Methadone, Abstinence-Based Treatments Activate Different Brain Pathways

Methadone maintenance treatment and abstinence-based treatment are two approaches used in recovery programs for people affected by opioid addiction. When successful, each of these treatment options helps opioid addicts reduce their level of craving for continued drug/medication use.

In a study published March/April 2014 in the Journal of Addiction Medicine, a multinational team of researchers compared the brain effects of successful methadone maintenance treatment to the brain effects of successful abstinence-based treatment. These researchers concluded that each of the two approaches to opioid addiction treatment has its own unique impact on brain function.

Harm Reduction

Methadone maintenance treatment is one form of a harm reduction-based approach to substance addiction. In harm reduction, doctors don’t set complete abstinence from substance intake as a necessary goal of treatment.

Instead, they attempt to limit the damage caused by uncontrolled substance use, even if this means that their patients still engage in substance use to a lesser degree or in more strictly limited circumstances.

An opioid addict participating in methadone maintenance receives a specific amount of methadone (an opioid medication) every day instead of consuming an unknown or unpredictable amount of heroin or some other powerful opioid drug of abuse. This dose of methadone provides enough of an opioid effect to avoid triggering symptoms of withdrawal i

Abstinence-Based Treatment For Opioid Addiction

An abstinence-based approach to opioid addiction treatment may also involve the use of methadone or another opioid medication called buprenorphine as a temporary treatment to help recovering addicts avoid the worst symptoms of opioid withdrawal.

However, the ultimate aim of this approach is to help recovering addicts completely avoid opioid use on an ongoing basis. This means that the use of opioid medications is strictly limited, if it occurs at all. Abstinence-based programs may also use non-opioid-based medications such as naloxone or naltrexone, which actively block the drug effects of opioid substances in patients/clients who have completely detoxified from active opioid use.

Counseling And Psychotherapy Treatment Sessions

Both methadone maintenance and abstinence-based programs also typically use some form of counseling, psychotherapy or mutual support to augment the effects of medication and improve the odds that treatment will have a beneficial outcome.

Forms of counseling and psychotherapy used in opioid addiction treatment include a behavioral retraining approach called cognitive behavioral therapy and a modern-day form of psychoanalysis called psychodynamic therapy. Many mutual support groups for recovering opioid addicts follow a basic 12-step approach that emphasizes ongoing drug abstinence.

Differing Brain Effects For Methadone vs. Abstinence-Based Treatment

In the study published in the Journal of Addiction Medicine, researchers from Australia and Iran used an imaging technology called fMRI (functional magnetic resonance imaging) to compare the brain functions of a group of people who successfully participated in methadone maintenance treatment for heroin addiction to the brain functions of a group of people who successfully participated in abstinence-based treatment for heroin addiction.

For comparison’s sake, they also examined the brain functions of a third group of people unaffected by opioid addiction. The fMRI scans were taken while the members of all three groups viewed a mixture of stimulating cues, including cues designed to trigger any residual cravings for heroin. In addition to analyzing the data from these scans, the researchers asked each individual to report his or her level of drug craving prior to and after exposure to the heroin-related cues.

The researchers found that the members of the methadone maintenance group and the members of the abstinence-based treatment group displayed an equal ability to resist the heroin cues used during the fMRI scans. However, they concluded that different brain areas were activated in each group as a result of exposure to the cues.

Compared to people unaffected by opioid addiction, the people who participated in methadone maintenance showed an unusually high level of activity in parts of the brain responsible for visual processing, logical analysis, the control of both pleasure- and fear-based emotional responses, and basic muscle coordination.

On the other hand, the people who participated in abstinence-based treatment showed an unusually high level of activity in parts of the brain responsible for regulating decision-making, controlling impulsive behavior, anticipating rewards and controlling certain key involuntary functions in the cardiovascular (heart and blood vessel) system.

The authors of the study published in the Journal of Addiction Medicine note that, when successful, both methadone maintenance treatment and abstinence-based treatment are linked to increased activity in brain areas that help recovering opioid addicts significantly reduce their drug cravings. They also note the clearly differing brain pathways that are typically activated in participants in each type of treatment.

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