Integrating MAT, Abstinence-Based Approaches to Recovery Drives Patient Engagement

Medication-assisted treatment and 12-Step recovery support would seem, in theory, to have opposing approaches to recovery from opioid use disorder (OUD). But as Robert DuPont, MD, president of the Institute for Behavior and Health, Georgetown University School of Medicine, and Cara Poland, MD, MEd, assistant professor of addiction medicine, Michigan State University, will explain at the Rx and Illicit Drug Summit this week, the 2 treatment modalities not only can coexist, but together can provide patients with a more positive experience in recovery.

Ahead of their session at the Rx Summit, Drs DuPont and Poland spoke with Addiction Professional about the keys for getting buy-in on the hybrid approach from providers who historically have been wary of each other’s treatment philosophies, as well as the benefits of adding medications for opioid use disorder (MOUD) to abstinence-based programs, and the process for successfully integrating the 2 approaches.

Editor’s note: This interview has been edited for length and clarity.

What have been your keys to getting buy-in on this hybrid approach from MAT-based and abstinence-based treatment providers who previously were wary of each other’s approaches to addiction treatment?

Dr DuPont: The positive experiences of those who have put the 2 approaches together! They have found that their patients benefit, and their staff overcome any initial objections. Best of all, their original approach—before the integration of the other—works better and is not threatened by the additions.

Dr Poland: Integrating the 2 allows patients to have more choice in their treatment, which engages them better and creates a stronger therapeutic alliance between clinician and patient. The more support people have, the higher their chances of successful treatment.

What are the biggest benefits to adding MOUD to abstinence-based treatment programs?

Dr DuPont: Offering a wider range of options and having better retention. We are not talking about everyone in MOUD going to AA and NA meetings or everyone in 12-Step-oriented treatment programs getting on MOUD. We are promoting offering the alternative approach as a respected option to their usual patients. Respecting the alternative for those who want it and learning from this integrative experience.

Dr Poland: Exactly! We want to make sure patients have their needs respected and supported. As physicians, it’s important we know how people are treating their disease: whether it’s 12-Step or, say, acupuncture. In the name of helping patients, understanding, and respecting alternatives helps us better care for the people and communities we serve.

What is the process for successfully integrating these 2 approaches? What are the biggest hurdles providers face when accomplishing this goal?

Dr DuPont: The biggest hurdle is the staff reluctance, even the staff distaste, for the integration of an alternative as an option for patients who want it. There is an ideological and visceral rejection of the integration at the start that is challenging. But with gentle persistence, it has been overcome and the patients have benefited.  

Dr Poland: I also find that patients are a bit reluctant to share their experiences with 12-Step—good or bad—somehow, they’re expecting a reaction from me—either insistence they go or distain for the program. Again, being open and nonjudgmental about what works for an individual allows us to best care for them. And, I’ve definitely learned a lot from my patients about how to integrate the 2 modalities in a way that complements each other.

Can you provide any data that show how this combined approach has led to better outcomes?

Dr DuPont: I know of no controlled study comparing integrated vs segregated programs on these 2 alternative modalities. However, Hazelden Betty Ford Foundation has been a leader in integrating the use of MOUD into its traditionally 12-Step-based treatment program with excellent results.

The best evidence that supports this new blending of major modalities is the experience of many who have found this once unthinkable integration to be relatively easily achieved and the reactions of staff and patients have been positive.

There is 1 particularly positive payoff, and that is this integration helps tone down the hostility between the 2 dominant addiction treatment modalities. Reducing that hostility benefits both, because the entrenched hostility has the effect of undermining public confidence of both modalities. It is a little like hostility between residential vs outpatient addiction treatment or between treatment that has abundant psychosocial support and treatment that does not. The solution is not to declare 1 the winner but to value the variety of options. In this case, the solution is to combine them to capture the benefits of each.

Dr Poland: The very nature of 12-Step programs makes them difficult to study, as a key tenant is the anonymity. So, while, as Dr DuPont stated, there aren’t studies exactly exploring the outcomes of this approach, clinically, what we hear from patients, staff, providers, and prescribers is that this approach supports people in their treatment. With the high cost of addiction to individuals, families, and the community, finding and developing individualized care plans will only help us develop and create safer, healthier communities for generations to come. The time has come for us to work together to find the best individualized care plan that meets the person in front of us with kindness, compassion, and support to live the healthiest life they can.

Reference

DuPont R, Poland C. Stronger together: combining medication for opioid use disorders with 12-step recovery support to achieve five-year recovery. Presented at: Rx and Illicit Drug Summit; April 18-21, 2022; Atlanta.