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MSED, NCC, LPC

Medication assisted treatment (MAT) is medication therapy that can help an addict stop using illicit drugs. The best known forms of MAT are Methadone and Suboxone. Opiate addicts can enter a treatment program for opiate addiction that gives them Methadone or Suboxone as part of their treatment, or they can be placed on Suboxone by certain doctors who are specifically trained and licensed to prescribe it. MAT can be a wonderful tool but it has its pros and cons just like anything else. 

MAT helps addicts by reducing cravings and keeping them from having withdrawal symptoms. A person can stabilize on MAT; make changes to their life and then taper off the medication. Stabilization is when an addict is on the right dose of MAT so they don’t have withdrawal symptoms or cravings. Tapering is when the person chooses to gradually reduce the dose of their MAT until they are drug free. However, some people get stuck in the process of tapering and stay on MAT for years or never complete treatment.

What Keeps People Stuck on MAT?

  • Substitution
  • Fear
  • Complacency
  • Physical Withdrawal
  • Emotional Withdrawal
  • Cravings
  • False sense of security

Read on to learn more about common problems that stall tapering and about how to address these problems so they don't derail your recovery process.

Intoxication Substitution

Addicts who substitute MAT for opiates can become stuck on MAT for years. They use MAT not to stay clean but as a replacement for opiates and may continue to use other drugs to get high. A person has to get to a point that they see that their life is not getting better and realize that their drug use is responsible for their problems. People have to want help and ask for it to make improvements to their lives.

Fear and Complacency

The best way to combat the fear of withdrawal and the complacency of MAT is to be involved in a recovery program. In a recovery program, the addict will meet many other recovering addicts who have been where they are and understand how they feel. The addict will be able to talk about their struggles with tapering and get encouragement and hope from their peers. 

A recovery program will help the addict to not become complacent because they will be reminded by their peers that there is a better way to live. They will see examples of people who are abstinent and this will give them hope that they can do it too.

There are many types of recovery programs available, with Narcotics Anonymous being the best known program. However, if you think Narcotics Anonymous is not for you, there are other options like SMART Recovery, Rational Recovery or Women for Sobriety. There are also many counseling programs which could help addicts cope with their fear and complacency.

Fear of Physical Withdrawal Symptoms

During tapering, physical withdrawal symptoms are usually minimal or even absent; you may have some fatigue, trouble sleeping or restless legs. If you have more physical symptoms than this, consider slowing down your taper. How much withdrawal you experience all depends on your body and how quickly you taper.

Most treatment facilities and doctors who prescribe MAT will listen to how quickly you want to taper down. This can be a good thing or a bad thing:

  • It can be good because you can take your time.
  • But it can be a bad thing if you let your fear keep you from requesting decreases.

If you feel you are hindering yourself because of your fear, ask your doctor to help. Many methadone clinics offer blind dosing where you can be reduced without knowing your dose. This wouldn't be possible with Suboxone since it is given through a prescription but perhaps your doctor would be willing to reduce your dose at regular intervals. Or, you could take a friend or family member with you so you don't back out of asking for a decrease at the last minute.

How to Cope with Physical Withdrawal

Since physical withdrawal should be minimal, you may not have to do anything to cope with it. But if it is hindering your progress, it's a good idea to find ways to minimize your symptoms. 

Here are some tips for minimizing physical withdrawal symptoms:

  • Get plenty of rest
  • Drink lots of water
  • Eat healthy meals at regular intervals
  • Exercise
  • Ask your doctor about non-addictive medications for your symptoms
  • Take an over the counter sleep aid or a natural sleep supplement like Melatonin
  • Slow down how often you take decreases
  • Take smaller decreases

Handling Emotional Withdrawal Symptoms

While the physical symptoms of withdrawal should be minimal, you should expect emotional symptoms as well.

Whenever you stop using any substance there is a period of adjustment. Emotional withdrawal symptoms may last anywhere from one week to several months and you may find yourself getting more frustrated, easier to anger or crying a lot. While physical symptoms of withdrawal may seem more severe, emotional withdrawal is no less real and can be the bigger threat to getting clean. This is partly because addicts often have difficulty coping with their emotions and may try to numb their feelings with drug use.

