce alcohol consumption and begin their recovery journey. Finally, we want people seeking treatment for AUD to know and understand this:

The sooner a person who needs treatment for AUD gets the treatment they need, the better the outcome.

The post Medication-Assisted Treatment for Alcohol Use Disorder (MAT for AUD) appeared first on Pinnacle Treatment Centers.

Methadone Programs Save Lives

People in treatment for opioid addiction face a simple fact: all available evidence indicates relapse rates are very high.

Relapse is defined as a return to drug use after a significant period of non-use.

Estimates show that between 70% and 90% of people who try to quit using opioids without professional support relapse within 12 to 36 months.

However, those estimates leave out one thing. People who participate in methadone maintenance programs relapse far less frequently than people in other types of treatment programs. In fact, some studies show that people who receive treatment at licensed methadone clinics have a relapse rate between 32% and 44%. That’s a significantly lower rate than non-methadone programs. It’s also lower than abstinence-only programs for other substances such as alcohol or cocaine.

That begs the question. Why are methadone programs so much more effective than other approaches?

Because a methadone program is not just about methadone.

Methadone reduces the symptoms of withdrawal, reduces cravings, and blocks the action of other opioids in the brain.  This helps people in a methadone program get through the first week of treatment, which many say is the most difficult.

All that is true. It’s a big part of why methadone treatment is effective.

But that’s not the whole story.

When an individual commits to treatment in an Opioid Treatment Program (OTP) that’s certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA), federal law requires that OTPs provide the following:

• Professional support:
  • OTPs are required to provide counseling for substance use disorder – a.k.a. substance abuse counseling – provided by a program counselor with the appropriate credentials, education, and experience to assess their psychological and social needs
• Education:
  • OTPs are required to provide educational workshops and classes on addiction, safety, and prevention of communicable diseases related to opioid use.
• Community Engagement:
  • OTPs are required to provide support, mentorship, and guidance necessary to access community resources, vocational rehabilitation, ongoing education, and employment services.
• Treatment Plan:
  • OTPs are required to design a treatment plan that includes relapse prevention techniques, stress management techniques, and recommend lifestyle changes such as healthy eating, regular exercise, and other activities that support long-term recovery.

Evidence shows that when an individual participates in a detoxification program only and does not follow detoxification with a medication-assisted treatment program (MAT) such as a methadone program that includes counseling, community support, education, and a comprehensive treatment plan, they often relapse within days – if not the same day they leave detox.

What is Methadone?

Here’s how SAMHSA describes methadone:

“Methadone is a medication approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD) as a medication-assisted treatment (MAT). When taken as prescribed, methadone is safe and effective. Methadone helps individuals achieve and sustain recovery and to reclaim active and meaningful lives. Methadone is one component of a comprehensive treatment plan, which includes counseling and other behavioral health therapies to provide patients with a whole-person approach.”

Researchers first synthesized the compound that became known as methadone in the early 1940s while searching for an alternative to opioids for pain relief and exploring treatments for asthma and other respiratory conditions.

In the late 1940s, several U.S. pharmaceutical companies produced and sold methadone as an oral cough medication. In the early 1950s, Dr. J.F. Maddux treated people with heroin and morphine use disorders with oral methadone in a United States Public Health Service (USPHS) hospital in Fort Worth, Texas.

His work led to the opening of the first methadone clinic in New York City in 1964.

Following an exhaustive process of clinical research and safety trials, the Food and Drug Administration (FDA) approved methadone replacement therapy as a long-term treatment for opioid addiction. Over the following five decades, researchers have confirmed methadone as an effective and safe treatment for all types of opioid use disorder (OUD), including addiction to prescription opioids such as oxycontin and illicit opioids such as heroin.

The Benefits of Methadone Programs

Evidence published by SAMHSA shows that methadone treatment programs:

• Decrease opioid use
• Decrease opioid-related overdose deaths
• Reduce criminal activity
• Reduce transmission of infectious diseases
• Improve social functioning
• Increase time in treatment
• Improve ability to participate in family life
• Increase ability to seek and gain employment

It is due to these benefits that SAMSHA says “…Methadone helps individuals achieve and sustain recovery and to reclaim active and meaningful lives.”

Since methadone works so well and has a long history of safe and effective use for OUD treatment, why is there still so much stigma around methadone treatment?

The answer: myths and misinformation. Here are four common myths about methadone:

1. People use methadone to get high.
2. People in methadone programs lack willpower.
3. Methadone programs just replace one addiction with another.
4. Methadone programs are for heroin addiction only.

Thankfully, we know how to address these myths. We published a series of articles to refute each of these misconceptions in clear, simple, and direct language. If you read the myths listed above and agree with them, we encourage you to click the links and read the articles.

We hope that when you finish, you can re-evaluate your opinions and decide for yourself. Experts say the harm reduction approach, which includes methadone treatment and other forms of MAT, leads to better outcomes than the traditional, abstinence-only approach to treatment.

We concur.

While abstinence is, of course, the final goal, it’s one part of the big picture. We embrace this treatment model because helps people. It saves lives, improves communities, and reduces the overall negative impact of opioid addiction on society as a whole.

