November 20, 2023 • 28 mins
This episode explores the complexities of addiction, the benefits and controversies of medication for addiction treatment and the variety of medications available. Hear from iHeart’s Loraine Ballard Morrill, Tony Luke, and Recovery Centers of America VP of Nursing, Ashley Gardener and VP of Mental Health Services, Pete Vernig as they provide evidence-based clinical insights on the topic of MAT treatment.
This podcast episode and others are available to watch in video format here www.RCARecovery360.com
Any views or comments provided by individuals other than RCA employees are their own and do not represent the official views of Recovery Centers of America.
***Any views or comments provided by individuals other than RCA employees are their own and do not represent the official views of Recovery Centers of America.
This podcast episode and others are available to watch in video format here www.RCARecovery360.com
Any views or comments provided by individuals other than RCA employees are their own and do not represent the official views of Recovery Centers of America.
***Any views or comments provided by individuals other than RCA employees are their own and do not represent the official views of Recovery Centers of America.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Hello, and welcome to Recovery threesixty, the podcast dedicated to exploring the
pathways to treatment and recovery, broughtto you by Recovery Centers of America.
I'm Lorraine Ballard Morral, director ofNews and Community Affairs for iHeartMedia, Philadelphia,
and I am joined by the wonderfulTony Loop Junior Tony again and again,
(00:26):
I love it Well. We arethrilled to be your guide on this
journey to better understanding the world ofhealing and the many ways individuals can find
their way to recovery. In eachepisode, we'll sit down with experts,
survivors, and advocates in the fieldof treatment and recovery. We'll unravel the
complexities of addiction, mental health,and physical wellness while shedding light on the
(00:49):
diverse range of therapies, interventions,and approaches available. In today's episode,
we'll talk about medication assisted treatment.Medicassistant treatment or MATT. MAT is a
highly effective approach to treating substance useDISORDERSMAT combines FDA approved medications with counseling and
(01:11):
behavioral therapies to address addictions, physicaland psychological aspects. Well, We're going
to do a deep dive into MATand joining us our doctor Peter Vernick,
who serves as vice president of MentalHealth Services and Ashley Gardner, VP of
Nursing at Recovering Centers of America.It is so wonderful to have you here
(01:34):
today for this podcast. Thank youfor having us. Thank you. Yeah,
well, doctor Ashley Gardner, let'stalk about MAAT. What is MIT
and what's the goal? So MTmedication assistant treatment is the use of medications
to help support recovery. And sowe have several FDA approved medications for both
opioid use disorder and alcohol use disorder, and so the purpose of these medications
(01:59):
is really to assist people in theirlong term recovery by reducing cravings, reducing
overdose and death, as well asyou know several other benefits. You know,
I have this image not too farfrom where I live is a methadone
clinic and I think for years andyears that's basically what was used in order
(02:21):
to address medically assisted treatment methadone.So let's talk about how MAT and the
industry has evolved, doctor Vernick.So, as you said, for a
long time, sort of methodone wasone of the only games in town and
absolutely. Methadone is still effective.Many people utilize methodone as a part of
their treatment program. But there's somany different medications that are available now,
(02:44):
as doctor Gardner talked about, thatcan be incorporated with all of the other
elements of treatment. So this isthe recognition of the fact that, as
we've talked about so often on thisshow, substance use disorder is not just
an emotional issue, it's not justa family issue, it's not just a
physiological issue. It's all of theabove. And so a comprehensive plan of
(03:06):
treatment that brings all of those piecestogether for the patient and that's tailored to
their needs is really going to bethe best option. And so with new
medications that are available and new waysof receiving medications, this really enables more
people to take advantage of medication assistanttreatment. I know doctor Gardner can talk
about some of the more details ofthe different options that are available, but
(03:27):
it's just it's so important how thatintegrates into the work that we do in
the field. Well, that leadsinto in previous episodes of our podcast,
we talked about all the different typesof treatment for substance use disorder. Can
we go back briefly and touch onhow MAT supports these other treatment options.
MAAT is meant to be a oneform of treatment, right, And so
(03:50):
we look at an addiction, youknow, as a chronic brain disease,
and it's so it's like every otherchronic disease. So I like it,
liking it to diabetes, right,So for some people they can manage diabetes
with diet and exercise, and otherpeople they need to take maybe an oral
medication like metformin or something, andthen others maybe need insulin. And so
(04:12):
if we look at that in therealm of addiction, some people benefit from
medications, and certain medications maybe mightbe beneficial for one person over another,
but some also benefit from outpatient therapy, whether it be our partial hospitalization program
or intensive outpatient program or generalize outpatienttherapy, as well as working with a
(04:32):
psychiatrist, perhaps working with a peersupport recovery specialist. And so it's really
this whole gamut of leveraging these differenttreatment modalities for what each individual person would
benefit from. I wonder if youalso can talk more specifically about the different
types of MAT and what they actuallydo, because I know that in my
(04:56):
limited understanding of mat as it relatesto methadone. My perception of it was
that people took methadone to stop thecraving. Can you describe what the different
medications are and what do they actuallydo? Sure? Absolutely, So when
we think about methodone, so that'sa medication that's used for opiate use disorder.
