Understanding The MAT Trap
Here is an email I recently received that sums up the confusion and disillusion felt by so many people who’ve been led to believe that medications will solve their opioid use problems:
“I want off suboxone. Now. It’s horrible. I tried once on my own. I went cold turkey for 6 months. I never got back up until i broke down & reused.”
This person is in what I call “The MAT Trap.” When she started taking Suboxone the ‘experts’ had told her that her drug use was a purely medical problem – a disease. The opioids’ ability to produce withdrawal symptoms was the source of her cravings… or so she was led to believe. But here she is at a point long after withdrawal has subsided, and yet she’s still craving opioids, and she thinks she still needs help detoxifying. Unfortunately, millions of people are going through this today. The promise of a medical cure for addiction has left them feeling more lost and confused than opioid addicts of previous generations.
She thinks she’s still in withdrawal, which frankly is impossible after 6 months off any opioid, including Suboxone. She doesn’t need medical detoxification, because she isn’t withdrawing at this point. Yet she still feels like something is pushing her to need opioids. That feeling is real, but it just doesn’t happen to be the product of a physical withdrawal syndrome. What’s really going on is that she is feeling a desire for drugs, for the same reasons people desire most drugs. She believes on some deep level that she needs opioids to feel better. Whether that’s feeling better by getting a high/pleasure, feeling better by relieving negative emotions, or feeling better by just having something familiar to do that occupies her time and attention. But she’s so confused by her MAT experience that she thinks her desires are just a matter of withdrawal and detoxification. If she doesn’t break through this confusion, she’ll likely cycle back and forth between periods of reckless opioid use and abstinence (with or without MAT medications).
To begin clearing up the confusion, we need to go back to basics, and explain a few misunderstood concepts. Then we’ll return to getting her, and you, out of The MAT Trap.
It is horrible to feel addicted to anything, whether that be a drug such as cocaine, alcohol, methamphetamines, marijuana, or opioids; or an activity such as gambling, shopping, or masturbation. It is horrible to go through intense physical withdrawal symptoms from drugs such as opioids, alcohol, or benzodiazepines (tranquilizers such as Xanax and Valium, etc). But what you must understand is that what we call “addiction” and withdrawal are two distinct phenomena. Moreover, a third concept gets mixed up with these both: craving. The overlap and confusion of these topics makes it nearly impossible for anyone to make sense of what the “addict” is truly going through, and how they can solve their problems. The email above is the perfect example of this – the woman who wrote it can no longer tell the difference between wanting and withdrawing, and feels powerless in the face of all of it – still hoping for a medical cure to her difficulties.
Withdrawal is not addiction
Withdrawal is what happens when you stop taking a drug that your body has become accustomed to. It is a genuine medical syndrome that occurs as a result of the habitual drug-taking referred to as addiction, but it is not addiction. Here’s a quick overview of how it works.
In response to the constant presence of a drug, the body adjusts it’s normal output of neurotransmitters to areas the drug has been stimulating. For example, opioids send signals in the brain that slow down digestion and bowel movements. This would result in constipation, but as the drug is taken every day, the body compensates, and finds a new balance by sending more neurotransmitters to encourage digestion and bowel movement. Then if you abruptly stop taking opioids, the body will keep telling your digestive system to make bowel movements until it realizes it doesn’t need to overcompensate anymore. In the meantime you will get diarrhea, a symptom of withdrawal.
It might help to think of this as a tug of war. On one end of the rope the opioids are pulling in the direction of constipation. Your brain reacts by pulling stronger towards a bowel movement. When you quit opioids, they’ve effectively let go of their end of the rope, while your brain is still pulling hard in the other direction. This sends your body hurtling toward the toilet. After some time, your brain realizes it can stop excessively pulling in that direction, and digestion will return to normal.
Several systems of the brain/body are involved in this tug of war with the opioids. Each will be thrown into temporary disarray when opiod use is abruptly stopped, creating an array of unpleasant symptoms. Withdrawal syndrome is what happens in this transitional period as the body reorients itself to a drug-free state. Withdrawal is not a state of wanting to repeat a habit – it is a temporary medical condition that results from some habits.
