For alcohol use disorder, drugs like acamprosate and disulfiram are used in Medication-Assisted Treatment. For opioid use disorder, the drugs involved are various combinations of buprenorphine, naloxone, and naltrexone, depending on the extent of the dependence on opioids.
MAT is only one part of treatment. Participants need counseling and therapy to have the best chance of bringing their substance abuse under control.
Medication-Assisted Treatment (MAT) is the combination of medications with behavioral therapy and counseling to treat substance use disorders. MAT is also useful for sustaining long-term recovery from addiction. It is primarily used for those who are suffering from opioid use disorder, but it is also used in people who are struggling with alcohol use disorder.
The medications (different for each form of substance abuse) work by blocking how the brain responds to alcohol or opioids. This also has the effect of reducing cravings for the substances and treating withdrawal symptoms. This combination is what makes Medication-Assisted Treatment highly regarded for how it helps people control their addictions in the long term.
Acamprosate & Disulfiram
One drug used in Medication-Assisted Treatment for alcohol use disorder is acamprosate. Acamprosate undoes some of the damage done by long-term drinking by lowering cravings for alcohol use. Acamprosate does not help with withdrawal symptoms that arise from discontinuing alcohol use. It is most effective only after a person has not drank alcohol for a while. It has limited effectiveness if it is taken while alcohol use is active.
As with any other form of Medication-Assisted Treatment, acamprosate has to be used in conjunction with therapy, counseling, and social support, to maximize its benefits.
Another drug used in alcohol use disorder treatment is disulfiram, which is prescribed to those who have been long-term drinkers. When even small amounts of alcohol are consumed while on a disulfiram prescription, people experience headaches, nausea, vomiting, breathing difficulty, and anxiety. When used carefully and properly, disulfiram can deter people from continuing their drinking habits.
MAT in Opioid Abuse Treatment
Naltrexone is a drug that is used in opioid abuse treatment. It works by blocking the receptors in the brain that opioids (whether legal, like prescribed OxyContin, or illegal, like heroin) seek out when they are taken (either intravenously or snorted). When a person takes naltrexone as prescribed, the opioid receptors are blocked, preventing the opioids from recreational consumption from reaching the receptors and triggering the desirable effects. For this reason, naltrexone is known as a “full opioid antagonist.”
Naltrexone is one of the most popular drugs used in Medication-Assisted Treatment for opioid use disorder because of how easily it can be taken and its limited side effects. It has minimal side effects, and it has a very low potential for abuse. However, it should not be given to a person who is still actively using opioids.
Buprenorphine & Suboxone
Naltrexone works by completely blocking access to the brain’s opioid receptors, but this is not always what every person needs. An alternative is buprenorphine.
As opposed to a full opioid antagonist like naltrexone, buprenorphine is a partial opioid agonist. It only partially blocks the receptors, allowing a minimal dose of recreational opioid compounds to activate those receptors. This means that a person still consuming anything from OxyContin to fentanyl will not experience the same highs and cravings. This makes buprenorphine ideal for a person who still needs to be weaned off their opioid abuse.
Buprenorphine is a generic drug, so some doctors may recommend the use of its brand-name counterpart, Subutex. Both of these medications work in the same way. In tablet form, the medication is placed under the tongue, where it dissolves.
When buprenorphine is combined with naloxone, an opioid antagonist, the new medication is known as Suboxone. Naloxone is frequently used as an opioid overdose reversal drug, and it can be quite potent on its own. The combination with buprenorphine is used to smooth the experience as a person weans off their dependence on opioids, making the withdrawal process more bearable.
There is also methadone, which is highly favored in heroin treatment. Methadone is a long-acting opioid, so people do not experience the instantly powerful and addictive effects that they would from heroin, which is a short-acting opioid.
Methadone balances out many of heroin’s harmful effects. It is often prescribed to help people wean off heroin without going through the most distressing side effects.
Are These Drugs Addictive?
Medication-Assisted Treatment drugs are controversial because skeptics and critics contend that the process of using drugs to wean off harder drugs (or alcohol) is simply replacing one addiction with another. To that point, medications like buprenorphine and methadone can become sources of addiction on their own, if their use is not properly supervised and people are not given adequate counseling and therapy to address the psychological factors of their addiction.
If used properly, however, buprenorphine or methadone (or any drug used in Medication-Assisted Treatment) can safely reduce cravings, make withdrawal more comfortable, and help a person transition away from the original substance of addiction. These medications come with side effects, but they can be managed with correct care.
If the program of Medication-Assisted Treatment is combined with a sustained program of behavioral therapy and group/family counseling, this will maximize the person’s chances at maintaining their long-term sobriety.
- Medication-Assisted Treatment for Opioid Use Disorder Study (MAT Study). (July 2019). Centers for Disease Control and Prevention.
- Acamprosate (Campral) for Treatment of Alcoholism. (August 2006). American Family Pediatrician.
- Disulfiram (Antabuse). (January 2021). National Alliance on Mental Illness.
- How Can Prescription Drug Addiction Be Treated? (July 2021). National Institute on Drug Abuse.
- Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update). (August 2017). Substance Abuse and Mental Health Services Administration.
- What’s This Agonist / Antagonist Stuff? The National Alliance of Advocates for Buprenorphine Treatment.
- Opioid Agonists, Partial Agonists, Antagonists: Oh My! (January 2018). Pharmacy Times.
- Use of Methadone. (January 2000). Western Journal of Medicine.
- Long-Acting Opioid-Agonists in the Treatment of Heroin Addiction: Why Should We Call Them "Substitution"? (2009). Substance Use & Misuse.
- Treating Opioid Addiction With a Drug Raises Hope and Controversy. (May 2016). NPR.