So we have three FDA approved medicationsfor opiate use disorder, one of
(05:19):
them being methadone, the other beingbupern orphan in its various products, and
the last one being now trekstone,which comes in a long acting injectable called
vivitrol. So when we think aboutopiate use disorder, so opiate, you
know, work on the opiate receptorsin the brain. So when somebody takes
an opiate, and whether it bea prescribed opiate or you know, something
(05:41):
off the street like heroin and fentanyl, that activates that receptor. And so
methadone works in that. It's alsoa what we call an agonist, so
it activates that receptor. So whathappens with using methadone is that it binds
to that receptor and so it doesreduce the cravings and helps the person kind
of have a steady state, butwithout the abuse of other opiates. So
(06:06):
the research is strongest for methodone becausemethodone has been around the longest, and
so there's lots of evidence that showsthat it reduces overdose depths, it reduces
all cause mortality, it increases retentionand treatment super important for our patient population,
as well as it reduces several ofthe other associated diseases such as HIV
(06:28):
hepatitis, and so there's a lotof benefits for that. For boop or
an orphin which comes in both asublingual format that somebody would take every day,
as well as now some long actinginjectables which are great that they would
get in their medical provider's offices.It's what we call a partial agonist and
partial antagonist. So basically what thatmeans is it binds to that opioid receptor,
(06:50):
just like the methadone does or theother opiates, but it has a
ceiling effect, so once it getsto a certain level, it no more
amount is going to really have anyeffect. So it doesn't give that same
kind of high that people experience whenthey're abusing opiates, but it does give
them that steady state, and soit reduces cravings and you know, reduces
(07:12):
the risk of relapse through that nowtrekzone now is an antagonist, and so
what that means is it binds tothe receptor, but it blocks it basically
so that no other opiate if somebodywere to take it, could bind to
the receptor. So basically, ifsomeone used it while they were on the
now trek zone, then they wouldn'tfeel anything. These are all important medications,
(07:34):
and so they work a little bitdifferent and there's pros and cons to
each of them, but the mainthing that they do is help reduce the
cravings and help prevent relapse on thedrugs of abuse. You partially hit it.
I was just curious, is MATa long term treatment or is it
time limited? So again it's veryindividualized. So my recommendation for people is
(07:58):
always to recommend and to be onit for at least a year because it
takes a lot of time. Peopledidn't get to this point overnight, right
they didn't use ones, and nowthey're in full blown addiction. So usually
it's many years before they're coming andgetting help and seeing us, and so
it takes time to kind of undosome of the changes that happen in the
(08:18):
brain and for the people to developbetter coping skills and to just kind of
work through some of the underlying causes. And so the recommendation is that people
going on it stay on it fora year. However, it really is
individualized. So there's lots of peoplethat stay on these medications indefinitely and that's
(08:39):
okay if that's what they need andthat's what's helpful for them. But some
people decide that they want to getoff of them at some point, and
so really it's a tailored approach toeach individual. Yeah, doctor Vernig,
I would imagine that you can't reallyhave MAT without it being surrounded by other
types of treatments, whether it's behavioral, whether it's in patient or outpatient.
(09:01):
You can't just give somebody a drugand just say you're fine, now go
off and do your life. Right. It's really needs to be combined with
other types of treatment in order totruly be helpful. Because really, when
you're talking about being on a medicationin which you have to consistently be on
that medication, you have to wantto be on that medication, right,
(09:22):
you have to choose, You haveto make that choice exactly. So ma
AT is most often used in combinationwith other approaches, things that we've talked
about before, like twelve step approachor cognitive behavior therapy or dialectical behavior therapy
or other treatment modalities to really addressthe whole person, because that's I think
something that we've come back to somany times here is the fact that it's
(09:43):
not just one thing. There isthe family effect. There could be underlying
mental health concerns, trauma, etcetera. So all of that needs to
be addressed together. Take for example, cravings, something that doctor Gardner talked
about that is a really important partof recovery from a substance. So when
those cravings occur, we're going toteach people ways of coping with them.
(10:05):
We're going to teach them active skillsthat they can practice and that they can
use in the moment when they're havingthat craving. They may have things like
art and music involved, They mayhave their family included, so how can
the family support them at that pointin time? But what if also biologically
we could bring that craving down ormake that less serious, make it easier
for them to manage. And that'swhat the medication in that specific scenario is
(10:28):
doing for them, So it's allworking together. It has a synergistic effect,
which is why you know, manyof the treatment plans that you'll see
many people in recovery, they havedifferent different pieces and as we've talked about
also, those aren't going to lookthe same for from one person to the
next because people are different, circumstancesare different, and although there's a lot
of commonalities in the disease of addiction, the disease can be different from person
(10:50):
to person. To touch on whatdoctor Ashley said earlier, there's pros and
cons to both, and it goesback to it. You know what I
had said in a podcast that addictionsshouldn't be looked at as a chronic disease.
See diabetes is a chronic disease.Cancer is a chronic disease, So
people that have to be heart isa chronic disease, So people take medication
(11:13):
for the rest of their life becausethere is there's an actual physical dependency that
the body is not creating whatever thebody needs insulin or so it needs it.
So again she's one hundred percent right. There's the positive of getting rid
of the craving, getting rid ofthe need to do the opioid. But
(11:35):
then the massive negative to that isto want someone to be on methadone for
the rest of their life goes backto being a crutch again. Okay,
it's like it needs to be usedas one of the tools that you use.