There is no medical syndrome of withdrawal from gambling, methamphetamines, shopping, or cocaine, among other things. Mild forms of withdrawal have been found with extremely heavy marijuana use, but are almost never a factor in marijuana addiction (don’t scoff – roughly a quarter of people in addiction treatment are there for marijuana). Alcohol withdrawal can be deadly, yet the vast majority of those who count themselves as alcoholics have never even had the sort of symptoms that would require hospitalization. In short, many people feel addicted, even though they don’t experience withdrawal. If you don’t believe this, visit your nearest Narcotics Anonymous meeting and speak to someone who’s had a crack cocaine problem, or speak to someone from Gamblers Anonymous. Many feel quite “addicted,” without the factor of withdrawal.
The inverse is also true. Many people have gone through painful drug withdrawal syndromes without ever feeling addicted to a drug. This is well known in the field of medicine, where, following surgery and an extended stay in the hospital, countless millions of people have been given enough opioids such as morphine to become as physically dependent as the stereotypical heroin user. When the hospital releases them, they take them off the morphine cold turkey. Then their bodies go through the same withdrawal syndrome that the average heroin “addict” faces, yet they don’t know it. They feel sick. They have the joint pains, the nausea, the diarrhea, the hot and cold sweats, et cetera. But they do not mentally connect this physical discomfort to the medication they were given, or the fact that the medication was taken away. They just think of it as part of the recovery process from their surgery. They don’t crave or seek more of the drugs that caused their withdrawal pains. Opioid withdrawal syndrome has happened to more people than have ever felt addicted to opioids.
So to be clear:
- You can feel addicted without experiencing withdrawal.
- You can experience withdrawal without feeling addicted.
- You can feel addicted and experience withdrawal.
The main point we’re trying to establish by discussing the obvious truths listed above is that withdrawal syndrome and a feeling of addiction are not the same thing. They are two distinct phenomena. This may be obvious itself. Nevertheless, we see many people conflate withdrawal and feelings of addiction, as if they are the same thing. We also see people conflate withdrawal and “craving” as if they are one in the same.
Addiction is not withdrawal, and needn’t include withdrawal
Addiction is a big amorphous concept that’s hard to pin down. Much of what is said about it is wrong. For example, “addiction” is said to be a disease that robs the individual of free will and forces them to continually desire and use drugs. Important to this concept, once addicted, the individual is incapable of directly choosing to think in some different way that would lead them to choose differently. In this disease model, the forces that cause the person to use drugs must be physically removed in some way, usually on a biological level – the brain must be changed to a non-addicted state. This is all wrong, and we will show you why later; it would be too much to sort out in this brief introduction.
What’s important is that whether or not there really is a “disease of addiction” people still end up feeling addicted; feeling at times like our “free will has been hijacked.” If we didn’t feel this way, then we wouldn’t sincerely seek help for it. So while we won’t sort out the disease model just yet, we need to start sorting out what it means to personally feel addicted, and where that comes from.
The central experience for anyone who feels addicted comes down to unwanted “craving.” Craving can be very simply defined as feeling a strong desire or want. For example, you may “crave” pizza, thinking it is exactly what you want to eat right now, even though you have plenty of other things to eat in your kitchen, and it may not trouble you much – you either order the pizza or you don’t, without much emotional conflict. But in the case of feeling addicted, you both crave something, and wish you didn’t crave it. That is, in addiction you don’t want to want what you want.
For example, the “alcoholic” badly wants a drink, while alternately thinking about how much trouble he keeps getting himself into by drinking, and wishes he didn’t want to drink. He thinks about the promises he made his family not to drink, the warnings of his doctor, the potential breathalyzer he could be called to give by a probation officer at any moment, the other goals and responsibilities he will fail to meet due to drunkenness – and he also thinks that a drink would be the only thing that could make him feel good right now. These desires (cravings) can vary in intensity, but to a person who feels addicted, it seems like the drink is totally necessary, and that going without the drink would be unbearable, no matter what the cost. He wants to drink, and wishes he didn’t want to drink.
Anyone who feels addicted goes through this, whether they feel addicted to opioids, alcohol, gambling, cocaine, or anything else – whether they have any kind of physical withdrawal syndrome or not. To feel addicted is to feel a strong desire (to crave) that which you also wish you didn’t want. The reasons we wish we didn’t crave are simple: they are the high costs of an activity. These costs can be monetary, social, legal, health, etc. Many people think about all these costs right as they’re thinking about using the drug, and go through an internal battle of trying to suppress their desire. But this part about wishing you didn’t want what you want doesn’t have to occur simultaneously as craving or using a drug, for you to end up feeling addicted. Often, when people desire and choose to use a drug, they aren’t feeling this conflict of wants. But then they regret the outcomes of their drug use later, and wish they didn’t keep wanting to do it. When regret constantly follows drug use, it’s just as torturous as if you had the internal battle at the time of use. The effect is the same. Our life is defined by wishing we didn’t want what we want, feeling like it’ll never change, and hating ourselves for it.