Methadone Treatment at Pinnacle Treatment Centers

In our medication-assisted treatment programs, we use every tool available – including Methadone – to help as many people as possible achieve sustainable recovery and rebuild a full, vibrant, purpose-driven life beyond opioid addiction.

The post Medication-Assisted Treatment: Methadone Treatment for Opioid Use Disorder (OUD) appeared first on Pinnacle Treatment Centers.

Suboxone: Office-Based Opioid Treatment (OBOT)

People seeking treatment for opioid addiction should understand three things about Suboxone:

1. It’s safe.
2. It’s very effective.
3. It’s available in outpatient, office-based opioid treatment programs that meet federal, state, and local regulations.

Those three things are important for family and friends of people with OUD to understand as well. They need to know their friend or loved one is receiving the best possible support for their addiction disorder.

The Benefits of Suboxone

Suboxone is part of an overall approach to addiction treatment called medication-assisted treatment (MAT). Within MAT, Suboxone has a strong evidence base spanning over thirty years. It’s approved by the Food and Drug Administration (FDA). It’s recommended by the Substance Abuse and Health Services Administration (SAMHSA) as an evidence-based treatment for people with opioid use disorder. Clinics that dispense Suboxone must be supervised by a licensed prescriber who meets the clinical guidelines outlined by SAMHSA and the Department of Health and Human Services (HHS). Prescribers who participate in Suboxone treatment include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives.

Benefits of treatment with Suboxone include:

• Decreased risk of drug-related death
• Decreased rate of relapse
• Decreased transmission of infectious diseases such as HIV and hepatitis
• Increased time-in-treatment
• Increased quality of life
• Improved psychological functioning
• Improved social functioning

Suboxone is unique among other MAT medications – such as methadone – because it’s designed to simultaneously reduce cravings and symptoms of withdrawal while blocking the action of other opioids in the brain. What this means is that a person on a stable dose of Suboxone does not get high from Suboxone. And if they take other opioids while on Suboxone, those opioids will have no effect. That’s why the federal government eased restrictions on Suboxone in 2018. The ingredients in Suboxone made it an ideal medication to reduce barriers to treatment and expand access to MAT for opioid use disorder.

What is in Suboxone?

Suboxone is a combination of two medications – buprenorphine and naloxone – that work in tandem. The two medications help people with opioid use disorder manage the symptoms of opioid withdrawal, block cravings for opioids, and reduce negative behavior associated with opioid addiction.

According to the Substance Abuse and Health Services Administration (SAMHSA):

“Buprenorphine is a safe and effective alternative medication for people with OUD…for whom treatment in a methadone clinic is not appropriate.”

Buprenorphine is a partial opioid agonist. It works by binding to the same chemical structures in the brain as opioids, including illicit opioids like heroin and black-market fentanyl, or prescription opioids such as hydrocodone. Evidence for the effectiveness of buprenorphine in addiction treatment dates back to initial research performed in the mid-1980s and early 1990s. This evidence been verified and confirmed by more recent research performed over the past five years. The benefits of buprenorphine treatment reported in those studies are the same as the benefits of Suboxone we list above.

Now let’s talk about the second medication in Suboxone, naloxone.

According to the Substance Abuse and Health Services Administration (SAMHSA):

“Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone.”

Naloxone is the drug most people know of as the medication first responders, law enforcement agents, and emergency room nurses and doctors use to prevent overdose death. In the context of MAT for OUD, naloxone has a different function. In Suboxone it has almost no pharmacologic effect and was added to deter misuse.

Now let’s talk about how treatment for Suboxone works.

Office-Based Opioid Treatment: Suboxone

The federal guidelines that expanded access and reduced barriers to treatment of people with OUD included an updated set of best practices designed for physicians and staff who provide office-based MAT for OUD. These guidelines require providers to:

1. Fully assess the need for treatment. Assessments must include:
   • Full medical and psychiatric history
   • Full prescription drug history
   • Complete physical examination focusing on addiction complications
   • Comprehensive lab testing to assess opioid and other drug use
2. Educate potential patients about Suboxone.
   • Providers must discuss the benefits and risks associated with Suboxone, including risk of overdose, risk of relapse, and risk of using other drugs while on Suboxone
3. Evaluate the need for medically managed withdrawal.
   • Initiation of any buprenorphine treatment – including Suboxone – cannot begin until an individual is in the initial stages of withdrawal. Initiation must be directed by a federally licensed medical provider.
4. Screen for co-occurring disorders.
   • Any treatment plan including MAT must consider the role of mental health disorders in addiction treatment and recovery
5. Integrate treatment methods.
   • When possible, providers are strongly encouraged to provide access to psychosocial services, such as mental health counseling
6. Refer patients to a more intensive level of care as needed.
   • If a provider determines office-based MAT is not effective for an individual, they’re encouraged to refer that individual for more intensive or specialized level of care.

What these guidelines tell us is that, like the role of methadone in an opioid treatment program:

Suboxone treatment is not only about the Suboxone.