Because we said this earlier and doctorVernig has been on every podcast,
(11:58):
so it's nothing new to what Ihad said to him. Is that sobriety,
as important as it is, isnot as important as the mental health
aspect in what's going on. Andthe reason that I support m AT is
because it allows that person the breathingroom to address the trauma and the mental
(12:26):
health issues. I never was afan of what we talked in a previous
episode of going cold turkey and seekingsomeone in a room, you know,
and they get sick, and it'slike, okay, well, now physically
physically you're not dependent upon the drug. Go do what you gotta go do,
and you can be willpower and callno. That's why when people go
(12:48):
well and very much against well forme personally, I'm not against anything that
gives the ability for someone to notconcentrate on the physical demands of active addiction
where they can put themselves in aplace where they can be open to discussing
(13:09):
why you're self medicating, Why doyou need this to take the pain away?
What is the pain? And Ithink that's where Maat really shines for
me. But again the downside iswhat you don't want is Maat to be
the crotch of you spending another thirtyyears on methadone. To me that it
(13:33):
doesn't address the issue right. Youwant to get down to the reasons why
people are self medicating, which bringsme to a question which I think has
always been in the back of myhead, and that is discussing substance use
disorder as a physical condition. Weoften talk about you should have a strength
of character to stop. You've gotit within you. You can do it.
(13:56):
It's not that simple because we're talkingabout brain chemistry. Can you break
it down more in terms of talkingabout substance use disorder is a disorder.
There's a physical component to it.Because how does one person try heroin and
then that's it they walk away.You have another person they try it and
(14:16):
suddenly they see God and this becomesa craving that they can't step away from.
Well, you make a good point, So there is absolutely a genetic
component with the disease of addiction,and so there has been studies out where
they show that people that have ayou know, a parent or a direct
relative that has struggled with addiction,that they're more likely to struggle with addiction.
(14:41):
So that's one way we know thatit's a physical disease, not just
a mental shortcome right. Another thingthat they found is that you can actually
see the changes on brain scans.You can see the you know, with
somebody that's that's using versus somebody that'snever used, versus somebody that's been in
recovery for a long time. Youcan see that there's actually changes. Another
(15:03):
thing that's important that I have learnedis that when they do a EEG,
which is kind of looking at thesignals in your brain. So what they
have found is that they can actuallysee somebody that's predisposed to addiction based on
some of those brain waves. Sothey have lower delta waves, which basically
means that they don't have the warningsignals. So somebody that you know,
(15:26):
let's just say speeding, right,and so somebody that had the regular might
start to get worried when they're atone hundred miles an hour or one hundred
and twenty. But the person thatstruggles with addiction, they don't worry,
right so because they have decrease inthose those delta waves. And so there's
a lot of different scientific evidence topoint to there is something physically going on
(15:48):
that's contributing to somebody struggling with thedisease of addiction. I could make this
argument if I wanted to. Icould just make the argument, and I
know that there's a actual medical dataproof that backs everything that you just said.
And I'm not taking away from anyof that, but being around that,
(16:11):
being around a parent, now notme being around a parent who is
suffering from addiction. You can makethe point that it can be handed down
genetically. But I could also makean argument that watching the behavior of that
(16:33):
parent contributes to the factor of theway they handle issues gets passed along to
the child. Because I have threechildren. One fell in to that self
medicaid to that and died, twodid not, So there's more outside.
(16:57):
I believe that the environment mental aspectof it as well plays a key component.
You are right. I have afriend of mine who can't not drive
one hundred and twenty miles an hourin rush hour traffic while I'm sitting on
the chair and my knuckles are white. I'm like, do you not see
that this car? He's like,this is great? So I get it,
(17:21):
Like, I do get it.But I can also make an argument
we look up to our parents,we look up to people as children of
authority, and we want to emulatethem, and we learn how to cope
with things by the way we seeour environment copes with those things. So
(17:42):
as yes, I agree that itis definitely there is definitely a genetic issue
there, but I don't want todiscount the fact that the way someone who
is an active addiction is behaving infront of their children or their loved one
does absolutely cantribute to the way thatchild perceives the way the world is and
(18:06):
how to react to that. Absolutely, I think you The other point of
that is, you know, inthe cases of domestic violence, you often
see that those patterns of domestic violenceare repeated through generations because that's what people
know, and what you know iswhat you base your own behavior on.