If a person is fully happy with the results of the thing they want and willing to bear the costs, then they don’t feel addicted. They crave a thing, and they are happy and not regretful to fulfill their craving. They may have some regrets, but just consider that as part of the cost of getting what they need to be happy. Other people may call them addicted, but they certainly don’t feel addicted. For some, a hangover is a sign that a good night was had. For others, it’s a sign of powerless enslavement to a drug. It’s all a matter of perspective.
Many who identify as “recovering addicts” may be successful at denying themselves what they want, while complaining that recovery is a daily battle, because of course they still “crave.” They still feel like addicts, because they still have desires they wish they didn’t have. Those who go back to heavy problematic use say “the cravings” became “too powerful,” and that they couldn’t stop themselves from using drugs. Any which way, the individual’s experience of addiction is in the unwanted “craving.”
Why we crave
Craving is incredibly simple to understand, but the recovery world has shrouded it in mystery and made it quite confusing. This confusion started when Alcoholics Anonymous began talking about “the phenomenon of craving”; their use of the term “phenomenon” making it seem like a special sort of experience associated with insanity. Further, addiction experts have conflated craving with physical withdrawal syndromes, or some imaginary quality of things called “addictiveness.” Ask your typical addiction expert why people crave cocaine and they’ll say “cocaine is highly addictive” or “cocaine changes the brain, leading to overpowering cravings.” Let me be blunt in saying that these claims are unfounded and thus don’t give us real answers. When speaking of opioids the experts will say the same, with the added point that withdrawal pain is the main reason that troubled chronic users crave. This is a dangerously misleading and incomplete answer.
The reasons we crave substances are very simple to understand, without a degree in neuroscience. When we take drugs, we feel different – both physically and emotionally different. The quest to feel different, specifically better or happier, is what motivates us to do anything. If we believe that drugs help us to achieve this, we “crave” the drugs. If we believe the drugs are our only effective way to feel better, we crave the drugs even more intensely. It’s that simple. There are several changes in feeling people try to achieve by taking drugs:
- Pleasure/a high
- Relief of stress or anxiety
- Physical stimulation
- Relief of depression
- Physical relaxation
- To feel more outgoing and less socially inhibited
- Relief of withdrawal symptoms
Now that’s just a partial list, but it makes the point that relief of withdrawal is just one among many potential reasons that people crave drugs. In some ways, it matters little that drugs have various costs/downsides too. If you believe strongly enough that drugs are very effective at providing these benefits, and that drugs may be your only way to experience these benefits of feeling better/happier, you will still crave drugs, despite their high costs. You will pay any price for that which you believe you cannot do without.
The existence of these other reasons to crave doesn’t change the fact that for many habitual opioid users, withdrawal symptoms are sometimes their main reason for craving. But it explains why we might still continue to crave even when we have fully detoxified from opioids and no longer suffer withdrawal symptoms. Simply put, when withdrawal is out of the way, you may still believe you need opioids to feel any pleasure, to “feel comfortable in your own skin,” to relieve stress, or to deal with a rough day. As long as these ideas are kicking around in your mind, you will crave. This also explains why people can be “stabilized” on MAT drugs such as methadone or suboxone, and continue to crave, or start to crave again even after a long period of stabilization and not craving opioids at all.
This is all easy enough to understand, and I doubt few readers are confused by it right now. But when people struggling on MAT drugs contact us, they’ve always got it all mixed up. Again, this email we quoted at the beginning demonstrates the confusion well:
“I want off suboxone. Now. It’s horrible. I tried once on my own. I went cold turkey for 6 months. I never got back up until I broke down & reused.”
She doesn’t know it, but her primary problem is not withdrawal, nor is it “addiction.” She’s in the treatment and recovery trap, as well as the MAT Trap.
The Treatment & Recovery Trap, and The MAT Trap
We described the many pitfalls of what we call “the treatment and recovery trap” in our previous book. The MAT Trap is a heightened version of this same trap that substance users of all stripes get caught in when seeking help. We’ll review the basics of the general “treatment and recovery trap” here, then the specific elements of The MAT Trap.