It’s true. Restrictions have eased. And while rules requiring counseling and therapy are not as strong as they were before 2018, they’re still there. The guidelines prioritize an integrated, whole-person approach to addiction treatment. However, to help as many people as possible, reduce harm, and mitigate the negative effects of opioid addiction in as many communities as possible, the new SAMHSA advisory makes it clear:

“Buprenorphine [Suboxone] should be part of a comprehensive management program that includes psychosocial support. Providers should not withhold treatment in the absence of psychosocial support.”

That means the positive effects of Suboxone are persuasive. Lawmakers and the medical community determined that, based on the latest evidence, Suboxone is safe to administer in office-based treatment centers. The new rules allow suboxone treatment even when access to professional mental health treatment and auxiliary support is not available.

That’s a big step forward.

How did we get here?

MAT and Suboxone: From Stigma to Essential Support

The past twenty-two years have brought significant changes to medication-assisted treatment (MAT) for opioid use disorder. Three federal laws expanded MAT beyond the standard methadone treatment previously allowed by federal law only in licensed Opioid Treatment Programs (OTPs):

1. The Drug Addiction Treatment Act of 2000 (DATA 2000). This law allowed physicians to prescribe medication for opioid use disorder in office-based settings.
2. The Comprehensive Addiction and Recovery Act of 2016 (CARA). This law increased the number of patients that individual physicians could offer MAT.
3. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities or SUPPORT for Patients and Communities Act of 2018 (SUPPORT Act). This law allowed more providers to prescribe medication for OUD. The expanded list includes Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs).
4. The Mainstreaming Addiction Treatment Act of 2022 (MAT 2022). This law reduced restrictions around buprenorphine prescribing, increases access to MAT in underserved communities, and established policies to reduce stigma surrounding MAT.

The first law responded to advances in the use of MAT for OUD and reflected the decreasing stigma around MAT. The second law was our first nationwide response to the opioid crisis, and gave more people access to MAT. The third law doubled down on our nationwide response to the opioid crisis. It reduced barriers to treatment by increasing the number of providers allowed to evaluate and prescribe medications for opioid use disorder, including Suboxone. The fourth law made permanent many of the changes established during the COVID-19 pandemic and establishes a structure for implementing a nationwide harm-reduction approach to the opioid crisis.

Suboxone Treatment at Pinnacle Treatment Centers

In our Office-Based Opioid Treatment Programs, we use every tool available – including Suboxone – to help as many people as possible achieve sustainable recovery and rebuild a full, vibrant, purpose-driven life beyond opioid addiction.

The post Suboxone Treatment for Opioid Use Disorder appeared first on Pinnacle Treatment Centers.

While researching that article, we found a report that caught our attention:

Evidence Based Strategies for Abatement of Harms from the Opioid Epidemic

We’re always looking for evidence-based strategies to mitigate the harm caused by the opioid epidemic. It’s one of our core goals. This report caught and held our attention not only because of the title and the subject matter, but also because of the impressive array of contributors. Authors of the report include representatives from Harvard University School of Health, Johns Hopkins School of Public Health, Yale University, Stanford University, and others – a group that sets the standard for excellence in scientific research. The contributors were organized by the non-profit advocacy group Partnership to End Addiction.

Here’s a description of the report from the introduction:

“This report was designed to support and empower state and local officials in making critical allocation decisions and consolidates the best research evidence to provide recommendations for high-impact investments that will improve the addiction treatment system, strengthen prevention and harm reduction programming, and address substance use disorder.”

It’s our goal to use this article to empower any of our current, former, or potential patients with the latest evidence on best clinical practices in the treatment of opioid use disorder (OUD). To accomplish this goal, we’ll offer a summary of the report, which we’ll call “The Partnership Report” for the rest of this article. We’ll describe the sources the study authors used to evaluate the evidence, the classification system they used to determine the effectiveness of the various treatment modalities. Finally, we’ll share the conclusions they reached about the modalities themselves.

Ready?

The Partnership Report on Evidence-Based Practices for Treatment of Opioid Use Disorder (OUD)

First, we’ll review the sources the Partnership team used to review and evaluate the evidence for the various treatment modalities reviewed in the report.

The Sources

The authors gathered evidence supporting treatment for opioid use disorder from five major scientific studies published on the topic since the beginning of the opioid crisis. Unless otherwise noted, these studies are the source of the authoritative content presented and discussed throughout the rest of this article:

1. Medications for Opioid Use Disorder Save Lives, published by The National Academy of Sciences in 2019. Click here for the full .pdf document.
2. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, published by the National Institutes of Health in 2016. Click here for the full .pdf document.
3. Facing Addiction in America: The Surgeon General’s Spotlight on Opioids, published by the National Institutes of Health in 2018. Click here for the full .pdf document.
4. National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use, published by The American Society of Addiction Medicine in 2015. Click here for the full .pdf document
5. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence, published by The World Health Organization (WHO) in 2009. Click here for the full .pdf document.

The authors chose these studies because each involved a thorough analysis of all the available research, to date, on the specific topic addressed in the study. They gave preference to meta-analyses and review articles that included random-controlled trials (RCTs), real-world clinical trials, and large-scale population studies.

