Medicated Assisted Treatment: Whole Patient Approach to Substance Use Disorders

Medicated Assisted Treatment as part of the “whole patient" Approach to Substance use Disorders
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Introduction
Medicated Assisted Treatment (MAT) is a practical 'whole patient' solution for drug/substance use disorders. It involves using medicine and behavioral counseling modalities (Degenhardt et al., 2019). MAT is internationally accepted, as it brings forth several positive outcomes in individuals with substance use disorders. In Europe and Ireland to be specific, MAT has continued to ensure that all approaches towards patient recovery are geared towards appropriate and effective medications that are approved by the European medicines agency (EMA) (Degenhardt et al., 2019). In 2014, there were approximately eighteen thousand, nine hundred and eighty eight individuals who were opioid users in Ireland (Degenhardt et al., 2019). Not only is opioid use disorder a significant health problem in the country, but it is also a critical issue that needs urgent sensitization and consistent prevention measures. Alcoholism has also been identified as another health issue of concern, where approximately seventy percent men and thirty four percent women are at high risk of alcohol use disorder due to their heavy drinking nature (Knox et al., 2019). Generally, MAT aids in sustaining recovery and healing and preventing or reducing relapses and opioid overdose. Narcotic analgesics (opium) and central nervous system depressants (CNS) (alcohol) will be mentioned throughout the paper to illustrate the use of MAT and how it treats the two substance categories.
Opioids are primarily used to relieve pain, bearing analgesic and CNS depressant effects. They are also known to cause euphoria. Disordered opioid use can be done by misusing opioid medications or acquiring and using opioid medicines diverted (Padjen et al., 2019). Opioid use significantly causes relapses and an immense increase in mortality and morbidity. MAT works best in treating Opioid use disorder while employing maintenance approaches to prevent relapses. Disordered alcohol use involves consuming extreme and excess alcohol levels, even when causing immense physical and emotional harm (Padjen et al., 2019). Alcohol consumption is usually triggered or taken for several reasons. These include emotional stress, recalling early childhood scenarios, and genetic predisposition. Disordered use is triggered when people consume large amounts of alcohol over a long period and experience immeasurable trauma, such as sexual abuse and a family history of disordered alcohol use (Padjen et al., 2019). MAT is proven to be a successful approach to disordered alcohol consumption.
Pharmacological Approach to Substance Use Disorders
Opioids Use Disorder (OUD)
OUD may exist simultaneously with other comorbidities such as depression, bipolar, and a range of anxiety disorders. Some symptoms seen in OUD such as periods of euphoria and periods of sadness are because of existence of other illnesses that are not as superficial as OUD. There are several approaches to the treatment of OUD in Europe (Ireland). These include psychosocial/behavioral and pharmacological interventions. Before the pharmacological intervention, a conclusive and thorough assessment will be carried out on the patient (Padjen et al., 2019). Once a thorough assessment has been done, a plan to effectively treat OUD according to the methadone treatment protocol (MTP) is established. OUD is significantly characterized by severe mortality and morbidity, and socio economic hitches. The Irish general practice, through the MTP expands on harm reduction services through articulate opioid substitution treatment (Witkiewitz & Vowles, 2018). Other interventions include providing and availing naloxone, and facilitation of needles and syringes.
Primary interventions for OUD include pharmacological approaches such as methadone and buprenorphine. These medications are usually given in the outpatient department in combination with psychosocial and behavioral interventions (Hoffman et al., 2019). They work by reducing opioid use, the risk of overdose, and mortality. Even though methadone and buprenorphine are the most commonly used, other medications are utilized, including a combination of naloxone and buprenorphine (Sofuoglu et al., 2019). Though their efficacy has been confirmed, they bear some limitations which include a risk of severe and adverse effects on consuming them, such as drug withdrawal symptoms especially when on buprenorphine.
Non-pharmacological approaches such as incentive-based management are also applied to improve the effectiveness of treatment. Here, the patient’s behavior is either rewarded or punished every time the patient meets or fails to meet the objectives of the treatment (Fallin-Bennett et al., 2020). For instance, a patient may be rewarded with a shopping voucher once they meet their set objectives and targets. Another psychosocial intervention include cognitive behavioral therapy, which places key focus in changing behaviors and thoughts related to drug use (Rice et al., 2020). It is usually done and actualized through bold emphasis on self-control, prevention of a relapse occurrence, and social skills (Witkiewitz & Vowles, 2018). Motivational interviewing is another psychosocial intervention that aims to bring out a patient’s motivation and actively engage them in the process of treatment.
Another satisfying psychosocial approach towards OUD is the presence of therapeutic communities in Europe. Therapeutic communities are groups of like-minded people who live and work by similar objectives, mainly delivering themselves from opioid use slavery. Their idea is basically founded on enhancing mental health, facilitating self-help projects, furthering their education, and conducting social work (Witkiewitz & Vowles, 2018). they focus on social relationships and usually view the participation of all community members as a significant and critical way of founding and cementing personal change.
Alcohol Use Disorder (AUD)
AUD may exist simultaneously and show a significant association with other comorbidities such as panic disorder and some anxiety disorders. Therefore, a whole patient approach in treating AUD will see that all the other comorbidities are addressed. There are several approaches to correcting and treating AUD in Europe that have been adopted for decades now. Just like the strategies used to correct OUD, pharmacological and behavioral approaches must be used in combination for optimal results. These include behavioral treatments, medications, and mutual support groups. There are several pharmacological approaches that are approved by EMA and the world health organization (WHO) for the treatment of AUD. These medications work hand in hand with psychosocial approaches to ensure the patient does not suffer a relapse. They include disulfiram, naltrexone, and acamprosate (Shen, 2018). All the medications work by helping the patients to function normally even when they are not in the influence of alcohol. However, there are a few side effects that are experienced after taking either of the medications especially after the first few trials. The drugs are highly potent and highly effective. Other medicine agencies also approve of them, but insist that their efficacy is fully felt only when they are taken in combination with behavioral approaches such as cognitive behavioral therapy.
Acamprosate works by maintaining alcohol abstinence in patients who have already abstained from alcohol use by the time of treatment initiation (Shen, 2018). It is, therefore, highly useful in treating alcohol dependence. Further, it has zero potential for abuse and no substantial interactions with other medications used to treat substance use and mental disorders (Shen, 2018). It is highly safe since it bears no risk of overdose or tolerance. However, it has a few limitations, such as side effects that are felt for a few weeks. The most common is diarrhea, followed by intestinal cramps, headache, and muscle weakness.
The second medication is disulfiram, which works by disrupting alcohol metabolism, leading to the occurrence of an unpleasant reaction. The reaction worsens when the patient who is already on disulfiram consumes alcohol (Witkiewitz & Vowles, 2018). Disulfiram is highly useful in that it prevents and limits alcohol relapse occurrences. Additionally, it is proven safe, only that its severity is proportional to the drug dosage and the amount of consumed alcohol (Witkiewitz & Vowles, 2018). It has several limitations, including minor and severe side effects, which usually last for at least two weeks after the start of treatment. These effects include small eruptions on the skin, dermatitis, headache, and fatigue (Witkiewitz & Vowles, 2018). Adverse reactions that are posed by the drug include optical neuritis, polyneuritis, and liver problems such as hepatitis. Disulfiram interacts with other drugs, such as isoniazid, metronidazole, and anticoagulants (Witkiewitz & Vowles, 2018). Patients are therefore enco...