A revised definition of Medication Assisted Treatment (MAT) has surfaced in recent years which goes against the traditional definition and which has the potential to cause problematic consequences. In effect, the definition shifts MAT from being a single aspect of addiction treatment to being a stand-alone treatment. This article explores some of the possible consequences of such a change.

Kelly Clark, ASAM

Dr. Kelly Clark, courtesy of www.drkellyclark.com.

A few years ago, Dr. Kelly Clark, past president of the American Society of Addiction Medicine, modified the meaning of MAT. For years, the acronym MAT had referred to Medication-Assisted Treatment. Now, for her and some other people, it has a new meaning. 

At the 2018 Prescription Drug and Heroin Addiction Summit in Atlanta, Dr. Clark was quoted as saying: “MAT is now considered a transitional term. The science is clear: medication doesn’t ‘assist’ treating opioid use disorder, just as insulin doesn’t ‘assist’ treating diabetes. From here on out, MAT will be considered Medication for Addiction Treatment.” 

Redefining a term that has guided medical or rehabilitative care for years must be done judiciously and thoughtfully. A redefinition can change the way some practitioners approach treatment and the way those in recovery approach their returns to sobriety. 

There may be some pitfalls associated with this redefinition that we would like to examine here. 

  1. If MAT no longer “assists” treatment of opioid use disorder, does this mean that some people will consider that it is a standalone treatment for addiction? In other words, no other elements of treatment are needed, just MAT? The Substance Abuse and Mental Health Services Administration has defined what constitutes effective treatment in their document, Principles of Effective Treatment.
    This document states:
    Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems….
    Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence…
    Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. [Emphasis as it appears in the original document.] As you see, according to SAMHSA, medications are “an element” of treatment. Not the whole of treatment. Might this new definition lead some people to overlook these other components that are vital for a stable recovery?
  2. Dr. Clark likens treatment of addiction to the treatment of diabetes. This is a common analogy when people are talking about MAT and addiction treatment. Is this analogy accurate and is this analogy useful? Does it improve our understanding of how to help an addicted person achieve sobriety? If a person is diagnosed with diabetes, and their only treatment is insulin, that person can probably expect to continue to be diabetic for the rest of their life. But there are those who have ended their dependence on insulin by losing weight, exercising and improving their diets. So, in effect, they were able to address their diabetes and no longer depend on insulin.If we rely on this analogy to understand addiction treatment, aren’t we implying that an addicted person who relies on MAT is as permanently dependent on that medication as the person who only relies on insulin injections to manage their diabetes? One only needs to talk to the many people who have left addiction behind to know that is it not an incurable condition. Challenging? Yes. Difficult to recover from? Yes. Incurable? No. There is too much proof to the contrary.3. There is also plenty of evidence that not every person addicted to alcohol, opioids or other drugs needs medication. To the degree that this is true, the new definition of MAT might blind some people to this possibility.Just consider the millions of people who joined Alcoholics Anonymous or Narcotics Anonymous and found a new sobriety with the support of these meetings. According to Scientific American, there were two million people active in AA at one point, and that is just one of many types of “Anonymous” groups. Any term that implies, even vaguely, that addiction treatment requires medication belies the success of these millions. 
The Big Book, AA

The Big Book used by Alcoholics Anonymous.

The effects of a re-definition can be far more impactful than might be visible at first sight. It is vital if any redefinition is going to take place that it does not imply anything that is not within the realm of science. Neither should it influence people to think that there is only one way to recover from addiction when it is plain that there are many. In fact, SAMHSA supports this concept in the same document when they say:

“No single treatment is appropriate for everyone.”

This is echoed by almost the entire recovery community which for years has held that there are multiple pathways to recovery.