Substance Abuse Treatment Utilizing Medication Assisted Treatment as HIV Prevention

Abstract

International guidelines have been developed for the use of medications in the treatment of substance use disorders (WHO, 2008; WHO, 2009). Medications used in the detoxification from drug abuse and dependence provide symptomatic relief of drug and alcohol withdrawal. For long term treatment or medical maintenance treatment, medications eliminate the physiological effects of drug use by blocking drug-receptor binding in the brain and are an important part of the recovery process. The use of medication assistant treatment (MAT) is part of a comprehensive treatment plan for drug and alcohol dependence that addresses the medical, social, and psychological needs of the patient (SAMHSA, 2005; SAMHSA, 2009). An effective long term treatment paradigm for the successful treatment of alcohol or opioid dependence is the concomitant use of medications that block the effects of drug use in concert with behavior change counseling and psychotherapy. Medications which have demonstrated effectiveness in the long term treatment of opioid dependence are methadone, buprenorphine (subutex®, suboxone®), and naltrexone (Revia®, Depade®) or extended release injectable naltrexone (vivitrol®). Pharmacotherapies used in the treatment of alcohol dependence include acamprosate (Campral®), disulfiram (antabuse®, antabus®) and naltrexone (Revia®, Depade®) or extended release injectable naltrexone (vivitrol®). Time in treatment is a reliable indicator for successful treatment of drug dependence. Patients remain in treatment for longer periods of time when they perceive that their health care environment is supportive and non-stigmatizing, have a good patient-provider relationship, and feel that their needs are identified and met. Access to community-based substance abuse treatment that includes MAT is fundamental to achieving broad service coverage. Given that substance abuse treatment is Human Immunodeficiency Virus (HIV) prevention and the frequent co-morbidity of substance abuse and HIV infection, the provision of prevention, care and treatment for both need to be addressed in a coordinated manner for ideal patient outcomes. There are several models to achieve excellent patient outcomes for both HIV infection and the treatment of substance abuse (Proeschold-Bell et al 2010; Weiss et al, 2011). The highest level of coordinated care model has MAT and HIV services fully integrated with both the same medical record and health providers for both