The Real Common Treatable Podcast

Medication Assisted Treatment with Dr. Jennifer Montague

December 21, 2021 Clint Mally Season 1 Episode 23
The Real Common Treatable Podcast
Medication Assisted Treatment with Dr. Jennifer Montague
Show Notes Transcript

In this podcast, you'll hear from Dr. Jennifer Montague as she explains what medication-assisted treatment is and how it could be THE thing to help your kid get and stay sober. 

Some of the questions we cover are:

  • What is the goal of medication-assisted treatment?
  • Do you have to use it forever?
  • What are the different medications and their side effects? 

Our Parent Support Facebook Group👇
https://www.facebook.com/groups/rctcommunity/

Our Virtual Parent Support Group Led By Licensed Clinician 👇
https://www.eventbrite.com/e/virtual-parent-support-group-tickets-111055335498

Check out our full blog post👇
https://www.sandstonecare.com/medication-assisted-treatment

See the full youtube video👇
https://youtu.be/4K6EF1cUTO0

Dr. Montague is the senior medical director for our inpatient and outpatient levels of care. Trained in both Addiction Medicine and Internal Medicine, she embodies an integrative and holistic approach to medical care in recovery. Her passion for a multidisciplinary approach ensures her patients receive complete and compassionate care in every domain of their life. Dr. Montague uses her own story of recovery to inspire and empower change in her patients. When not working she enjoys hiking at state parks with her husband and two dogs, cooking new recipes, and playing board games.

Clint Mally:

See your kid decides to go to substance abuse treatment, which is a huge first step. How do they sit through a therapy session or go throughout their everyday life without craving drugs or alcohol? How is your child supposed to not use when they could be triggered by things connected to turning their life around? Like getting a job improving their grades, or searching for new sober friends? The answer is medication assisted treatment, a controversial form of substance abuse treatment that is surrounded by a ton of myths. And to help sort this out, I sat down with Dr. Jennifer Montague with sandstone care who has made it her mission to redefine what ma t is, and how it can be the thing to help someone stay sober long term. I'm Clint Mally, and this is the real common treatable podcast where we help parents help their kids overcome addiction and mental health challenges. Dr. Montague does a lot in the substance abuse field a whole lot.

Unknown:

I have the privilege of being the senior medical director at sandstone care. I oversee all of our facilities in the Colorado region that includes our inpatient detox our inpatient cascade adolescent unit, our outpatient centers in Colorado Springs, Denver and Broomfield, we have a full continuum of services that I have the privilege of overseeing, and I do direct care work also in the outpatient centers.

Clint Mally:

Many people disagree with aspects of medication assisted treatment, but first we need to define what it is. So what exactly is medication assisted treatment?

Unknown:

It is as it sounds. So it's a treatment that is apart from the psychotherapy apart from the group therapy, family therapy, it involves medications. So medication assisted treatment is something that a provider medical provider can counsel you on as to your choices of different treatment options. So it's not just one medication, it is several different medications that fall under the container header of medication assisted treatment. So medication assisted treatment is for people with an substance use disorder. And it can be alcohol use disorder, or opiate use disorder, or stimulant use disorder. So it has various disorders that it can treat. But the idea is the same is that this is a prescription medication that is specifically designed to treat somebody with a substance use disorder.

Clint Mally:

There are a lot of different medications that someone can use to combat substance abuse, and more on this later, but is medication assisted treatment, something that you can use alone to get better or does it need to be paired with other things to

Unknown:

medication assisted treatment is a treatment best served with clinical services such as psychotherapy, group therapy, family therapy, and individual therapy. However, the real crux of medication assisted treatment is stabilizing the physiology if you have a physiology, so your biology is in a fight or flight state or in a high craving state, or in a state of euphoric recall all the time about your drug use, you're going to have a lot of trouble getting traction in those therapies that can be life saving, right? And so that's where a doctor like me comes in and says, Hey, I see that you are struggling with your physiology, your physiology is primed for drug use, we need to get your brain centered not on drug use, but on recovery. And how do we do that? Like, how do we do that when it's fundamentally inside of the center of your brain? And the answer is we do that through medications to stabilize the centers of the brain that are overacting.