The Treatment and Recovery Trap
Addiction treatment trains us to believe in a fictitious disease of addiction that controls us. It tells us that drugs have a hold over us, as if they’re living, breathing entities with a will of their own that possess us. It tells us that we are powerless to change our course of behavior and must depend on lifelong treatment and “support.” It tells us that drugs have “hijacked” our free will. It tells us that we “lose control” the moment we ingest any amount of any drug, and that doing so will result in nonstop substance use until treatment somehow stops us. It tells us nobody can get over their substance use problems without treatment. It tells us that our brains are forever changed by drugs, and that this will leave us craving and relapsing for the rest of our lives. It tells us that our many normal life problems, such as sadness, depression, anxiety, stress, grief, and more will trigger us to use substances, and so we must constantly be focused on preventing and addressing these problems or else we’re doomed. And of course they say we need a lot of therapy and other professional guidance to do that. It further leads us to believe we must become moral pillars, maintain the proper diet, develop a higher purpose and a spiritual lifestyle – or else we’ll fall apart and go back to heavy drug use. It then conscripts our family in “family treatment” to police us into following all of these guidelines and parroting these recovery ideas as well. They convince us that the entire family is diseased too, and that any imbalance in family life can send us back into heavy drug use. This final point really shows that this supposed disease can be nothing more than a metaphor.
In short, addiction treatment swallows up our whole lives, and teaches us that any little imbalance in the superhuman lifestyle we’re supposed to develop “in recovery” will knock us “off the wagon.” It makes a temporary problem into a full identity – the identity of the “recovering addict.” As we take on this identity, a permanent solution to our substance use problems becomes, by definition, impossible.
This entire “disease of addiction,” “plan of recovery,” and “treatment” of the disease is a giant charade. But we have a tough time seeing through it because it’s dressed up in the trappings of science (medical and neuroscience jargon along with impressive looking brain scans, etc). Further, authoritative people are telling us it’s true, and our families and the legal system coerce us into playing the charade.
Once you get into the treatment and recovery world, it all seems like a very active endeavor, but at the same time we become mentally passive. It’s active because it gives us many appointments to go to, many therapists and counselors to talk to, meetings to attend, lingo to learn and use, recovery activities to get involved in, etc. But it’s passive because it puts us into the role of the “patient suffering from a disease.” We’re linguistically transformed from a person who currently loves to get high into a “person with a substance use disorder.” We are no longer choosing to do something (drugs), we become a person with something, or suffering from something – a disease that requires medical treatment. Instead of active choosers of our highs, we begin to see ourselves as passively becoming intoxicated with no choice in the matter.
When you’re suffering from a disease, you put yourself in the hands of the medical professionals and hope the treatment works. Sure, you may seek second opinions and investigate other potential treatments, but you’re still pinning your hopes on the idea that someone else can make your “disease” go away by some medical intervention or magic. In a disease the cause of the problem is physical, and it’s not a matter of our mind. With a real disease, we rightly believe something physical needs to happen for the problem to go away.
But with “the disease of addiction” the cause isn’t really physical. We’re attached to our drug because we believe we need it to feel good, and we believe we’ll be miserable without it. The only thing that will solve this problem is to rearrange the way we think about the drug – by weighing out our options in a way that we haven’t before, and becoming convinced that we’d be happier to make a change. That is to say, ending an addiction is ultimately a choice. This can be a complex and emotion-laden choice, but it’s a choice nonetheless. It happens purely in the mind, by choosing to think things through differently.
A doctor or counselor can’t change our mind for us, and a pill can’t make it happen any more than a pill can teach you math.Surgery won’t stop us from wanting drugs either. There was a team of doctors in China that experimented on heroin addicts. They surgically burned away the part of the pleasure center of the brain said to cause heroin addiction. Five years later, more than half of the heroin addicts were still using heroin. For perspective on how awful this result is: 50% of opioid addicts already get over their addictions in 5 years or less – without such a surgery. Of course you can probably guess that there were also bad side effects to this procedure. The medical establishment has become reckless in their embrace of the disease model of addiction. They’ve taken the charade to dangerous new heights.