The Evaluation

When considering each of the treatment modalities under review, authors used a classification system adopted by the Centers for Disease Control in 2011. Here’s how they ranked each modality:

• Well supported: Evidence includes data from multiple controlled trials and/or large-scale population studies.
• Supported: Evidence includes data from rigorous, well-designed, and well-reviewed studies, but from fewer studies with smaller sample sizes
• Promising: Evidence or findings not found in rigorous scientific studies, but is practical, sensible, and already in use in many treatment programs.

The Modalities

The study authors evaluated the primary components of integrated, personalized treatment plans based on best clinical practices for the treatment of opioid use disorder. Reviewed modalities included treatments in the following categories:

1. Medications for opioid use disorder (MOUD)
2. Behavioral therapies
3. Recovery support

When a treatment program for people diagnosed with OUD includes modalities from all three categories, their chances of achieving sustainable recovery increase, compared to programs that don’t include treatments from all three categories.

We’ll now present the review of the evidence for these treatment modalities, beginning with medications for opioid use disorder (MOUD).

Medications for Opioid Use Disorder: What the Evidence Shows

There are the MOUDs approved by the Food and Drug Administration (FDA) for treating OUD: methadone, buprenorphine, and naltrexone. Treatment involving MOUDs is called medication-assisted treatment (MAT). The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as “…the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

We’ll discuss each of these MOUDs, beginning with methadone.

Methadone: Evidence and Evaluation

About Methadone

Methadone is a full opioid agonist, meaning it occupies opioid receptors in the brain and prevents other opioids from occupying those receptors. Treatment with methadone can prevent/reduce symptoms of withdrawal from opioids and reduce cravings for opioids, without the extreme euphoria associated with most opioids. Methadone allows patients to achieve the psychological and emotional stability that allows them to participate in the counseling, treatment, and life-repair components of treatment.

Evidence

The studies reviewed show robust evidence for the following outcomes for people with OUD who participate in MAT with methadone:

• Reduced number of overdoses
• Reduced overall mortality
• Decreased injection drug use
• Reduced transmission of infectious disease
• Increased social function
• Decreased criminal activity
• Decreased use of other opioids

Evaluation

After a review of the evidence, the study authors concluded methadone is a well-supported treatment for opioid use disorder.

Overall, experts in addiction treatment consider methadone the “gold standard” treatment for people with OUD.

Buprenorphine: Evidence and Evaluation

About Buprenorphine

Like methadone, buprenorphine can prevent/reduce symptoms of withdrawal from opioids and reduce cravings for opioids, without the extreme euphoria associated with most opioids. Unlike methadone, buprenorphine is a partial opioid agonist. This creates both a benefit and a drawback. The benefit: it can’t produce the mild euphoria, or the respiratory depression associated with methadone. The drawback: it doesn’t prevent withdrawal symptoms and cravings as effectively as methadone. Overall, the benefits far outweighs the drawbacks, because it reduces the chance of diversion for illicit purposes, thereby drastically reducing likelihood of misuse and overdose.

Evidence

The studies reviewed show robust evidence for the following outcomes for people with OUD who participate in MAT with buprenorphine:

• Improved overall patient outcomes
• Reduced overdose rates
• Increased time-in-treatment
• Reduced injection drug use
• Reduced transmission of infectious disease
• Increased social function
• Reduced criminal activity
• Reduced use of other opioids

Federal guidelines require pharmaceutical companies to combine buprenorphine with naloxone in a medication commonly known as Suboxone. When used as directed, naloxone remains inactive. However, when injected or ingested orally, it immediately occupies opioid receptors and precipitates withdrawal. This prevents diversion and drastically reduces the use of Suboxone for recreational purposes.

Evaluation

After a review of the evidence, the study authors concluded buprenorphine is a well-supported treatment for opioid use disorder.

Overall, experts in addiction treatment consider buprenorphine a “…second-line therapy [for OUD] for patients in whom methadone is unwanted, inappropriate, or ineffective.”

Naltrexone: Evidence and Evaluation

About Naltrexone

Naltrexone, unlike methadone and buprenorphine, which are opioid receptor agonists, is a full opioid receptor antagonist. This means it prevents other opioids from occupying opioid receptors without activating the opioid receptors themselves. This characteristic of naltrexone prevents the possibility of opioid intoxication/euphoria and opioid overdose. That makes naltrexone the safest of the three FDA-approved MOUDs.

Naltrexone may be an attractive alternative for some patients and prescribing physicians for three reasons. First, since it’s not an opioid or controlled substance, the DEA doesn’t require a special license to prescribe it: this makes it more accessible to patients seeking treatment. Second, there is no risk of diversion, since naltrexone does not induce euphoria or intoxication. Third, the only FDA-approved formulation of naltrexone – Vivitrol – is available only in extended release injections that last 30 days. Therefore, patients only need to see their doctor once a month to maintain treatment with naltrexone.

