Place medication in the rightful context

Many habits of the addiction treatment industry remind us that even though providers want to see the illness treated equally to others, the field's own practices often stand in the way.

We recently highlighted the subject of how the field's language impedes progress, and we are heartened by the positive responses we received from readers. One of the language components that is increasingly being targeted by prominent and respected voices in the industry involves use of the term “medication-assisted treatment,” or MAT, to describe interventions with drugs such as methadone and buprenorphine.

As far back as the spring of 2015, American Society of Addiction Medicine (ASAM) past president Stuart Gitlow, MD, was writing this in an e-mailed response to an inquiry from me:

“We've really moved away from the term 'MAT' entirely,” Gitlow wrote. “Treatment of addictive disease, as with almost any major illness, involves a multimodal approach that includes medication. In treatment of diabetes, for instance, there are psychological issues as well as lifestyle changes that need to take place in addition to use of pharmacotherapy. That is equally true in the addiction field.”

Gitlow continued, “Medication is used no differently in addiction treatment than it is in treatment of hypertension or diabetes. So there's simply 'treatment,' which includes pharmacotherapy or not depending upon the specifics of the individual case.”

More recently, renowned Harvard Medical School associate professor of psychiatry in addiction medicine John F. Kelly, PhD, weighed in on the topic in an early June blog post for Psychology Today. Citing a growing body of scholarly writing that has argued against stigmatizing language, Kelly specifically mentioned MAT and the attention that clinical leader Sarah Wakeman and others have brought to it.

“Medications used to treat addiction symptoms and cravings (e.g., methadone, buprenorphine [Suboxone]) should be labeled no differently, and the word 'assisted' should be removed,” Kelly wrote. “Research has shown that with or without psychosocial support, medications are effective and often life-saving treatments for addiction. Wakeman instead recommends saying more simply, “medications for addiction treatment.'”

Kelly's blog goes even farther, suggesting that the federal government would be justified in going through the painstaking process of pursuing an act of Congress to remove outmoded terms from the names of federal agencies such as the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). That might be unlikely to happen anytime soon, but clearly the field's professionals have greater leeway to effect change in the everyday discourse about addiction.

“If we want addiction destigmatized, we need a language that is unified, and that accurately portrays the true nature of what we are dealing with,” Kelly concluded in his blog. Simple and powerful words, ones that increasingly are seen as deserving of reinforcement.