12 Step programs say that addicts and alcoholics have an obsession with taking drugs. This is one of the few points on which I agree with them. But since when is an obsession a genuinely physical disease? In romantic relationships people can be seen as having an obsession with their lover. But we all recognize that ending a relationship is a choice that a person can make at any time. I went through this myself. I was in a very bad relationship for 5 years. I knew it was bad 2 years into it, but I also thought that “nobody else would love me,” that “I should just be grateful for what I have,” that “this is all I have right now,” and more. Those thoughts kept me from leaving even though I also viewed my significant other as manipulative and abusive and I had a laundry list of downsides and complaints about the relationship. I even sought help from my therapist to end the relationship, and it helped. Through our conversations I got to the point where I finally made the decision to end the relationship. But none of this was approached under the premise that our relationship was a disease, or that my significant other somehow “hijacked my free will,” or that the cause of my continuing the relationship was physiological. It was all approached as a process of figuring out whether I really wanted to make this decision and follow through on it. To do that, I had to arrive at the conviction that I’d be happier going forward alone.
It’s very telling that some people call bad relationships “addictions” (or “co-dependency”). There are many parallels between the two. On paper, as you stack up all the upsides and downsides of the relationship, it makes sense to break up or divorce. The same goes for our attachment to drugs. In the bad relationship, many of our loved ones can see quite clearly that our chosen relationship is making us less happy than if we’d end it. The same goes for our relationship to drugs. But inside of us, we still think the downsides are tolerable, whether that be in the romantic relationship or the drug relationship. We pay the high costs, because the alternative seems worse. “Yes,” we think “if I quit drugs I could put an end to so many troubles” as we think about the downsides, “but I can’t deal with my stress today without the drug” or have fun, or escape reality, or whatever it is that you’re trying to achieve by taking drugs. “If we broke up now I wouldn’t have to endure this daily arguing any longer” we think, but then “I won’t know what to do with myself single, I don’t want to date or try to find sexual partners, I’ll be so alone” etc. The same sort of inner conflict that keeps us in all sorts of dissatisfying life involvements is what also keeps us hanging on to dissatisfying drug habits. You may languish in these involvements for a long time feeling trapped. But you’re never really trapped by anything other than your perspective on the situation. When you finally bring it to an end, it’s a matter of choice.
If drug “addiction” is a matter of decision-making like we’ve briefly demonstrated above, rather than a medical condition, then attempting to “treat it” or “recover from it” truly is a charade. Engaging in this charade may be benign in some cases, but dangerous in other cases. It’s dangerous because it busies you with a quest to make your “disease of addiction” go away with useless treatment and recovery activities. This keeps you mentally passive toward the beliefs that keep you craving dangerous levels of drug use; it keeps you from making a truly motivated decision to change.
The Recovery Charade
As we said, the charade of “recovering from the disease of addiction” is sometimes benign. Many people diagnosed as addicts genuinely realize they’d just be happier on a daily basis by ceasing to use substances so extremely. They come to this realization through much experience and reflection just as we do for many other big life decisions. But at the same time that they decide to quit they also enter into treatment because they’ve been told that’s what they’re supposed to do. So at the exact moment that they genuinely quit their problematic drug use they also begin to play the charade. They come out of rehab or counseling just fine because the real work (the decision-making process) was already done. I’ve met many people like this, and they don’t seem to take the whole disease thing so literally. For them it’s a metaphor, and it comes with advantages. It helps to smooth over the past troubles they caused while intoxicated or feverishly pursuing drugs. It can get them out of legal troubles as well as family and other social troubles. Where the habit left a lot of bitterness in the family, playing the recovery charade can elicit forgiveness, and continued “recovering” can put the family’s minds at ease. These people don’t need to keep “working on recovery” in order to stop from doing the thing they genuinely don’t want to do anymore. But “working on recovery” benefits them in other ways. It gives them an acceptable narrative to explain a rough spot in life, and can even make the “recovering” person into a hero of sorts. They’re valiantly “battling their disease!”
These folks may or may not believe they need to keep “battling the disease” and “work on maintaining recovery” but it’s all an elaborate placebo whether they know it or not. To some degree, I was one of these people. When I got over my heroin use problem, I was taught that “service work” was important to overcoming my problem. This entailed helping others with substance use problems, and engaging in all sorts of volunteerism and good deeds. I did it religiously. I preached it and led others to do it. But I also saw plenty of people around me do this same “service work” and end up going back to their former drug habits. I should add that most of them probably did much more service work than me. I also saw many others do no service work and yet they never returned to their former habits. I eventually realized that service work had nothing to do with getting over a drug problem, except that some think they need to do it, and will inexorably connect it to their success in quitting drugs – as I once did.