Evidence

The studies reviewed show evidence for the following outcomes for people with OUD who participate in MAT with naltrexone:

• Decreased rates of opioid use
• Decreased opioid cravings
• Reduced polysubstance use

Naltrexone is most often recommended for patients who:

• Went through withdrawal in an abstinence-based program or while incarcerated, and want to prevent relapse
• Have completed an MAT program with methadone or buprenorphine and want to taper off all opioid medication completely
• Are younger: naltrexone is often preferred by adolescent or young adults

Note: Patients must be abstinent form opioids for three full days before initiating treatment with naltrexone.

Evaluation

After a review of the evidence, the study authors concluded buprenorphine is a supported treatment for opioid use disorder.

Data shows that in comparison to other MOUDs, naltrexone has the lowest rates of initiation and shortest average time-in-treatment. While it is extremely effective in preventing relapse, overdose, and opioid-related euphoria, the specific characteristics of naltrexone make it a less attractive option for many patients.

That’s the evidence contained in the Partnership Report on treatment for opioid use disorder with MOUDs. Next, we’ll look at the evidence for behavioral therapies.

Behavioral Therapies for Opioid Use Disorder: What the Evidence Shows

Behavioral therapies for people diagnosed with OUD generally take two forms: counseling and psychotherapy. Both are similar in that these interventions revolve around formalized, structured interactions between the patient in treatment and the counselor or therapist. In general, both counselors and therapists are trained and licensed professionals. Therapists have more training in treating mental health disorders, while addiction counselors are trained to support people in recovery from the disordered use of substances.

We’ll review the evidence base for three behavioral therapies: contingency management, cognitive behavioral therapy, and family therapy. We’ll begin with contingency management.

Contingency Management: Evidence and Evaluation

About Contingency Management

Contingency management is a type of addiction counseling that’s effective alone, and more effective when combined with medication-assisted treatment. Treatment programs often pair contingency management with cognitive behavioral therapy (CBT) and family therapy. The process of contingency management involves giving small, practical rewards for behavior that aligns with the recovery goals of a patient in treatment for OUD. Rewards can include vouchers for shopping at local stores or vouchers for desired recreational activities, such as going to a movie.

Evidence

The studies reviewed show evidence for the following outcomes for people with OUD who engage in the contingency management modality:

• Longer time-in-treatment
• Increased rates of abstinence
• Improved social functioning
• Improved personal functioning

Evaluation

After a review of the evidence, the study authors concluded contingency management is a well-supported treatment for opioid use disorder.

Evidence shows contingency management is most effective when people in MAT programs identify take-home medication as a reward for negative drug tests and when people in MAT programs identify vouchers for goods or services as a reward for negative drug tests.

Cognitive Behavioral Therapy (CBT): Evidence and Evaluation

About CBT

CBT is a well-researched approach to the treatment of a variety of mental health and substance use disorders. During CBT sessions, a trained therapist helps patients identify counterproductive, negative thoughts and feelings or behaviors and replace them with positive, productive thoughts and feelings. In most cases, CBT therapists teach patients practical tools to accomplish this goal. In treatment for opioid use disorder, the primary goal of CBT is to help patients identify and replace patterns of thought and behavior associated with opioid use with patterns of thought and behavior associated with recovery.

Evidence

The studies reviewed show evidence for the following outcomes for people with OUD who engage in cognitive behavioral therapy (CBT):

• Improved stress management
• Improved general coping skills
• Increased ability to refuse drugs
• Improved problem-solving skills
• Enhanced self-control

Evaluation

After a review of the evidence, the study authors concluded cognitive behavioral therapy is a well-supported treatment for opioid use disorder.

The American Society of Addiction Medicine (ASAM) found that CBT shows “evidence of superiority” compared to other behavioral therapies when used in MAT programs with MOUD, and the National Academies of Science found that CBT is “empirically supported” when combined with MOUD.

Family Therapy: Evidence and Evaluation

About Family Therapy

The underlying assumption behind the use of family therapy in addiction is that in order to understand an individual, it’s essential to understand the dynamic web of human relationships within which that individual grew up. When suggesting family therapy to a patient in OUD treatment, for instance, a therapist might say something like this:

“To get to know you, it will help if we get to know your family, too.”

In addition, when family members know what a person in treatment is going through, they know how to better support them upon discharge from treatment.

Evidence

The studies reviewed show family therapy during OUD treatment can lead to the following beneficial outcomes:

• Longer time-in-treatment
• Increased treatment engagement
• Improved overall treatment experience
• Improved communication skills

Evaluation

After a review of the evidence, the study authors concluded family therapy is a well-supported treatment for opioid use disorder.

The study authors point out that family therapy can improve interpersonal family relationships and basic interpersonal communication skills. These skills can translate to reduced baseline levels of stress and reduced baseline levels of interpersonal conflict, which can decrease likelihood of relapse and improve the chance of achieving long-term recovery.

That’s the evidence the Partnership Report provides for the effectiveness of behavioral therapies in treatment for opioid use disorder (OUD). The third and final category of treatment addressed in the report is Recovery Support, which we’ll discuss now.

Recovery Support for Opioid Use Disorder: What the Evidence Shows

Recovery support refers to a broad range of services for people with OUD. In most cases, recovery support refers to non-treatment modalities that help patients in treatment focus on the treatment and recovery process, rather than the details of life outside of treatment.