So that certainly, I think avery it's a very good point. I
(18:26):
wonder we talk a lot about substanceuse disorder, and we tend to think
of it as drug abuse, butit's also alcohol. Alcohol is absolutely you
know, we don't really I don'tthink we really talk about that enough or
in the context of the overall recoveryspace. Alcohol use disorder is is real
(18:48):
and it's serious. And so howdoes MT relate to that? Is that
also used for alcohol use disorder?Yeah, so we have three medications also
for alcohol use disorder that our FDAapproved, So you're right. We do
focus on the opiate use disorder becausethat's what kills somebody suddenly, but alcohol
(19:10):
use disorder actually kills more people.It's just over a longer period of time,
so you're right, there's not asmuch focus. But we do have
three medications and interestingly enough, oneof them is the same that we use
for opiate use disorder, and thatis the now trek Zone or Vivitrol in
its stock formation, it actually hasbeen shown to be effective for both alcohol
and opiate use disorder. There's alsotwo others, a Camper's Aid or Camprol,
(19:36):
which also helps reduce cravings and preventrelapse on alcohol. And then there's
an interesting one called ant abuse andso antibuse is different than the other ones
in that it doesn't necessarily reduce aperson's craving, but it prevents them from
using alcohol because it gives them reallybad side effects if they did. I
(19:56):
was going to bring that up.I was going to ask you what is
the drug that someone takes some whenthey drink they get violently ill. And
again, I don't even know howthat is an option because it goes back
to again, it's almost like punishingsomeone like a shot collar. How does
that work that cannot prevent someone.I'm glad you brought it up because I
(20:18):
was going to ask you what isthat drug called? Yeah? You,
Yeah, that would be an interestingchoice to make. That's interesting, so
tell us more. I'm also anurse practitioner, so I'm a prescriber,
and so I've prescribed all of thesemedications. And so what they found with
an abuse is it's not super effectivein because people don't want to take it
because of the side effects. Sowhat I have seen it be effective for
(20:41):
is those people that know they're goingto be in a high risk event for
a short period of time. Let'ssay they're going on a cruise and you
know alcohol is everywhere on cruises,or maybe they're going to a wedding and
they feel like they're going to bereally tempted for that period of time,
so they just take it for ashort period of time, a couple of
days, and then they have thatreal assurance that even if they feel like
they want to drink, they're notgoing to because otherwise they're going to be
(21:04):
in the bathroom throwing up and veryviolently ill. So that's kind of how
that one typically is used. Orthey take it on the cruise on day
one, drink and finally ill,and then throw the pills overboard and go
never taking that again. Well,I guess again, it's all about finding
the right medication, the right strategies, whether it's behavioral health strategies, doctor
(21:27):
Vernig, it's really about holistically lookingat what is best served for that particular
person. Absolutely, it's about thewhole person. It's about their needs and
all of the different domains that areimpacted by their illness. You know,
you brought up the issue of natureversus nurture. I think that's an important
piece. Anytime we ask that question, the answer is usually both. It's
(21:48):
a combination, and so we needto be able to address each of those
components as a comprehensive plan. Now, there's unfortunately a lot of stigma when
it comes to or some people whobelieve that it's not really being in recovery
because if you're using MAT you know, that's not that that's not real recovery.
You should be able to do itwithout. And really, you know,
(22:10):
it's about what works for that individualperson. You know, that's a
medical decision that's between them and theirprescriber to discuss is this something that could
be a part of of my treatmentprogram, even when it comes down to
something like ant abuse, which youknow, I kind of have some of
the same thoughts about it that itseems very punitive. It seems like something
that and it has been in thepast used almost as a punishment for somebody
(22:33):
because you know, you've demonstrated thatyou can't use alcohol responsibly, so I'm
going to tell you you have totake this, so you'll be punished if
you do. But as as doctorGardner talked about, there are ways that
people might choose to take that themselvesand use it in a very specific way
because they know that's going to givethem that additional motivation that's going to give
them that additional reason to not experiencea return to use or a relapse in
(22:56):
that high risk situation. So it'svery individualized, and we have to take
into account all of those components andthe whole person, you know, when
we're considering and when the individual themselvesand their family are considering, what's recovery
going to look like for them?Right, So it's just another tool in
the toolbox, exactly. Yeah.Plus all of my opinions, I always
like to PostScript or preface that Idon't believe anything in this world, anything
(23:23):
is a hundred percent. So eventhough i may strongly feel one way about
something, I'm never under the illusionthat I'm a hundred percent on point,
like I'm one hundred percent there.I'm not. You know, I'm not.
And I'm also I try to beintelligent enough to understand that I'm learning
(23:45):
every day and that if I'm stillthinking exactly the way i'm thinking now five
years from now, I didn't getit. I'm not getting it. You
should always be evolving. Your opinionshould always be evolving, because the more
you learn about life, the moreyou learn, those things should change,
you know, hopefully for the better. I mean that's what you know.
(24:07):
We try to do, but Iagree with you that there are some Look,
I self medicate through food, andwe've had this conversation. I do
great on the weekends because my girlcomes over on the weekends and she knows
if I eat anything past seven o'clock, I don't get a good night's sleep.
And when I open up the refrigerator, she goes, do you not
want to sleep tonight? And Igo, no, I'm closing the refrigerator.
(24:30):
Yes, it's like the pill.It's like she's the pill on the
weekend. Well, I think what'sgreat about this conversation in this podcast series
is that we're learning something every dayevery podcast, I learn something new,
and I also know that people outthere listening are learning and growing from this
(24:51):
information. The other thing that weknow is that this field is constantly evolving.
What we knew ten years ago isnot what we know now. What
we know ten years from now isgoing to be different as well. And
that's why we're here today to giveyou the cutting edge, the latest,
the most accurate information that we knowfrom experts like you all and from the
(25:15):
personal experiences of people like you.Tony. Yeah, I mean you know
some of the lessons can be mindblowing. I didn't truly understand what my
son was going through until I wasdealing with the pain of his death,
and I realized that I would havedone anything to stop that pain. That
(25:42):
it becomes a selfish thing because thepain becomes so unbearable that the thought of
waking up the next day feels likea punishment, and whatever I needed to
do to wake up the next day, I would have done it, not
(26:03):
caring about the consequences of anyone aroundme or what that would do to hurt
the people that loved me, becausethe pain was greater than all of that.
And again repeating myself, music savedme. I am sitting in this
chair because the outlet for me wasmusic. And all I can do is
(26:30):
pray that wherever anyone is, whoeveris feeling that type of pain, and
people in active addiction feel it everysingle day, that I pray that they
find an outlet that can give thema relief that they need and one that
isn't going to take their life.Tonny, we appreciate your authentic expressions of
(26:56):
your experiences and what you've been through, and hopefully there's some folks out there
that are listening right now to us, to all of us, and are
getting some information that will help themtowards that goal of recovery. That's what
Recovery through sixty is all about.And we want to thank you doctor Peter
(27:17):
Vernick, vice President of Mental HealthServices, and doctor Ashley Garner, who
is Corporate VP of Nursing with RecoveryCenters of America, Doctor Vernack. If
people want more information, where dothey go? If you'd like more information
about Recovery Centers of America, youcan visit us online at RCA Recovery three
sixty dot com or call us ateight four four two five. Recovery Tony
(27:38):
always a pleasure. Pleasure is alwaysmine. We'll see you next time.