In that period of my life, I was part of the lure into the recovery trap. This is one way in which the recovery charade is not benign, but in fact harmful. Some of the people who I led to believe this “worked” followed my lead. Imagine the way they emulated me, but then found themselves strongly craving drugs again. They probably felt more hopeless than before. They probably felt as if something was wrong with them. They might’ve thought “why did it work for Steve and not for me? I must be REALLY addicted.” In this way, all the people who get over their problems while crediting “treatment” and “recovery methods” will help to lead some others into the trap of trying to “recover” from the fictitious “disease” of addiction with some kind of useless treatment or methods. They should credit themselves for their change. They figured out they’d be happier changing their drug use, which is not always an easy task, and they decided to change. The rest of what they went through was just a ritual – the recovery charade.
To be crystal clear, my point is that treatment and recovery methods do not make anyone stop wanting drugs. When people credit treatment for their success in overcoming addiction, they are wrong. They essentially changed “on their own.” That is, they changed their mind about drug use and firmly decided to make a change in their drug use. Their specific treatment or support group involvement may be benign to them, but if people look to them as examples of what to do they can be led astray.We think we can emulate their actions of going to meetings, rehab, dealing with trauma, or doing service work etc, and get the same results. Then when we don’t get the same results, our involvement in those treatments and recovery methods has actually done us harm. This is because we pinned our hopes on things that aren’t the real cause of change. We end up disillusioned and more hopeless as a result of the charade.
The charade is harmful because it takes the focus away from what matters and what really leads to a change. When you really dig into the way you see your options, and challenge yourself to see them differently, you can reach the genuine conviction that you’ll be happier both in the future and the present if you let go of your heavy drug use habit today. But because you’re doing the busywork of the recovery charade, you aren’t doing the real work of making a decision.
Moreover, the charade just makes continued heavy use more attractive, and we don’t even realize it’s having this effect. Before we encounter the recovery charade we already think that life without our heavy drug use will be boring, miserable, and unbearable. The tenets of the recovery world only confirm this perspective. They tell us that we’ll be stuck with cravings for life, and will be triggered by nearly anything. They tell us that the feeling provided by heroin is so much better than anything else in life that we’ll never be able to forget it. They teach us that when you quit a drug habit, you’ll have to spend the rest of your life feeling deprived and fighting to stay sober. The busywork of recovery that is so attractive to some is absolutely repellent to most. The prospect of spending every waking moment hyper-aware of and trying to avoid potential triggers is not attractive. It sounds like a lot of work, and it’s all to avoid the thing you believe you genuinely need to feel god. They teach us to accept that we’re stuck with cravings and will need to learn to “cope” with them.
Great. A life of deprivation, coping, and constantly talking about and thinking about what you’re trying to not do. All of this registers emotionally, and it depletes any motivation we had to quit. We turn right back to drugs quickly, because for all the work it takes to sustain a heavy drug use habit, at least it has a payoff. A desire to avoid problems is not what gets us out of bed in the morning. A desire for happiness does. The recovery charade doesn’t promise happiness. It promises periods of avoidance of problems punctuated by periodic “relapses” into disastrous drug use. Oh yeah, and it takes constant work to get these moments of problem avoidance.
This only persuades us to dive deeper into heavy drug use, and give up hope of change. Many people’s problems become worse once they enter treatment and begin to believe in the disease of addiction along with the tenets of recovery. This leads to demoralizing cycles in and out of treatments, in and out of “relapses,” making us more and more hopeless as the cycle continues. Many years are wasted on a wild goose chase, and unfortunately many lives are lost as well. Granted, the drugs are the direct and immediate cause of death. But in an age where recovery activists regularly decry the fact that only a fraction of addicts receive treatment, it also seems that every person who tragically dies of drug use has received treatment. The disease model of addiction and recovery doesn’t help people stop using substances and it is not benign. It causes harm. It delays or even prevents us from ever solving our problem. That’s why we call it “the treatment and recovery trap.”
The MAT Trap
The promise of “Medication Assisted Treatment” magnifies the damaging effects of the treatment trap a thousand-fold. This is because, for all the talk about addiction being a disease, most “treatment” for addiction to most substances doesn’t appear to be medical at all. That’s kind of the open secret of the entire disease and recovery charade. The so-called medical “treatment”of the disease of addiction tends to be made up of counseling, support meetings, and various talk therapies. That is, it doesn’t usually include medications or medical procedures. It’s mostly just sitting around talking about drugs, addiction, and other life problems. Of course, there are exceptions to this. Antabuse and Naltrexone are medications given for alcohol addiction, but they’re used minimally, and there are no such medications for the treatment of addiction to stimulants, cocaine, tranquilizers, marijuana, or any other drugs. The main place where medicine plays a role in quitting other drugs is in the detox centers, where alcohol and tranquilizer users are treated for the dangerous complications that can arise during withdrawal. But even there nobody pretends the longer term problem is or will be treated with medications. Detox is just a stop on the way to the real “treatment” – talking about addiction.