We’ll discuss these supports and the evidence base for this category of treatment in a different way than we did for MOUDs and behavioral therapy, primarily because – with two notable exceptions – recovery support is a relatively new concept in addiction treatment. As of 2023, a credible evidence base exists for two recovery support modalities: drug-free housing and mutual self-help groups are well-supported modalities for opioid use disorder (OUD). The rest of the modalities we discuss next are considered promising modalities for opioid use disorder (OUD).

Recovery support services include the following:

Drug-Free Housing

• Patients in treatment live in housing that requires drug testing, along with other patients in treatment for OUD or other substance use disorders.
• Evidence-based benefits of drug-free housing include sustained abstinence, reduced substance use, increased employment, and reduced illegal activity.

Mutual Self-Help Groups

• Mutual self-help groups are commonly known as 12-step groups and include peer support meetings like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
• AA and NA are two of the most extensively studied addiction treatment modalities.
• Experts conclude AA/NA type-program are effective components of treatment and recovery for people with OUD, or any other substance use disorder.

Childcare

• This is exactly what it appears to be: helping parents in treatment by arranging childcare when they’re actively engaged in treatment activities.
• While there’s little evidence to support outcomes for childcare during treatment, it’s logical to assume that offering childcare services could increase both treatment initiation and retention, and reduce overall stress that can contribute to substance use and relapse to substance use.

Employment Counseling and Support

• This is also exactly what it sounds like: helping patients in treatment seek and secure gainful employment.
• Like with childcare, there’s little evidence to support improved outcomes for vocational counseling/support during treatment. And like childcare, it’s logical to assume that helping people find and keep a job can improve self-esteem, address housing and food instability, and reduce overall stress that can contribute to substance use and relapse to substance use.

Case Management

• Some treatment centers offer case management services. Case managers help people manage non-treatment details/support related to treatment. These include healthcare beyond addiction treatment, such as care for physical and mental illness. Case managers help patients identify and access all the support available to them, as provide by private insurance, their treatment program, or public social services.
• As of now, there is no real evidence base that indicates case management improves outcomes. However, as with childcare and vocational support, it’s logical to assume that case management can improve overall treatment outcomes. Therefore, it’s a recommended component of effective treatment programs.

Peer Support/Peer Support Specialists

• Many treatment centers engage the help of peer support specialists, who are people in recovery with direct, personal, experiential knowledge of the treatment and recovery process.
• When people in recovery from OUD meet and spend time with other people with OUD who are further down the road to recovery, the relationships they form can become pivotal components to treatment.
• A person in treatment may be more likely to listen to someone who has literally “been there and done that” as opposed to a clinician with no personal history of substance use and no direct experience with the recovery process outside of their professional work.
• This is a widespread, sensible practice. People in recovery cite the value of peer support and peer specialists, but as of now, there’s no real evidence base for this type of peer support, as there is for programs like AA or NA.

That’s the information the Partnership Report provides for the effectiveness of recovery support services in treatment for opioid use disorder (OUD). We’ll add that recovery support – although the least supported by evidence – is an important and promising component of OUD treatment. It’s also worth reiterating that Alcoholics Anonymous (AA) is a type of recovery support. It’s one of the most effective and extensively researched modalities in addiction treatment, and the AA model of honest, open, non-judgmental peer support suffuses most evidence-based treatment programs available.

How This Information Helps

The primary reason we wrote this article is to share the evidence base for the treatment modalities we use at Pinnacle Treatment Centers. We offer almost all of the treatment modalities above at almost all of our treatment centers nationwide. We’re proud of our clinical standards and proud of our commitment to evidence-based treatment for opioid use disorder (OUD). That means we were pleased when we found this report. It confirmed something we knew already: our approach to OUD treatment is well-supported by an extensive evidence base.

But our pride and happiness with our offerings is unimportant. What’s important is that any current, potential, or former patient – and their family and friends – can rest assured that the personalized addiction programs we offer at Pinnacle Treatment Centers are well-supported by the latest peer-reviewed scientific research and evidence.

The post The Evidence Supporting Opioid Use Disorder Treatment appeared first on Pinnacle Treatment Centers.

About PRIDE Month: Origins and History

The origins of the gay rights movement in the United States goes back further than most people think. Notable figures in the early movement include the work of Henry Gerber and The Society for Human Rights in the 1920s and the Mattachine Society and the Daughters of Bilitis in the 1940s and 1950s. Those pioneers paved the way for the gay rights revolution that followed, and we all owe a debt of gratitude to their courage and perseverance in the face of significant – and often violent – opposition,

The modern movement started in 1970 with the first Gay Pride marches in various cities around the U.S. Advocates organized those marches in response to the Stonewall Uprising in New York City the previous year, during which gay rights advocates clashed with police in protests lasting several days. In the ensuing 50 years, the movement has expanded.

In 2023, LGBTQIA+ people can celebrate PRIDE month by participating in marches, rallies, parades, concerts, workshops, and educational events around the world. At every event, LGBTQIA+ people will take heart in seeing the gay pride flag flying high to remind themselves of not only the solidarity they now experience but also of the long road it took to get where we are today.

