Understanding Addiction and Medication in Addiction Treatment
According to the ASAM Definition of Addiction, Addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” with a “dysfunction in these circuits” leading to “characteristic biological, psychological, social, and spiritual manifestations.” Brain changes result in the pathologic behavior of pursuing reward and/or relief by substance use and other maladaptive behaviors.
Addiction is about a physiologic change in the brain – not just about behaviors. While it is crucial to consider psychosocial and behavioral interventions in addiction treatment due to their efficacy, it is also crucial to consider the use of medications necessary to address the changes in brain circuitry and improve outcomes in conjunction with comprehensive psychosocial treatment.
According to the pocket guide produced by the American Society of Addiction and Medication (ASAM) and the National Association of Drug Court Professionals (NADCP):
Medication Assisted Treatment
Medicated Assisted Treatment represents scientifically supported treatment shown to reduce drug use and foster meaningful recovery. It helps participants focus on their ongoing recovery by reducing cravings. However, it is not substituting one addictive drug for another. Combining medication assisted treatment with addiction counselling is essential for recovery.
Assessment, Diagnosis, and Treatment
Assessment
The multidimensional assessment must be conducted by a skilled clinician using a valid assessment tool that facilitates the following of an ASAM Criteria multidimensional assessment. An ASAM Criteria assessment includes evaluating the individual's needs related to withdrawal management, other medical conditions, mental health needs, motivation, relapse risk, and living environment
Diagnosis
The clinician will verify a diagnosis of OUD before prescribing pharmacotherapy for OUD. The diagnosis and/or referral for evaluation are conducted for any suspected mental health or medical disorders.
Treatment Setting
Counselors collaborate in shared decision-making between the prescribing clinician and participant to choose from available treatment options after discussing potential benefits and risks for different options available to the drug court participant. • Prescribing clinicians consider participant preferences, past treatment history, and setting when deciding between use of methadone, buprenorphine, or naltrexone for OUD
