TIPS & TOPICS Volume 6, No.6 October 2008 In this issue — SAVVY — SKILLS — SOUL — Until Next Time Welcome to October’s TIPS and TOPICS (TNT). Occasionally I have a respected friend and colleague contribute their ideas to TNT, especially where there has been a topic of debate or controversy in the addiction and mental health fields. This is one of those months. SAVVY Gerald D. Shulman, M.A., M.A.C., FACATA has been in the design, delivery and administration of addiction services long before many of you thought about entering the field. Jerry’s years of experience on the frontline of services as well in training and consulting around the country has given him a perspective about a variety of issues that not many have a chance to match. This month in SAVVY, Jerry shares some thoughts on Medication Assisted Treatment. With his permission, I’ve edited his work; and all of the text in italics is excerpted from a larger manuscript he is preparing for future publication. Medication Assisted Treatment (MAT) in Addiction Services Stirs Attitudes and Practices Early treatment for alcoholism in the USA consisted of psychosocial interventions, modeled on the philosophy of the Twelve Steps of Alcoholics Anonymous. Early clients were “rehabilitatable” (e.g., had acquired the skills to function effectively, but whose drinking interfered with the application of these skills). Later, clients referred to treatment presented with a much greater complexity and pathology, and often these clients were only “habilitatable.”) Riding a Unicycle The only treatments available were psychosocial, and even when evidenced-based practices were used, successful treatment outcome was considerably less than desired by providers, payers and the clients themselves. The use of psychosocial treatments alone was like riding a unicycle, very difficult to do, many falls while learning and limited to only a small number of people, and for clients, of limited effectiveness alone, especially after initial treatment. Graduating to the Bicycle It became clear that without environmental supports (e.g., housing, education, employment, etc.), that even the best psychosocial treatments would be limited in effectiveness. In part because of the Center for Substance Abuse Treatment’s (CSAT) Access To Recovery grants, the field then began to couple Recovery Support Services (RSS) with psychosocial treatments. The field graduated from trying to ride a unicycle to riding a bicycle, something that provided more support (two wheels instead of one) that many more people could do, rather than to ride a unicycle. But even at this point, the hoped-for outcomes for alcoholism treatment fell far short of expectations. Moving to a Tricycle More recently, there has been a focus on Medication Assisted Treatment (MAT), particularly the use of medications which reduce craving and therefore increase probabilities of remaining abstinent. MAT is not designed to replace, but to augment, psychosocial treatments and RSS. To complete the analogy, we have now moved to a tricycle. A cycle that can effectively be utilized by the greatest number of people including young children who have not yet acquired the skills to ride; and older …