Behavioral Health and the LGBTQIA+ Community: What You Should Know

Here’s something the experts at the National Institutes of Health (NIH) observe that we should all understand:

“People who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) often face social stigma, discrimination, and other challenges not encountered by people who identify as heterosexual. They also face a greater risk of harassment and violence. As a result of these and other stressors, sexual minorities are at increased risk for various behavioral health issues.”

Behavioral health issues include clinical mental health diagnoses such as depression and anxiety, among others, and well as the disordered use of substances, including alcohol, opioids, and others. To explore the differences in rates substance use and co-occurring mental substance use and mental health disorders between LGBTQIA+ people and people in the gender and sexual majority, researchers administering the National Survey on Drug Use and Health (2020 NSDUH) collected and analyzed data on the following:

• Prevalence of substance use, misuse, and disordered use among people in the LGBTQIA+ community
• Prevalence of co-occurring disorders among people in the LGBTQIA+ community

We’ll share that data now, starting with rates of alcohol, opioid, and methamphetamine use and misuse. We’ll include the rates identified in the non-LGBTQIA+ community for comparison. We include data on methamphetamine use because research shows methamphetamine misuse is a primary driver of the recent increase in drug overdose deaths in the U.S.

Before we share that data, there are a few basic facts about the LGBTQIA+ community everyone should know.

The LGBTQIA+ Experience: More Facts You Should Know

When we discuss the LGBTQIA+ community, addiction, and behavioral health, there are several key points we need to mention:

1. Diversity. The LGBTQI+ community is not monolithic: that’s why their symbol is a rainbow flag. There are LBGTIA+ people in and of every culture, ethnicity, race, religion, nationality, and socioeconomic class in the world.
2. Stigma. These two statistics explain part of the stigma and discrimination LGBTQIA+ people face:
   1. 40% of LBGTQIA+ adults experience negative judgment and/or rejections from family and friends
   2. 86% of LGBTQIA+ youth experience bullying and/or harassment at school
3. Mental Health.
   1. Members of the LGBTQI+ community are twice as likely to develop a mental health disorder, compared with people in the gender/sexual majority
   2. Transgender individuals are four times as likely to develop a mental health disorder, compared with people in the gender/sexual majority
4. Suicide. LGBTQI+ youth and adults are at increased risk of suicide attempts and suicidal ideation. Key statistics:
   1. LGBTQI+ youth are twice as likely to attempt suicide than non-LGBTQI+ youth.
   2. Over 50% of transgender individuals report considering suicide.

We share these facts to inform people that the LGBTQIA+ community is a true melting pot, made up of people from all walks of life. And no matter who they are – from Fortune 500 CEOs to schoolteachers to doctors, lawyers, and tradespeople – their lived identity can create significant difficulty in their daily lives.

That’s why PRIDE month is important, and that’s why we participate. The increased rates of addiction and mental health challenges in the community are the result of external factors primarily associated with stigma: that’s something we can all work to change.

Now let’s look at the statistics, in order to understand – in real numbers – the harm stigma and misunderstanding can cause.

Substance Use and Co-Occurring Disorders Among LGBTQIA+ People: Facts and Figures

We retrieved this information from the 2020 National Survey on Drug Use and Health (2020 NSDUH), which included specific analysis of substance use and mental health issues among LGBTQIA+ people. Previous and subsequent editions of the NSDUH did not collect specific data on substance use and mental health issues in the LGBTQIA+ community.

Here’s the data:

2020 NSDUH: Alcohol, Opioid, Methamphetamine (Adults 18+)

Alcohol Use/Alcohol Use Disorder

• LGBTQIA+ adults aged 18 to 25:
  • 55.7% (or 3.0 million people) reported past-month alcohol use
    • Compared to 51% for non-LGBTQIA+
  • 23.8% (or 1.3 million people) had alcohol use disorder
    • Compared to 15.6% for non-LGBTQIA+
  • LGBTQIA+ adults aged 26+:
    • 62.% (or 6.6 million people) reported past-month alcohol use
      • Compared to 54% for non-LGBTQIA+
    • 20.8% (or 2.2 million people) had alcohol use disorder
      • Compared to 10.3% for non-LGBTQIA+

Opioid Use/Opioid Use Disorder (OUD)

• LGBTQIA+ adults aged 18 to 25:
  • 5.4% (or 292,000 people) misused opioids in the past year
    • Compared to 4.1% for non-LGBTQIA+
  • 1.6% (or 87,000 people) had opioid use disorder
    • Compared to 0.9% for non-LGBTQIA+
  • Among LGBTQIA+ adults aged 26+:
    • 7.4% (or 790,000 people) reported past-year opioid misuse
      • Compared to 3.5% for non-LGBTQIA+
    • 2.8% had opioid use disorder
      • Compared to 1.1% for non-LGBTQIA+

Methamphetamine Use

• LGBTQIA+ adults aged 18 to 25:
  • 1.2% (or 63,000 people) reported past-year methamphetamine use
    • Compared to 0.5% for non-LGBTQIA+
  • LGBTQIA+ adults aged 26+:
    • 3.11% (or 328,000 people) reported past-year methamphetamine use
      • Compared to 1.1% for non-LGBTQIA+

Now let’s look at the rates of co-occurring SUD and mental illness and treatment for co-occurring SUD and mental illness among LGBTQIA+ people.