Here is a list of some common emotional withdrawal symptoms

  • Anger
  • Irritability
  • Frustration
  • Restlessness
  • Boredom
  • Sadness
  • Depression

How to Cope with Emotional Withdrawal

Since the majority of your symptoms will be emotional, it's wise to have a plan for handling emotional withdrawal.

Here are some tips for coping with emotional withdrawal:

  • Keep busy
  • Write about your thoughts and feelings in a journal
  • Find a creative outlet for your feelings
  • Think positive
  • Listen to music
  • Try relaxation techniques
  • Yoga
  • Meditation
  • Deep breathing
  • Mindfulness
  • Guided visualization
  • Progressive muscle relaxation
  • Find fun, sober activities that you enjoy
  • Spend time with family
  • Have a support system of people you can talk to about your feelings

While your instinct may be to take it easy while going through emotional withdrawal, nothing can be worse for dealing with emotional withdrawal than staying at home in bed and isolating yourself. Doing this will only make you more depressed and increase the severity of your emotional withdrawal.

  • Keeping busy will keep your mind occupied with something other than your tapering.
  • Writing will help you understand your feelings and gain insight into your behavior.
  • A creative outlet can be a way to focus your emotions toward something productive. You may have a tendency to think negatively while going through emotional withdrawal. An awareness of your negativity will help you focus on the positive side of things.
  • Remember that every decrease is progress toward your goal. 

You may find yourself feeling more stressed while tapering. Having several relaxation techniques at your disposal will help reduce the tension you feel.

Yoga and meditation are great relaxation tools. Many gyms offer classes in yoga. Meditation is a process of clearing your mind and learning to focus. You can meditate by focusing on your breathing or a manta. A mantra is a word or phrase that has meaning for you. Deep breathing involves taking several slow deep breaths from your abdominal area. Mindfulness is when you focus on staying in the present moment and are fully aware of your environment. Use all five of your senses to experience and enjoy the world while practicing mindfulness. Guided visualization is listening to someone describe a peaceful scene while imagining yourself in the peaceful scene. You can even record your own visualization and listen to it when you feel under stress. 

The most important of all the coping techniques involve your support system. Talking about your feelings with a friend will help you understand and cope with them. Having someone to call when you feel upset can relieve unpleasant emotions. Spending time with family will take your mind off your troubles and can be an enjoyable way to relax.

Cravings and False Sense of Security

Physical withdrawal, emotional withdrawal and cravings are the major issues you may have to deal with when tapering.

Cravings are when you begin to think about or obsess about using drugs. MAT reduces cravings for opiates. This is one of the functions of MAT that makes it great for staying off opiates, but this can create a problem when the addict begins tapering.

The problem with MAT reducing cravings is that the addict can have a false sense of security on MAT. Addicts who have been on MAT for many years are most often prone to developing a false sense of security. It is possible that they have had very few or no cravings for a long time because their medication has kept them from having cravings. They may forget that MAT reduces cravings and take the lack of cravings as a sign of how well they are doing in their recovery. This does not mean they are not working hard on their recovery and are not responsible for reducing some of the cravings themselves. However, the medication may be doing some of the work.

Over time, the addict can begin to forget how hard it is to cope with cravings. They can start to believe that they won’t ever have cravings again. A false sense of security can even make the addict believe they are cured. This will make the addict fail to make a plan to cope with cravings that can return when they begin tapering. When the addict begins tapering, they may be unprepared for the return of cravings. This could lead to a relapse or the addict may stop tapering to avoid cravings and relapse.

The way to combat the false sense of security that MAT can create is to educate yourself about addiction and how cravings work. If someone on MAT prepares themselves for an increase of cravings during the tapering process, they can learn to cope with them and cravings will be reduced over time.

The best way to handle cravings is to have a relapse prevention plan. A relapse prevention plan is simply a plan for how to handle anything that could lead to relapse. It can be as simple as a couple pages or an elaborate, detailed plan. You can include your triggers for cravings and how you plan to cope with them.

As long as you consider what may keep you stuck on MAT and how to handle these issues, you can taper off MAT with little to no problems. You can live a full life in recovery without relapsing if you continue to work on your recovery.

About the author Anna Deeds:
I am a recovering addict and a Licensed Professional Counselor. I have over 7 years clean from all substances and more than 10 years from illicit drugs. I work as an addiction counselor and have more than 5 years experience counseling addicts.
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Page last updated Feb 11, 2014

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