Take care,
Hello, and welcome to Recovery threesixty, the podcast dedicated to exploring the
pathways to treatment and recovery, broughtto you by Recovery Centers of America.
I'm Lorraine Ballard Morral, director ofNews and Community Affairs for iHeartMedia, Philadelphia,
and I am joined by the wonderfulTony Loop Junior Tony again and again,
(00:26):
I love it Well. We arethrilled to be your guide on this
journey to better understanding the world ofhealing and the many ways individuals can find
their way to recovery. In eachepisode, we'll sit down with experts,
survivors, and advocates in the fieldof treatment and recovery. We'll unravel the
complexities of addiction, mental health,and physical wellness while shedding light on the
(00:49):
diverse range of therapies, interventions,and approaches available. In today's episode,
we'll talk about medication assisted treatment.Medicassistant treatment or MATT. MAT is a
highly effective approach to treating substance useDISORDERSMAT combines FDA approved medications with counseling and
(01:11):
behavioral therapies to address addictions, physicaland psychological aspects. Well, We're going
to do a deep dive into MATand joining us our doctor Peter Vernick,
who serves as vice president of MentalHealth Services and Ashley Gardner, VP of
Nursing at Recovering Centers of America.It is so wonderful to have you here
(01:34):
today for this podcast. Thank youfor having us. Thank you. Yeah,
well, doctor Ashley Gardner, let'stalk about MAAT. What is MIT
and what's the goal? So MTmedication assistant treatment is the use of medications
to help support recovery. And sowe have several FDA approved medications for both
opioid use disorder and alcohol use disorder, and so the purpose of these medications
(01:59):
is really to assist people in theirlong term recovery by reducing cravings, reducing
overdose and death, as well asyou know several other benefits. You know,
I have this image not too farfrom where I live is a methadone
clinic and I think for years andyears that's basically what was used in order
(02:21):
to address medically assisted treatment methadone.So let's talk about how MAT and the
industry has evolved, doctor Vernick.So, as you said, for a
long time, sort of methodone wasone of the only games in town and
absolutely. Methadone is still effective.Many people utilize methodone as a part of
their treatment program. But there's somany different medications that are available now,
(02:44):
as doctor Gardner talked about, thatcan be incorporated with all of the other
elements of treatment. So this isthe recognition of the fact that, as
we've talked about so often on thisshow, substance use disorder is not just
an emotional issue, it's not justa family issue, it's not just a
physiological issue. It's all of theabove. And so a comprehensive plan of
(03:06):
treatment that brings all of those piecestogether for the patient and that's tailored to
their needs is really going to bethe best option. And so with new
medications that are available and new waysof receiving medications, this really enables more
people to take advantage of medication assistanttreatment. I know doctor Gardner can talk
about some of the more details ofthe different options that are available, but
(03:27):
it's just it's so important how thatintegrates into the work that we do in
the field. Well, that leadsinto in previous episodes of our podcast,
we talked about all the different typesof treatment for substance use disorder. Can
we go back briefly and touch onhow MAT supports these other treatment options.
MAAT is meant to be a oneform of treatment, right, And so
(03:50):
we look at an addiction, youknow, as a chronic brain disease,
and it's so it's like every otherchronic disease. So I like it,
liking it to diabetes, right,So for some people they can manage diabetes
with diet and exercise, and otherpeople they need to take maybe an oral
medication like metformin or something, andthen others maybe need insulin. And so
(04:12):
if we look at that in therealm of addiction, some people benefit from
medications, and certain medications maybe mightbe beneficial for one person over another,
but some also benefit from outpatient therapy, whether it be our partial hospitalization program
or intensive outpatient program or generalize outpatienttherapy, as well as working with a
(04:32):
psychiatrist, perhaps working with a peersupport recovery specialist. And so it's really
this whole gamut of leveraging these differenttreatment modalities for what each individual person would
benefit from. I wonder if youalso can talk more specifically about the different
types of MAT and what they actuallydo, because I know that in my
(04:56):
limited understanding of mat as it relatesto methadone. My perception of it was
that people took methadone to stop thecraving. Can you describe what the different
medications are and what do they actuallydo? Sure? Absolutely, So when
we think about methodone, so that'sa medication that's used for opiate use disorder.