Clint Mally:

Basically, when you stop using drugs or alcohol, your brain is not working at full capacity, it can feel like you are in danger, like you will die if you do not use again, as Dr. Montague said, you can also enter into euphoric recall, which means that your brain dramatically emphasizes the experience of being drunk or high. And this can make the very real negative aspects of using feel tiny in comparison to the extreme pleasure that the drug is currently promising your brain.

Unknown:

So medication assisted treatment can be that foothold that you need in order to anchor yourself to be able to participate in the healing therapies that bring you recovery in all spheres. Have your life. But if somebody is out there who is jonesing for their next fix, who can't even sleep because they're in such a fight or flight response, if somebody is unable to eat, or find shelter, or do all of the basic survivals, because their brain has been hijacked to think that their number one survival skill is drug seeking behavior, then that person isn't going to be able to sit through 45 minutes of group therapy, they're not going to be able to do the family work. The life saving potential of medication assisted therapy is that we stabilize the brain, we stabilize the biology, and allow the person to do the healing work here at sandstone that they need to actually do recovery for the future.

Clint Mally:

Maybe you're thinking this could be just the thing to help my son or daughter out? Where do you even start, it can feel like a lot to suggest to a doctor that they start using some sort of medication to help the detox and recovery process.

Unknown:

They think, oh, this is a huge thing. If I try it, I can never go back. If I try it, I won't actually be abstinent. That's a big misunderstanding. Lots of people come in with a lot of hesitations. And so I'd really like to boil it down. It's like any other time you went to a doctor with a problem. And you were honest with your doctor and said, Hey, like I'm struggling with XY and Z. And when you're in addiction, that x, y and z is probably going to be sleep cravings. And recall, let's say like, where you're just recalling your euphoric use over and over. And it's like a endless loop. And you can't do or say anything else. But this euphoric recall, and you want to be sober, but you don't know how to be sober. And so what that doctor can do for you is explained to you the basic choices for your substance use disorder specific to you, and go through the risk benefit of each type of medication, so that you can be in the know as far as what you're signing up for. What's the commitment? Is this a week? Is this going to be months is this going to be yours, it's specific to your particular issue. There's not a one size fits all for everybody. So I might prescribe one medication to you for several months and one medication, the same medication to another person, for a year. Right. So it's designed and tailored to your specific situation. And that's as simple as it gets talking honestly, with a doctor about your different treatment options, going to a pharmacy, getting your medication, taking it and having follow ups with your doctor.

Clint Mally:

There is an idea that people who use medication to get sober are not truly sober. Even sober communities debate this idea. Some people think that they are just trading one drug for another. So is medication assisted treatment, cheating,

Unknown:

huge myth, major mythbuster there. So we got this idea, often from well meaning people who misunderstood that medications are not drugs. So they thought, Oh, if you're taking a medication that must be that you're on another drug, the two words are not interchangeable. So we certainly don't penalize a diabetic for needing insulin. We certainly don't penalize somebody with high blood pressure for needing a high blood pressure medicine.

Clint Mally:

Some of this misconception is related to confusing opioids, which have been proven to be addictive and are often prescribed for pain management for things like a broken bone with other types of medication used to prevent substance abuse, which they are not, they are very different.

Unknown:

The key components of addiction where you are seeking the drug at the cost of everything else, where you are abandoning all your other hopes and dreams and values in order to get high, where you are basically, in a one track mind where you have become determined just by your substance use disorder, that you are a one dimensional person, all of that is what addiction is when you're on a medication, you are free from those addictive behaviors. So when somebody is on a medication for cravings, they no longer are jonesing they're no longer stealing money from their parents or their loved ones. They're no longer trying to get their next fix through whatever means they have to do. They're stabilized. They have a medicine that they take every day that makes them feel normal. Just like insulin makes the diabetic feel normal, or how we would prescribe a sleep medicine to somebody who needs help sleeping. Like we don't penalize people who have chronic conditions for needing a medication in the same way we would never ever Hold that over somebody's head who has the chronic disease of addiction saying you don't get to be that person who gets help everyone else gets help with their chronic conditions but you you have to do it stone cold by yourself.

Clint Mally:

By the way, this is not just Dr. Montague's opinion, this is research based. And the results kind of speak for themselves

Unknown:

from really great scientific studies. This is not just wishful thinking. This is science says when you're able to stabilize physiology with medication, that person has a better quality of life, they have more absent drug free days, they have less sexually transmitted infections, they have less arrests, less time in prison in jails, they have less time in the ers, like we have unplanned pregnancy goes down, all of these determinants of quality of life go up. And it's amazing. And if you are that person who's on the fence, saying I should be able to do this on my own, I don't make it harder than it has to be. It's already a hard disease to beat. So go ahead have some gentleness and some grace for yourself that you deserve help and that you deserve what science has to offer you.