2020 NDSUH: Co-Occurring Disorders and The Treatment Gap (Adults 18+)

• SUD and Any Mental Illness (AMI)
  • Total: 3.9 million
  • Received treatment for mental illness or SUD: 56.9%
  • Treatment for mental illness but not SUD: 50.2%
  • Received treatment for SUD but not mental health: 2.1%
  • Treatment for both: 4.6%
• Treatment Gap:
  • Total: 95.4% of LGBTQIA+ people with co-occurring disorders did not get the treatment they needed

The data teach us that millions of LGBTQIA+ people in the U.S. experience addiction and mental illness. While some get treatment for addiction and others get treatment for mental illness, the facts tell us that over 95 percent do not get treatment for both. That’s something we need to improve. Evidence indicates that when a person with co-occurring disorders receives treatment for one disorder and not the other, both can deteriorate, but when a person with co-occurring disorders receives treatment for both disorders, both can improve.

How We Can All Participate in PRIDE Month

Let’s be clear: anyone and everyone can participate in PRIDE month. Identifying as lesbian, gay, trans, queer, intersex, aromantic or questions is not required. However, compassion, understanding, and a desire for equality and justice for all are required. If you support your LGBTQIA+ friends, then you’re called an ally.

Founded in 1985 as the Gay and Lesbian Alliance Against Defamation (GLAAD), this influential gay rights advocacy group offers a list of ten things we can all do to be better friends and allies to the LGBTQIA+ community, which we’ll share now.

10 Ways to Be an Ally to the LGBTQIA+ Community

1. Listen to members of the community when they raise their voices to advocate for themselves.
2. Keep an open mind: leave your preconceptions behind and embrace the opportunity to learn something new.
3. Talk about things you don’t understand with people who do. That’s how you learn.
4. Practice inclusivity. Invite your LGBTQIA+ friends to any and all social events.
5. Assume you may have friends or coworkers who are LGBTQIA+s – and you don’t know. They may look to you for support, compassion, and understanding, even if they haven’t come out to you yet. Give them the space they need to share personal information if and when they’re ready.
6. Understand, once and for all, that jokes and judgmental comments about the LGBTQIA+ community cause real harm, perpetuate stigma, and can lead to violence. Don’t let friends, family members, and coworkers off the hook: if their jokes and comments are offensive, tell them.
7. Examine, confront, and understand your personal biases and preconceptions, no matter how difficult or painful it might be.
8. Stand up for your LGBTQIA+ friends against stigma, injustice, and discrimination.
9. Embrace the concept that all people should be treated with compassion, respect, and dignity. All means all: no exceptions.
10. Contact GLAAD if you see harmful representations of LGBTQIA+ people in the media.

Here’s something to consider:

When we all become allies, we can end stigma and level the playing field for our LGBTQIA+ friends, peers, and family members.

In 2023, these neighbors and friends need our support more than ever. While we have made significant progress over the past several decades, some recent developments put that progress at risk, and may undo years of work toward embracing diversity, equity, and inclusion in public life for many members of the LGBTQIA+ community.

We’ll close with a list of helpful resources for members of the LGBTQIA+ community.

LGBTQIA+ Helpful Resources and Links

The National Alliance for Mental Illness (NAMI) provides this excellent list of LGBTQI friendly mental health resources for you:

• The Association of Gay and Lesbian Psychiatrists provides an updated directory of LGBTQIA+ friendly therapists.
• The Gay, Lesbian, and Straight Education Network (GLSEN) is a valuable resource for all things LGBTQIA+
• The GLBT National Help Center provides multiple resources and access to a hotline and a youth chat line.
• The Trevor Project provides specialized suicide and crisis intervention support for LGBTQI youth.
• The American Psychological Association (APA) offers resources for a wide range of topics relevant to the LGBTQIA+ community
• The Gay and Lesbian Medical Association’s Provider Directory offers a list of LGBTQIA+ friendly healthcare providers in the U.S.
• The National Center for Transgender Equality provides a list of trans-friendly healthcare providers in the U.S.
• SAGE National LGBT Elder Hotline maintains a hotline for older LGBTQIA+ people who need support with a variety of health, social, and other issues
• Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE) provides LGBTQIA+ friendly mental health resources
• Trans Lifeline connects trans people to various resources to help support them fully live their gender identity
• Depression Looks Like Me is a program designed to support members of the LGBTQIA+ community diagnosed with depression

If you know a member of the LGBTQIA+ community who needs help and support for addiction or another mental health disorder, please share this list with them – and offer any immediate support and compassion you can. In some cases, one kind word, one well-meaning friend, and one act of kindness can change everything.

During PRIDE Month, you can be that one person – and make a difference in the life of someone you care about.

The post June is PRIDE Month at Pinnacle: The LGBTQIA+ Community and Addiction appeared first on Pinnacle Treatment Centers.