So we have three FDA approved medicationsfor opiate use disorder, one of
(05:19):
them being methadone, the other beingbupern orphan in its various products, and
the last one being now trekstone,which comes in a long acting injectable called
vivitrol. So when we think aboutopiate use disorder, so opiate, you
know, work on the opiate receptorsin the brain. So when somebody takes
an opiate, and whether it bea prescribed opiate or you know, something
(05:41):
off the street like heroin and fentanyl, that activates that receptor. And so
methadone works in that. It's alsoa what we call an agonist, so
it activates that receptor. So whathappens with using methadone is that it binds
to that receptor and so it doesreduce the cravings and helps the person kind
of have a steady state, butwithout the abuse of other opiates. So
(06:06):
the research is strongest for methodone becausemethodone has been around the longest, and
so there's lots of evidence that showsthat it reduces overdose depths, it reduces
all cause mortality, it increases retentionand treatment super important for our patient population,
as well as it reduces several ofthe other associated diseases such as HIV
(06:28):
hepatitis, and so there's a lotof benefits for that. For boop or
an orphin which comes in both asublingual format that somebody would take every day,
as well as now some long actinginjectables which are great that they would
get in their medical provider's offices.It's what we call a partial agonist and
partial antagonist. So basically what thatmeans is it binds to that opioid receptor,
(06:50):
just like the methadone does or theother opiates, but it has a
ceiling effect, so once it getsto a certain level, it no more
amount is going to really have anyeffect. So it doesn't give that same
kind of high that people experience whenthey're abusing opiates, but it does give
them that steady state, and soit reduces cravings and you know, reduces
(07:12):
the risk of relapse through that nowtrekzone now is an antagonist, and so
what that means is it binds tothe receptor, but it blocks it basically
so that no other opiate if somebodywere to take it, could bind to
the receptor. So basically, ifsomeone used it while they were on the
now trek zone, then they wouldn'tfeel anything. These are all important medications,
(07:34):
and so they work a little bitdifferent and there's pros and cons to
each of them, but the mainthing that they do is help reduce the
cravings and help prevent relapse on thedrugs of abuse. You partially hit it.
I was just curious, is MATa long term treatment or is it
time limited? So again it's veryindividualized. So my recommendation for people is
(07:58):
always to recommend and to be onit for at least a year because it
takes a lot of time. Peopledidn't get to this point overnight, right
they didn't use ones, and nowthey're in full blown addiction. So usually
it's many years before they're coming andgetting help and seeing us, and so
it takes time to kind of undosome of the changes that happen in the
(08:18):
brain and for the people to developbetter coping skills and to just kind of
work through some of the underlying causes. And so the recommendation is that people
going on it stay on it fora year. However, it really is
individualized. So there's lots of peoplethat stay on these medications indefinitely and that's
(08:39):
okay if that's what they need andthat's what's helpful for them. But some
people decide that they want to getoff of them at some point, and
so really it's a tailored approach toeach individual. Yeah, doctor Vernig,
I would imagine that you can't reallyhave MAT without it being surrounded by other
types of treatments, whether it's behavioral, whether it's in patient or outpatient.
(09:01):
You can't just give somebody a drugand just say you're fine, now go
off and do your life. Right. It's really needs to be combined with
other types of treatment in order totruly be helpful. Because really, when
you're talking about being on a medicationin which you have to consistently be on
that medication, you have to wantto be on that medication, right,
(09:22):
you have to choose, You haveto make that choice exactly. So ma
AT is most often used in combinationwith other approaches, things that we've talked
about before, like twelve step approachor cognitive behavior therapy or dialectical behavior therapy
or other treatment modalities to really addressthe whole person, because that's I think
something that we've come back to somany times here is the fact that it's
(09:43):
not just one thing. There isthe family effect. There could be underlying
mental health concerns, trauma, etcetera. So all of that needs to
be addressed together. Take for example, cravings, something that doctor Gardner talked
about that is a really important partof recovery from a substance. So when
those cravings occur, we're going toteach people ways of coping with them.
(10:05):
We're going to teach them active skillsthat they can practice and that they can
use in the moment when they're havingthat craving. They may have things like
art and music involved, They mayhave their family included, so how can
the family support them at that pointin time? But what if also biologically
we could bring that craving down ormake that less serious, make it easier
for them to manage. And that'swhat the medication in that specific scenario is
(10:28):
doing for them, So it's allworking together. It has a synergistic effect,
which is why you know, manyof the treatment plans that you'll see
many people in recovery, they havedifferent different pieces and as we've talked about
also, those aren't going to lookthe same for from one person to the
next because people are different, circumstancesare different, and although there's a lot
of commonalities in the disease of addiction, the disease can be different from person
(10:50):
to person. To touch on whatdoctor Ashley said earlier, there's pros and
cons to both, and it goesback to it. You know what I
had said in a podcast that addictionsshouldn't be looked at as a chronic disease.
See diabetes is a chronic disease.Cancer is a chronic disease, So
people that have to be heart isa chronic disease, So people take medication
(11:13):
for the rest of their life becausethere is there's an actual physical dependency that
the body is not creating whatever thebody needs insulin or so it needs it.
So again she's one hundred percent right. There's the positive of getting rid
of the craving, getting rid ofthe need to do the opioid. But
(11:35):
then the massive negative to that isto want someone to be on methadone for
the rest of their life goes backto being a crutch again. Okay,
it's like it needs to be usedas one of the tools that you use.
Because we said this earlier and doctorVernig has been on every podcast,
(11:58):
so it's nothing new to what Ihad said to him. Is that sobriety,
as important as it is, isnot as important as the mental health
aspect in what's going on. Andthe reason that I support m AT is
because it allows that person the breathingroom to address the trauma and the mental
(12:26):
health issues. I never was afan of what we talked in a previous
episode of going cold turkey and seekingsomeone in a room, you know,
and they get sick, and it'slike, okay, well, now physically
physically you're not dependent upon the drug. Go do what you gotta go do,
and you can be willpower and callno. That's why when people go
(12:48):
well and very much against well forme personally, I'm not against anything that
gives the ability for someone to notconcentrate on the physical demands of active addiction
where they can put themselves in aplace where they can be open to discussing
(13:09):
why you're self medicating, Why doyou need this to take the pain away?