Clint Mally:

There is another myth though, maybe you decide to take medication to manage your sobriety. Is there a detox period for this stuff? Will you have to use it forever, are you going to have to come down from this medication like you would from other drugs,

Unknown:

I love the way that you said that because even the the phrase coming down off of a drug is going to elicit this idea that somehow you're high on the medicine, which I would just again, like gently say that the purpose of MIT is never to get the person high. It's never to put them on a big cloud and then have to bring them down later on. It's to stabilize, it's to normalize, and it's to get them to reengage in normal life. When a patient comes to me for ma t, what I tell them, what I'm going to do in the beginning is be very aggressive, trying to get you stable, the early weeks in recovery are essential to the stabilization process. So we've got to get you in a structured living situation, whether that's sober living, whether that's at home with great supports, whatever that looks like for you is what we need to be passionate towards.

Clint Mally:

Experts agree that addiction is a bio psychosocial disease. Biologically, there are real physical effects that the brain and body have to overcome to become stable and sober. But it is also psychological, such as how you think, which is usually sorted out through group or individual therapy, then there's the social aspect to support groups, your circle of friends, your home environment, these all play a huge role in staying sober long term.

Unknown:

So when a patient comes to me for treatment, I tell them, we have options. But what we want to do through medication assisted treatment is stabilize your future. So we want to get you traction in every domain of your life that matters. So that bio psychosocial disease process is real. And when we look at the psychosocial domains, they are a huge driver for relapse, and a huge driver for continued addiction. And so what I tell my patients is, I want you to stay on this medication and tell you are stabilized in these other domains, that you have stable housing, you have stable income, you have stable friendships and supports, you have stable therapy, like you are not wondering anymore, where your next meal is gonna come from, or where you're gonna lay your head on your pillow, you're not wondering if you're going to end up in the hospital Odede next week, like you have a solid future in front of you. And I use medications often for months while somebody is trying to achieve those goals. And once they have achieved those goals, then I say let's look at the role medications playing in your life right now. So is it continuing to help you with your cravings? If so, maybe we should continue it. Right? Because we know biologically that those cravings can come back, even if you've been a year sober. For other people, they may say, You know what, Dr. Montague, I don't have a lot of issues with cravings. And I would really like to try decreasing my dose. And in those situations, I say great, let's partner up, make sure your treatment team is involved. And that we do this responsibly. And we do it little by little and we see how you do and for some people, it may just be a few months where they're on the medication assisted treatment.

Clint Mally:

So far we've talked about what medication assisted treatment is why it works. But what are the specific medications that we're talking about here? Is there a catch? Or could these medications be a golden ticket to getting sober and staying sober? We'll find out after a quick message from our sponsor. This podcast is brought to you by sandstone care. They help teams young adults and their families overcome challenges with substance use addiction and mental health conditions. Remember Dr. Montague from this podcast? Yeah, that's where she works. Go to sandstone care.com. Or call using the number in the show notes to talk to a real human who will get to know you and your situation and connect you with help. Even if it's not what that probably one of the most well known medications for medically assisted treatment or MIT is methadone, which I think seriously needs to rebrand its name because of the stigma around the word meth. But what exactly is methadone?

Unknown:

Methadone is the oldest of rmat options. So it has been around has the most data has a ton of studies behind its efficacy. Methadone is a highly regulated medication for opiate use disorder, it acts as a replacement therapy, meaning that it is something that attaches to the opiate receptor in the brain. But it does not give you the same high that heroin or fentanyl or Percocet would give you. So done correctly. Methadone at a therapeutic dose keeps the brain from craving an opiate, but doesn't make you high on methadone.

Clint Mally:

Okay, this sounds like a win. How come all people striving to get sober don't use methadone.

Unknown:

It's also unfortunately the hardest to get. So getting methadone usually requires going to a methadone clinic daily, and receiving a dose daily, having evaluations a several times a month by a provider who will slowly graduate you towards take home doses.

Clint Mally:

That is a lot if you have a job or family or a bunch of other responsibilities that you have to juggle in your daily life.

