Substance use disorder treatment involves a multi-faceted, comprehensive approach using various therapeutic interventions. One of these may involve the use of medications in a method known as Medication Supported Recovery (MSR) to assist the individual in the recovery process.
MSR is not intended for everyone in treatment for a substance use disorder, but may be one of the most effective treatment methods as determined on a case-by-case basis. The medications available are only effective for helping certain substance use disorders, primarily opioid or alcohol use disorders.
The decision to include MSR in a treatment plan depends on factors such as the individual patient’s degree of motivation, their available support system, the presence of co-occurring disorders, their level of functioning, and the number of previous attempts at abstinence.
What is medication-supported recovery (MSR)?
While abstinence remains the gold standard in substance recovery, it is not always a realistic first step. Thankfully, recovery programs allow treatment planning to be customized to each individual’s unique needs. For someone who has attempted abstinence-based programs in the past and was not able to sustain sobriety, MSR can prove useful.
MSR utilizes medications such as buprenorphine and naltrexone to provide an additional layer of support in the early months or years of recovery. For MSR patients, medication becomes an integral aftercare component, alongside outpatient services, sober living and participation in a 12-Step community.
Medications like buprenorphine and naltrexone help reinforce and solidify early recovery by blocking or dramatically reducing the effects of opioids on the brain. With continued use of the medication, the desire to seek the substance eventually fades away, which leads to a reduced risk of relapse and overdose.
Medications used for medication-supported recovery
Buprenorphine and naltrexone are the two most commonly prescribed MSR medications. These medications are available in various formulations, such as tablet, sublingual film, pellet implant, extended release injection or dermal patch.
What is buprenorphine?
Buprenorphine is a synthetic opioid partial agonist. This medication cannot be administered until the individual has abstained from opioids for a minimum of 12-24 hours. If given sooner than this, it can possibly trigger acute withdrawal symptoms.
With continued use, buprenorphine causes diminished opioid effects, which naturally causes a loss of interest in opioids and reduced cravings for the drug. Once the individual has discontinued opioid use and no longer experiences opioid cravings, the buprenorphine dosage can be reduced or the dosing schedule changed to alternate-day dosing. The duration of buprenorphine use is determined by the specific recovery needs of each individual.
What is naltrexone?
Naltrexone is a non-narcotic medication that binds to opioid receptors and blocks the euphoric and sedative effects of opioids. It also has the same effect on endorphin receptors, which blocks the effects of alcohol. Additionally, Naltrexone reduces and suppresses opioid or alcohol cravings, which helps reduce the risk of relapse.
A naltrexone regimen should not be started until the individual is well into the withdrawal phase. For instance, about one week for someone with opioid use disorder, or for someone with alcohol use disorder, after alcohol detox has been completed. Starting naltrexone too early could lead to acute withdrawal symptoms. Naltrexone is typically prescribed for 3-4 months.
The purpose of integrating MSR into aftercare planning is to help the individual achieve a better quality of life. These medications accomplish this by eliminating cravings, extending sobriety and stabilizing recovery. For these reasons, MSR should be included as an essential tool in overall recovery planning for those individuals who would most benefit from these medications.
Ashley Addiction Treatment, formerly Father Martin’s Ashley, is a nationally recognized nonprofit leader in integrated, evidence-based treatment for substance use disorders. Our programs are accredited by The Joint Commission, and result in frequent publications of ongoing research into effective treatment methodologies. We offer holistic care that encompasses the mind, body and spirit through inpatient and outpatient treatment, provide drug detox, relapse prevention plans, family wellness programs and a variety of other services tailored to each patient’s unique needs. Our driving principle — “everything for recovery” — reinforces our mission to transform and save lives through the science of medicine, the art of therapy and the compassion of spirituality, and is complemented by our philosophy of healing with respect and dignity. For information about our comprehensive programs, please call (866) 313-6307.