The treatment of opioid addiction then, is truly unique. It’s the only drug addiction where it is promised that a special version of the drug you’re quitting – another opioid – will be the long-term cure to your addiction. We don’t give alcoholics a special type of alcohol to take daily, or marijuana users a special strain of marijuana. I’m not raising this point to criticize MAT (though I definitely will be criticizing MAT at some point). If it worked it’d be great, and I’d be MAT’s biggest cheerleader, but it doesn’t work. I’m bringing it up to say this uniqueness makes opioid addiction appear to be more of a medical issue than other addictions. The message of this treatment approach is that as opioid users, our brains have been so extremely “hijacked” that the only solution is to accept that we will need to take opioids for the rest of our lives!
This, like all of the messages of the treatment trap, registers on a deep emotional level, and convinces us that we have no hope of letting go of this drug. We think we’ve got the one and only REAL ADDICTION – the one where society has decided to just keep us on a regulated supply of the drug for the rest of our lives. Without it, they say, we’re doomed to experience “overpowering cravings” which will make us run out to buy the dangerous street versions of opioids, and ultimately die of an overdose. So this isn’t just any old disease now, it’s a fatal disease. This messaging leads us to see our predicament as being on a par with having cancer. Now we feel like we’re just as helpless and powerless as a cancer victim. Our future is in the hands of medical technology and miracles – not in our mind and ability to problem-solve and choose. The other addicts can sit around pondering their painful childhoods and find the insight to change, but we opioid addicts can’t bother with that nonsense. We need medicine (or so we are now fully convinced).
Anywhere you look for information on how to deal with opioid addiction, everyone says that MAT drugs such as methadone and suboxone are the answer. Journalists and experts in the media incessantly repeat the phrase that these medications “are the gold standard of opioid addiction treatment.” As you will learn later in the book, the evidence doesn’t justify such high praise. You’re reading this now because it’s not working for you.
How does it feel to be lucky enough to get “the gold standard of treatment” and then it doesn’t work? It leaves us feeling completely hopeless. That’s how I felt when I was taking methadone. I was told it would make me stop craving. After my first week or two on methadone I did stop craving, and that lasted for a few months. But then, without my dose being changed at all, I started to crave again. I kept thinking more and more about getting some heroin, until I finally did it, and predictably I got back to a full time habit after a few weeks. My experience was not at all unique. I began to notice that most others at the methadone clinics were going through the same thing. They’d have their doses increased, and sometimes that would seem to help, but they’d soon be struggling with “cravings” once again.
It is routinely claimed that MAT drugs “reduce cravings,” “stave off cravings,” “prevent” or even “eliminate cravings.” You need to understand that MAT drugs don’t really take away anyone’s cravings.
Remember, there are many reasons that people crave drugs. At best, MAT takes away just one of those many potential reasons: the desire to avoid withdrawal pain. We could also crave because we want to get high and feel pleasure, relieve emotional pain, or just because we feel empty and bored and it’s the thing we used for so long to just feel something. There are plenty more specific reasons. This truth means that it is wrong and misleading to tell people that MAT drugs take away our cravings for opioids. A steady supply of methadone or buprenorphine keeps us from feeling withdrawal, and that is all.
For some, this will be enough. Many people, after much painful struggle to quit opioids, cease to find them attractive. They don’t find the high to be much of a high anymore, they realize that the drugs don’t make their emotional pain and stress go away, and they’d just rather be sober than under the influence of these drugs. Their only obstacle is withdrawal syndrome. They may try to go cold turkey a few times, but they keep giving up and never fully detoxify. When a person is at this stage, then MAT will “work” for them. It will provide a steady supply of opioids in their body that keeps them from going into withdrawal, and thus keeps them from chasing opioids, and thus makes it easy for them to build a life that is no longer oriented around the obsession with keeping a steady supply of the drugs going. If they don’t feel any significantly bad side effects, they may stay on MAT indefinitely. Or they may taper down easily at some point.