Unknown:

So this is really good for people who are in a very unstable psychosocial situation. So such as being homeless, for instance. So having a clinic downtown, that you can just come to meet with a social worker, get your dose of methadone, triage your daily problems, and have that daily support. That's what methadone is really good for people who have busy lives who have work or who have family responsibilities that they can't get to a methadone clinic every day,

Clint Mally:

not so much. But there are other options that take a lot less time, but have also been shown to have a great result.

Unknown:

Now trek zone is such an interesting medicine. So what now trek zone is it takes up the slot of the receptor for opiates, and the reward receptor for alcohol. But it does not activate the receptor. So you could envision like a baseball glove, the baseball comes in, but doesn't actually act on the glove in any way. It just sits there, just making sure that no other baseball's can come into the glove, that the glove is busy now, and it can't be activated by any other of the baseballs. So if somebody were to relapse, and try to fit a fit, no baseball in there, or a heroin baseball in there, the receptor would be like, Nope, I'm already taken up by now trek zone. And I will not be responding to other drugs that come in. So now Trek's own is what we call an antagonist. Meaning that it antagonizes the receptor but it doesn't activate it. It takes up the place of but it doesn't activate.

Clint Mally:

Basically, it prevents someone from getting high or nearly as high if they use which can also reduce cravings over time when not toxin is in your system. The drugs don't have nearly the same effect on you. But with methadone, you have to take it daily. And now chockstone is different.

Unknown:

Interesting Lee enough is it can decrease cravings when given in a long acting formulation. So the most common brand name of this formulation is Vivitrol which is a 28 day injection that you get once a month of long acting now trek zone to help you stay sober and if you do relapse, not allow any of the other substances to reach that pivotal on off switch in your brain.

Clint Mally:

The tra is a long acting or slow releasing form of naltrexone. But is this for everyone? Does it work for all drugs? Does it work for alcohol too?

Unknown:

So what's really interesting about naltrexone and Vivitrol is that they have a role in both opiate use disorder, and alcohol use disorder. And so people who are studying this are really looking at the relationship between reward behavior. So what the opiate track is often about pleasure and rewards. And if you block that you actually not only blocked people's ability to get high off of opiates, but you also block the reward from alcohol. So it's really surprising because you'd be like, what is the opiate pathway have to do with alcohol? Apparently a lot and we're still learning the association between the two. That basically, giving now trek sound to somebody who has alcohol use disorder, increases the number of abstinence days per month, decreases the number of drinks per time that they decided to drink, and overall decreases the cravings for alcohol.

Clint Mally:

It makes sense, right? Why would I continue to drink if I'm not getting drunk? I don't care what you say. Nobody drinks something that much for the taste like Kool Aid tastes good, but it's not making anyone go broke or flip upside down to do a Kool Aid keg stand. Another way to think about this is like coffee. Would you still drink coffee? If it didn't give you that does? For me? That's a big hell no, and I drink mine black. I know that there are some strange and mysterious people that drink decaf. But I think for many others, the answer would be no to. But what if just blocking the receptor so that you can't get drunk or high isn't enough? People are still connected with the ritual or the process of using or getting drunk? What if your body is still craving substances? Well as Dr. Montague's absolutely adorable and nerdy assignment will show you. There is one more medication that's worth explaining.

Unknown:

Well, we've saved maybe the best for last, because I'm especially excited about Suboxone. So Suboxone is a brand name for what the active ingredient that is the actual MIT, which is a mouthful. It's called buprenorphine. So buprenorphine is the medication inside Suboxone. So I'm going to be talking about buprenorphine, and that the most common brand name of it is Suboxone. But just to do justice to the actual medication we're talking about, I'm going to say buprenorphine, that is also Suboxone. So buprenorphine is a wonderful medication that you can actually get a prescription for at the pharmacy, you can take home, you can have a full time job or be a full time stay at home mom, and not have to go to a clinic every day to get your daily dose of medication. Suboxone is something that is safe to take for opiate use disorder. So it is specifically a partial agonist. So we talked about how Naltrexone is a full antagonist, meaning it sits there and it doesn't activate the glove. What Suboxone or buprenorphine does is it actually sits there and halfway activates the glove. So it says, Hey, let's play a little bit of baseball. Let's just have the brain receptor be tickled enough to say, hey, I have an opiate in here. So I have an opiate in here. I don't need to be jonesing for opiates.

