The Benefits of Integrating MAT and IOP Level of Care

The Benefits of Integrating MAT and IOP Level of Care

Approximately 1 in 25 adults in the U.S. (11.2 million) experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities. Additionally, more than 70,200 Americans died from drug overdoses in 2017, including illicit drugs and prescription opioids, which was a 2-fold increase over the past decade. With amplified attention focused on the opioid crisis in the United States over the past decade, effort is being given to developing treatment modalities to better address addiction issues and their co-occurring mental health symptoms. One of these treatments, medication-assisted treatment (MAT), is gaining ground among medical and mental health professionals and the latest research is showing promise.

Most commonly, medication-assisted treatment (MAT), has consisted of using medication concurrently with therapeutic services to treat addiction related problems in adults. However, the success in applying MAT in treating substance use has researchers and mental health providers expanding treatment possibilities for other mental health diagnosis like treatment resistant depression (TRD), suicidality, post-partum depression, and neonatal abstinent syndrome (NAS). This shift in the the mental health field is happening as a result of the scientific literature detailing the overwhelmingly positive outcome data. Research suggests that clients who engage in MAT have far better outcomes. For those struggling with addiction, they not only stay sober more consistently and for longer periods than standard behavioral “treatment as usual” participants, they also score higher in associated recovery behaviors such as treatment attendance, reduced risk-taking behavior, more pro-social behavior, less criminal activity and show less depression and anxiety than those not receiving MAT.

As the need for opioid and severe mental illness treatment increases, programs are looking for better way to access and treat clients. One growth potential is the integration of MAT treatment in intensive outpatient treatment programing (IOP). IOP’s are treatment programs used to address mental health issues such as addictions, depression, eating disorders, or other dependencies that do not require detoxification or round-the-clock supervision. They enable patients to continue with their normal, day-to-day lives in a way that residential treatment programs do not. Historically, MAT generally existed as a part of the in-patient residential model due to residential treatment programs being a more “structured and controllable environment”. The problem is that the majority of the adults (59%) suffering from mental illness do not receive treatment. IOP’s which are much more integrated in local communities could help in bridging the disparity.   

The pairing of MAT in an IOP setting offers a number of benefits. IOP’s offer an increased duration of treatment, which varies with the severity of the patient’s illness and his or her response to during the process. Furthermore, IOP’s offer the opportunity to engage and treat clients while they remain in their home environments, which affords clients the opportunity to practice newly learned behaviors. It gives clients a place to go where others who are dealing with similar struggles can relate and provide support through milieu and group activities. For many clients who have busy lives but also struggling with addiction and/or severe mental illness, IOP treatment can provde the flexibility needed.

IOP’s that offer MAT as a modality are increasing all over the country because research showing positive outcomes is strong and clients are showing interest. In substance use, research shows that MAT utilizing methadone and buprenorphine significantly increases a patient’s adherence to treatment and reduces illicit opioid use compared with nondrug approaches. Furthermore, by reducing risk behaviors such as injection of illicit drugs, it also decreases transmission of infectious diseases such as HIV and hepatitis C. In treating treatment resistance depression (TRD) with  Ketamine research found Ketamine appeared to directly target core depressive symptoms such as sad mood, suicidality, helplessness and worthlessness, rather than inducing a nonspecific mood-elevating effect. This was true even in patients with previous medication resistance. Furthermore, IV ketamine was associated with rapid reductions in explicit and implicit suicidal cognitions within the first 24 hours after infusion, which persisted for patients who received additional infusions.

However, without psychosocial support, MAT shows little long-term success. Among 14 studies examining methadone maintenance, 12 (86%) showed better outcomes for patients who received a psychosocial intervention along with methadone as compared to methadone alone. Psychosocial therapies included cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), contingency management and general supportive counseling. IOP’s provide an excellent structure for integrating MAT and psychosocial care because of their flexibility in addressing the needs of their clients. Deeper, more significant relationships are able to be built with therapists because of the longer length of treatment. In local IOP care, treatment can be more sensitive to life work issues that often cause barriers to healing. Family therapy and developing community support to coincide with MAT is more feasible in an IOP structure. Also, for many family’s IOP treatment is the cheapest option.

Flexibility and integrated care are needed to address the disparities in mental health and substance use treatment. MAT, when paired with therapy and psychosocial support, has shown excellent results in reducing symptoms in addiction and other severe mental health issues. It makes sense that IOP’s are gaining ground in providing MAT services concurrently with therapeutic services as they are grounded in the community that their clients live and work. IOP’s may be better prepared to include families in in a client’s healing and recovery. While more research focused on the IOP/MAT partnership would help in increasing our knowledge about MAT with specific populations and communities. The possibilities moving in the future are exciting. 

Resources

Any Mental Illness (AMI) Among Adults. (n.d.). Retrieved May 1, 2019, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154785

Brown, M. S., Hayes, M. J., & Thornton, L. M. (2014). Methadone versus morphine for treatment of neonatal abstinence syndrome: A prospective randomized clinical trial. Journal of Perinatology,35(4), 278-283. doi:10.1038/jp.2014.194

Mattick et al., “Methadone Maintenance Therapy”; Comer et al., “Injectable, Sustained-Release Naltrexone”; and Fudala et al., “Office-Based Treatment.”

National Institute on Drug Abuse. (2019, January 29). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Price, R. B., Nock, M. K., Charney, D. S., & Mathew, S. J. (2009). Effects of Intravenous Ketamine on Explicit and Implicit Measures of Suicidality in Treatment-Resistant Depression. Biological Psychiatry,66(5), 522-526. doi:10.1016/j.biopsych.2009.04.029

Schwartz et al., “Opioid Agonist Treatments”; Judith I. Tsui et al., “Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users,” JAMA Internal Medicine 174, no. 12 (2014): 1974–81, https://archinte.jamanetwork.com/article.aspx?articleid=1918926; and David S. Metzger et al., “Human Immunodeficiency Virus Seroconversion Among Intravenous Drug Users In- and Out-of-Treatment: An 18-Month Prospective Follow-Up,” Journal of Acquired Immune Deficiency Syndromes 6, no. 9 (1993): 1049–56, https://www.ncbi.nlm.nih.gov/pubmed/8340896.