What is the pain? And Ithink that's where Maat really shines for
me. But again the downside iswhat you don't want is Maat to be
the crotch of you spending another thirtyyears on methadone. To me that it
(13:33):
doesn't address the issue right. Youwant to get down to the reasons why
people are self medicating, which bringsme to a question which I think has
always been in the back of myhead, and that is discussing substance use
disorder as a physical condition. Weoften talk about you should have a strength
of character to stop. You've gotit within you. You can do it.
(13:56):
It's not that simple because we're talkingabout brain chemistry. Can you break
it down more in terms of talkingabout substance use disorder is a disorder.
There's a physical component to it.Because how does one person try heroin and
then that's it they walk away.You have another person they try it and
(14:16):
suddenly they see God and this becomesa craving that they can't step away from.
Well, you make a good point, So there is absolutely a genetic
component with the disease of addiction,and so there has been studies out where
they show that people that have ayou know, a parent or a direct
relative that has struggled with addiction,that they're more likely to struggle with addiction.
(14:41):
So that's one way we know thatit's a physical disease, not just
a mental shortcome right. Another thingthat they found is that you can actually
see the changes on brain scans.You can see the you know, with
somebody that's that's using versus somebody that'snever used, versus somebody that's been in
recovery for a long time. Youcan see that there's actually changes. Another
(15:03):
thing that's important that I have learnedis that when they do a EEG,
which is kind of looking at thesignals in your brain. So what they
have found is that they can actuallysee somebody that's predisposed to addiction based on
some of those brain waves. Sothey have lower delta waves, which basically
means that they don't have the warningsignals. So somebody that you know,
(15:26):
let's just say speeding, right,and so somebody that had the regular might
start to get worried when they're atone hundred miles an hour or one hundred
and twenty. But the person thatstruggles with addiction, they don't worry,
right so because they have decrease inthose those delta waves. And so there's
a lot of different scientific evidence topoint to there is something physically going on
(15:48):
that's contributing to somebody struggling with thedisease of addiction. I could make this
argument if I wanted to. Icould just make the argument, and I
know that there's a actual medical dataproof that backs everything that you just said.
And I'm not taking away from anyof that, but being around that,
(16:11):
being around a parent, now notme being around a parent who is
suffering from addiction. You can makethe point that it can be handed down
genetically. But I could also makean argument that watching the behavior of that
(16:33):
parent contributes to the factor of theway they handle issues gets passed along to
the child. Because I have threechildren. One fell in to that self
medicaid to that and died, twodid not, So there's more outside.
(16:57):
I believe that the environment mental aspectof it as well plays a key component.
You are right. I have afriend of mine who can't not drive
one hundred and twenty miles an hourin rush hour traffic while I'm sitting on
the chair and my knuckles are white. I'm like, do you not see
that this car? He's like,this is great? So I get it,
(17:21):
Like, I do get it.But I can also make an argument
we look up to our parents,we look up to people as children of
authority, and we want to emulatethem, and we learn how to cope
with things by the way we seeour environment copes with those things. So
(17:42):
as yes, I agree that itis definitely there is definitely a genetic issue
there, but I don't want todiscount the fact that the way someone who
is an active addiction is behaving infront of their children or their loved one
does absolutely cantribute to the way thatchild perceives the way the world is and
(18:06):
how to react to that. Absolutely, I think you The other point of
that is, you know, inthe cases of domestic violence, you often
see that those patterns of domestic violenceare repeated through generations because that's what people
know, and what you know iswhat you base your own behavior on.
So that certainly, I think avery it's a very good point. I
(18:26):
wonder we talk a lot about substanceuse disorder, and we tend to think
of it as drug abuse, butit's also alcohol. Alcohol is absolutely you
know, we don't really I don'tthink we really talk about that enough or
in the context of the overall recoveryspace. Alcohol use disorder is is real
(18:48):
and it's serious. And so howdoes MT relate to that? Is that
also used for alcohol use disorder?Yeah, so we have three medications also
for alcohol use disorder that our FDAapproved, So you're right. We do
focus on the opiate use disorder becausethat's what kills somebody suddenly, but alcohol
(19:10):
use disorder actually kills more people.It's just over a longer period of time,
so you're right, there's not asmuch focus. But we do have
three medications and interestingly enough, oneof them is the same that we use
for opiate use disorder, and thatis the now trek Zone or Vivitrol in
its stock formation, it actually hasbeen shown to be effective for both alcohol
and opiate use disorder. There's alsotwo others, a Camper's Aid or Camprol,
(19:36):
which also helps reduce cravings and preventrelapse on alcohol. And then there's
an interesting one called ant abuse andso antibuse is different than the other ones
in that it doesn't necessarily reduce aperson's craving, but it prevents them from
using alcohol because it gives them reallybad side effects if they did. I
(19:56):
was going to bring that up.I was going to ask you what is
the drug that someone takes some whenthey drink they get violently ill. And
again, I don't even know howthat is an option because it goes back
to again, it's almost like punishingsomeone like a shot collar. How does
that work that cannot prevent someone.I'm glad you brought it up because I
(20:18):
was going to ask you what isthat drug called? Yeah? You,
Yeah, that would be an interestingchoice to make. That's interesting, so
tell us more. I'm also anurse practitioner, so I'm a prescriber,
and so I've prescribed all of thesemedications. And so what they found with
an abuse is it's not super effectivein because people don't want to take it
because of the side effects. Sowhat I have seen it be effective for
(20:41):
is those people that know they're goingto be in a high risk event for
a short period of time. Let'ssay they're going on a cruise and you
know alcohol is everywhere on cruises,or maybe they're going to a wedding and
they feel like they're going to bereally tempted for that period of time,
so they just take it for ashort period of time, a couple of
days, and then they have thatreal assurance that even if they feel like
they want to drink, they're notgoing to because otherwise they're going to be
(21:04):
in the bathroom throwing up and veryviolently ill. So that's kind of how
that one typically is used. Orthey take it on the cruise on day
one, drink and finally ill,and then throw the pills overboard and go
never taking that again. Well,I guess again, it's all about finding
the right medication, the right strategies, whether it's behavioral health strategies, doctor
(21:27):
Vernig, it's really about holistically lookingat what is best served for that particular
person. Absolutely, it's about thewhole person. It's about their needs and
all of the different domains that areimpacted by their illness. You know,
you brought up the issue of natureversus nurture. I think that's an important
piece. Anytime we ask that question, the answer is usually both. It's
(21:48):
a combination, and so we needto be able to address each of those
components as a comprehensive plan. Now, there's unfortunately a lot of stigma when
it comes to or some people whobelieve that it's not really being in recovery
because if you're using MAT you know, that's not that that's not real recovery.