Clint Mally:

Essentially, it combines the not getting drunk or high antagonist part of naltrexone. And it tricks the brain into thinking that it is used back to our coffee example, if you drink coffee and you don't feel a buzz, then you're less likely to drink coffee. That's not truck zone. But suboxone does that. And it also tells your brain that you've already had a cup or two. So skip the Starbucks.

Unknown:

I have an opiate in here. I don't need to go get my next fix. Because I have this buprenorphine that has tricked my brain into thinking that I no longer need drugs. And so it's great for cravings. It's great to stabilize that fight or flight response. It's great to get you traction in recovery. And it's something that you can take at home and be responsible for in your daily life as opposed to having to be micromanaged at a clinic.

Clint Mally:

So between methadone, naltrexone and Suboxone, which one is the best option?

Unknown:

Sure. So really, it comes down to need. So what is your biggest need in your recovery? Do you Want to be the type of person who gets a shot once a month? Some people are very averse to needles and having a shot in their bum or their thigh is a deal breaker for them. And they're not going to do it. And okay, then Vivitrol is off the table for them. Are you the type of person who doesn't do well with just a blocker, you have cravings on just a blocker? Do you need something that's going to be tickling the receptor a little bit to say, Hey, I'm going to reset your biology and make your biology think that you're stable that you're no longer craving. And so it really comes down to what medication works best for people Suboxone or buprenorphine is very safe in that even if a person were to take a bunch of it, they're not going to overdose like you would on Percocet or Vicodin. So Suboxone or buprenorphine has a ceiling limit of your physiology. That's why it's safe to have a take home dose of it. There are side effects to anything that tickles that receptor, right. And so we use a trial and error approach based on what your specific needs are,

Clint Mally:

ah, the side effects. We knew this would come up. But Dr. Montague is ready to squash side effect concerns by shifting our perspective.

Unknown:

They're like, I don't want to put chemicals in my body. I want to do this naturally. And I'm like, oh, hon, that ship has sailed, of putting chemicals in your body, like you have put chemicals in your body. And what we need to do now is stabilize you with medication, so that you don't put any more chemicals in your body. And so this desire to do it all natural or to prove that you don't need something is really counterproductive to recovery is really counterproductive to stabilizing your physiology.

Clint Mally:

What if people are still on the fence, ma T can seem like a big first step,

Unknown:

I want you to know that there is hope. You do not have to do this alone. There are trained doctors, nurse practitioners PDAs, whose heart passion is to stabilize you on a medication so that you can get the rewards of recovery. My goal is not to put as many people on medication as possible. My goal is to get people in recovery. And to get people in recovery, I have to do something about their fight or flight response, I have to do something that keeps them in the chair so that they can have the healing that comes with intensive recovery services. If I can't keep you in the chair here, then I've lost the whole game. If I can't slow your brain down to the point where you're able to hear what we have to say where you're able to start to do the healing, then the then it's over. And I don't want people to feel guilty for needing a stabilizing help. I don't want people to feel like they've already lost just because they needed something for cravings. That's normal. That's okay. That's to be expected. This idea that you did it on your own, just put that away that we made it harder than it had to be, don't make it harder than it has to be. Don't make it harder than it has to be for your loved one. Encourage them to get a mentee encourage them to get an evaluation, it could be the most life saving step that they've ever taken.

Clint Mally:

Your child's addiction is real, but it's also more common than you think. And it's treatable. One of the ways that you can help treat their addiction is by stabilizing those biological factors, so that they can sort out the rest, but you don't have to do it alone. If you want to continue the discussion or if you have any other questions about medication assisted treatment, then join us in the free real common treatable Facebook group. There you'll find real parents just like you who are trying to navigate this really tricky time. If you're looking for even more personal support, and sandstone care has graciously opened up their parent support group run by a licensed clinician, and is also completely free. You can find links and information to both in the show notes in description box, as well as more information on sandstone care in general, if this episode was helpful or brought you value, and please share it with a parent friend or a loved one. Also, it would personally mean the world to me if you would leave us a review on Apple podcast or wherever you get your podcast. If you're watching this on YouTube, please subscribe to our channel so that we can keep you up to date when new videos come out. This is Clint Mally reminding you that you are not alone. That addiction and mental health challenges are real, but that they're also common and treatable.