The major error is to look at those people and think that MAT cured them of their addictions. MAT was not the cause of their change. Instead, we should credit the fact that through experience and by changing their mind about their options, they ceased wanting opioids. Their mental list of reasons to crave had been whittled down over time as they realized opioids just didn’t do it for them anymore:
- Pleasure/a high
- Relief of stress or anxiety
- Physical stimulation
- Relief of depression
- Physical relaxation
- To feel more outgoing and less socially inhibited
- Relief of withdrawal symptoms
They realized they were barely getting any pleasure, they had become more and more stressed as a result of their habit, the stimulation and relaxation were minimal, their depression ceased to lift at all upon taking the drug, and it kept them isolated instead of social. All that was left was withdrawal, and so anything that got them through withdrawal would’ve worked at that point.
These folks would’ve done just as well staying in a detox clinic for a few weeks, or jail, or with a short course of clonidine or MAT – because they just didn’t want opioids anymore. If you were at this point, you wouldn’t be struggling now. You must remember, MAT didn’t cure these people’s addictions. MAT cured their withdrawal, or at least it’s delaying the onset of withdrawal indefinitely.
Don’t let those people lure you into the MAT Trap the same way I lured people into thinking service work was the key to getting over addiction. They essentially got over their attachment to opioids on their own, as you will at some point. They got over their withdrawal with medical help as you can at any point. These are two separate issues. But the claim that MAT is “the gold standard treatment for opioid addiction” and “takes away cravings” obliterates the differences between addiction, craving, and withdrawal.
If you are currently taking MAT medications, and continue to be troubled by craving, then withdrawal is not your problem. Your problem is that you still have some powerful reasons that you are attracted to opioids. It could be simple as you just want to be high, or you think you need opioids to deal with your life problems, or you just want that familiar feeling you get from opioids because you’re so used to it. In short, you’re dealing with the same issues that anyone who feels addicted to any drug or activity is dealing with. It won’t go away just by waiting for it to go away. It won’t go away by getting a higher dosage or switching back and forth between methadone and buprenorphine or whatever new MAT medication they market next. It will only go away by facing the facts of what you’re trying to get out of opioids, whether they’re really delivering, and whether you’re ready to believe you can get what you want out of life without these drugs. It will go away when you’ve analyzed these facts and made a solid decision to let go of your attachment to opioids.
Before you can do any of that though, you simply need to recognize that you are in the MAT trap. You got into the trap the moment you believed the folks who told you that you need to be on MAT. What you agreed to believe in that moment, is that your problem is purely medical – that opioids have warped your brain into a state that drives you to continuously desire opioids. You got deeper into the trap when it became clear that the medication wasn’t working. You then began to believe that you must be a particularly hopeless case.
You are not a hopeless case. Your experience on MAT is not the exception – it is the rule. In a recent trial of a long-lasting buprenorphine injection, only 17.4% percent of the test subjects were successful. The bar for success was low too, requiring only 9 opioid free urine screens over the last 15 weeks of a 6 month trial. So even with that low bar, only 1 in 6 were successful. Moreover, two thirds of all urine screens taken throughout the trial were positive for illicit opioids. Amazingly, this trial was hailed as demonstrating success and effectiveness for buprenorphine, with the lead researchers stating that the injection was “not inferior” to standard oral Suboxone. Most experts also say that buprenorphine and methadone are comparable in effectiveness, which is to say that the vast majority of people taking any kind of MAT are not finding success with this treatment.
The good news is that despite the dismal success rates of MAT, over 95% of people diagnosed with opioid use disorder will eventually get over it. The probability of getting over alcohol use disorder is only 90%. Hopefully this gives you some perspective. You will get over this. Your problem isn’t primarily medical, and the solution definitely isn’t medical. It’s good old-fashioned decision making, and you’ll be fully prepared to make that decision once you understand the facts.
The MAT Trap is a state of believing that your “addiction” to opioids is primarily medical. Once this belief is in place, you become passive, waiting for medication to take your desire for opioids away. You then become even more helpless in the face of any slight desire for opioids, giving up and giving in even faster. This just drags out your opioid use problem for much longer than it needs to last.
The Freedom Model for Escaping the MAT Trap is an educational approach designed to help you see through the trap. Once you see through it, you can then focus on what matters. This is also covered with powerful information that will challenge your romance with opioids, and show you how to assess and frame your options in a way that allows you to finally choose to happily leave problematic opioid use in your past.