You should be able to do itwithout. And really, you know,
(22:10):
it's about what works for that individualperson. You know, that's a
medical decision that's between them and theirprescriber to discuss is this something that could
be a part of of my treatmentprogram, even when it comes down to
something like ant abuse, which youknow, I kind of have some of
the same thoughts about it that itseems very punitive. It seems like something
that and it has been in thepast used almost as a punishment for somebody
(22:33):
because you know, you've demonstrated thatyou can't use alcohol responsibly, so I'm
going to tell you you have totake this, so you'll be punished if
you do. But as as doctorGardner talked about, there are ways that
people might choose to take that themselvesand use it in a very specific way
because they know that's going to givethem that additional motivation that's going to give
them that additional reason to not experiencea return to use or a relapse in
(22:56):
that high risk situation. So it'svery individualized, and we have to take
into account all of those components andthe whole person, you know, when
we're considering and when the individual themselvesand their family are considering, what's recovery
going to look like for them?Right, So it's just another tool in
the toolbox, exactly. Yeah.Plus all of my opinions, I always
like to PostScript or preface that Idon't believe anything in this world, anything
(23:23):
is a hundred percent. So eventhough i may strongly feel one way about
something, I'm never under the illusionthat I'm a hundred percent on point,
like I'm one hundred percent there.I'm not. You know, I'm not.
And I'm also I try to beintelligent enough to understand that I'm learning
(23:45):
every day and that if I'm stillthinking exactly the way i'm thinking now five
years from now, I didn't getit. I'm not getting it. You
should always be evolving. Your opinionshould always be evolving, because the more
you learn about life, the moreyou learn, those things should change,
you know, hopefully for the better. I mean that's what you know.
(24:07):
We try to do, but Iagree with you that there are some Look,
I self medicate through food, andwe've had this conversation. I do
great on the weekends because my girlcomes over on the weekends and she knows
if I eat anything past seven o'clock, I don't get a good night's sleep.
And when I open up the refrigerator, she goes, do you not
want to sleep tonight? And Igo, no, I'm closing the refrigerator.
(24:30):
Yes, it's like the pill.It's like she's the pill on the
weekend. Well, I think what'sgreat about this conversation in this podcast series
is that we're learning something every dayevery podcast, I learn something new,
and I also know that people outthere listening are learning and growing from this
(24:51):
information. The other thing that weknow is that this field is constantly evolving.
What we knew ten years ago isnot what we know now. What
we know ten years from now isgoing to be different as well. And
that's why we're here today to giveyou the cutting edge, the latest,
the most accurate information that we knowfrom experts like you all and from the
(25:15):
personal experiences of people like you.Tony. Yeah, I mean you know
some of the lessons can be mindblowing. I didn't truly understand what my
son was going through until I wasdealing with the pain of his death,
and I realized that I would havedone anything to stop that pain. That
(25:42):
it becomes a selfish thing because thepain becomes so unbearable that the thought of
waking up the next day feels likea punishment, and whatever I needed to
do to wake up the next day, I would have done it, not
(26:03):
caring about the consequences of anyone aroundme or what that would do to hurt
the people that loved me, becausethe pain was greater than all of that.
And again repeating myself, music savedme. I am sitting in this
chair because the outlet for me wasmusic. And all I can do is
(26:30):
pray that wherever anyone is, whoeveris feeling that type of pain, and
people in active addiction feel it everysingle day, that I pray that they
find an outlet that can give thema relief that they need and one that
isn't going to take their life.Tonny, we appreciate your authentic expressions of
(26:56):
your experiences and what you've been through, and hopefully there's some folks out there
that are listening right now to us, to all of us, and are
getting some information that will help themtowards that goal of recovery. That's what
Recovery through sixty is all about.And we want to thank you doctor Peter
(27:17):
Vernick, vice President of Mental HealthServices, and doctor Ashley Garner, who
is Corporate VP of Nursing with RecoveryCenters of America, Doctor Vernack. If
people want more information, where dothey go? If you'd like more information
about Recovery Centers of America, youcan visit us online at RCA Recovery three
sixty dot com or call us ateight four four two five. Recovery Tony
(27:38):
always a pleasure. Pleasure is alwaysmine. We'll see you next time.
Take care,
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