Is MAT the Bad Boy of Addiction Treatment?

By Tony Bratko, MSC, LPC, LISAC

“If we only address the physical part of the disorder, other areas
 will be overwhelmed and lead the addict to relapse.”

Is this Deja vu?
There was a time in our history when “Drug Replacement Therapy” was highly encouraged by our government under the guise of “Harm Reduction.” Methadone was supposed to be the answer for heroin addiction.

We were told if heroin addicts could legally get opiates from a clinic, they would stop using heroin and not share needles. This would stop the spread of communicable diseases, thus reducing harm to themselves and society. The only problem? Many addicts continued using heroin intravenously and diverted the methadone (to sell for heroin) or used heroin in addition to the methadone. Methadone only addresses opiates and not other illicit drugs that addicts use such as methamphetamine. This still exists today.

Drive by any methadone clinic at 6:00 a.m. and you’ll see lines of Uber and Lyft cars waiting to take addicts back home — all on the government’s dime and taxpayer’s money. Rarely are the addict’s clean from all illicit substances, yet they stay on methadone maintenance for years, even decades.

There is no incentive for the addict to get off methadone and definitely no incentive for the owners of the clinics to have patients free of methadone. The business is a cash cow for owners. If a patient wants to titrate off methadone, the clinics require it take up to two years, if you can’t pay or lose your Medicaid, they titrate you off in three days. It’s called “Fee-Toxing.”

So here we are again with the government encouraging the use of medication to stop addiction. I suppose they feel it’s the cheaper way than to provide addicts primary treatment in an effort to learn how to change their thoughts and behaviors. Remember, we have Doctors of Medicine dictating public policy and treatment, most of who are not educated or even have a basic understanding of addiction. Maybe it’ll be different this time — I think not. Similar to methadone maintenance programs, only one hour of counseling per month is required for a patient in a MAT program. As a licensed addiction professional, I know more is needed.

Positive Aspects of MAT
I believe there are positive aspects to a MAT program, especially for addicts who constantly relapse. It gives them the ability to stop using illicit substances and create a foundation of recovery. A distinction also needs to be made between maintenance, stabilization with the goal of titration, and eventual termination of use.

As we know, addiction is a physical, psychological, and spiritual disease and all three areas need to be addressed on a daily basis for any addict to be successful.

If we only address the physical part of the disorder, other areas will be overwhelmed and lead the addict to relapse.

Optimally, a MAT program would also consist of at least one hour of individual counseling, a two hour, CBT Based Relapse Prevention group session, and consistent 12-step support meetings. Eventually, the addict will be off the medication but if they are not taught coping skills for triggers and cravings, we are setting them up for failure.

Another consideration needing to be addressed is the misuse regarding Buprenorphine — a narcotic often abused by addicts to get high.

So I ask….

• What systems will be in place to ensure that diversion is not taking place?
• What is the process and/or consequences for addict who consistently test positive for any illicit drugs while in the MAT Program?

Should an addict who has never attempted primary treatment be admitted into the program or should they be encouraged or referred to a traditional substance use treatment center first?

These are all questions a successful and responsible MAT Program should have answered before a person in active addiction walks into their clinic.

In conclusion, I am an addict in long term-recovery as well as a professional in the substance use and mental health field. I was able to get clean by medical detox and participation in primary treatment. I also have experience working in a methadone clinic. The traditional methadone clinic concept does not work. I only had a few clients who were able to stay clean from opiates and other illicit substances, most tested positive. I had 95 clients I was required to see on a monthly basis for a one hour, individual, counseling session. Most never showed for their appointments and the ones who did were not interested in therapy. They were there to keep getting their drug. I hope our field doesn’t go down this road again.

Medication Assisted Treatment needs to be used as a tool — not the answer to addiction. As we know, the addict is always looking for the softer, gentler way out of their addiction and that is not always the best way. Doing the work required is what is needed for a successful and long-term recovery.


Tony Bratko, MSC, LPC, LISAC is Executive Director of Clinical Services, Continuum Recovery Center, tbratko@continuumrecoverycenter.com. 602-402-4474. 

www.continuumrecoverycenter.com