A Guide to Medication-Assisted Treatment

Medication-assisted treatment (MAT) is primarily used to treat alcohol use disorder (AUD) and opioid use disorder (OUD). It involves the use of medications along with therapy to treat the physical, mental, and emotional aspects of addiction.

These medications can work in a number of different ways, but they often focus on reducing a person’s drug cravings and deterring them from engaging in drug use. They also keep withdrawal symptoms at bay, so people in recovery can effectively focus on the work they’re doing in therapy.

The Basics of MAT

A medication-assisted treatment is a type of addiction treatment that involves the use of medications, generally combined with counseling and behavioral therapy, to help a patient gain control over their addiction symptoms. 

MAT is primarily available for alcohol use disorder (AUD) and opioid use disorder (OUD), with different medications tackling a person’s addiction treatment in different ways. If one MAT option seems ineffective for a patient or otherwise doesn’t meet their needs, their doctor may recommend another. 

While some people claim medication-assisted treatment is “trading one addiction for another,” it’s important to understand that this is just a misconception about what these treatments entail. While it’s true that some of these are long-term treatments, all the options discussed in this article are approved by the FDA and evidence-based. These medications can help a person reduce their drug cravings, regain control over their life, and greatly reduce their chance of a deadly overdose. 

While it’s important to talk with a treatment professional about both the benefits and drawbacks of any treatment, these options are not simply replacing a person’s addiction with a different addiction. They are all legitimate medical treatments. Myths about MAT and related stigma often prevent people who need it from getting the lifesaving help they need.

MAT for Alcohol Use Disorder

There are three medications that can generally be used to treat a person with an alcohol use disorder. These include the following:

Acamprosate

Acamprosate is meant to be taken by people in recovery who want to avoid drinking and who have had at least five days of abstinence before taking this medication. 

It essentially helps by temporarily correcting changes long-term alcohol use can cause in the brain. Put very simply, a sober person taking acamprosate will usually have an easier time avoiding alcohol, even if they have been a long-time drinker and suffer from AUD. 

Note that this drug is not effective for people still heavily drinking or abusing drugs, and it also doesn’t prevent withdrawal. With that said, it also shouldn’t cause any unpleasant reactions if taken with alcohol, although you should call your doctor if you relapse while on this medication.

Disulfiram

Disulfiram is a medication that works by actively deterring people from drinking alcohol by causing an unpleasant reaction if a person drinks or eats even small amounts of alcohol with disulfiram in their system. 

If a person on disulfiram consumes any alcohol, they will begin to experience a number of unpleasant symptoms within about 10 minutes, including these: 

• Facial flushing
• Nausea and vomiting 
• Faintness
• Chest discomfort
• Blurry vision
• Confusion
• Sweating
• Headache
• Choking
• Difficulty breathing
• Anxiety

This reaction can be long-lasting, sometimes lasting for as long as an hour. 

One downside of this medication is that some foods and beverages may have small amounts of alcohol in them but would normally not be considered “alcoholic” in that they aren’t consumed for the purpose of getting drunk. For example, some sauces and vinegars contain small amounts of alcohol that could still cause a negative reaction for someone who is taking disulfiram.

Naltrexone

Naltrexone, which can also be used to treat opioid use disorder, can help with AUD by binding to endorphin receptors in the body. This blocks the effects of alcohol, preventing a person from getting drunk and reducing their cravings for alcohol. 

It’s important that a person isn’t physically dependent on alcohol or opioids when taking naltrexone, as this can cause strong and unpleasant side effects. Like disulfiram, this is a drug that is meant to help a person maintain their sobriety rather than become sober. 

MAT for Opioid Use Disorder

The following medications are commonly prescribed as treatments for opioid use disorder and are approved by the FDA for that purpose:

Buprenorphine

Buprenorphine is a partial opioid agonist. It works similar to full opioid agonists, like heroin, acting on the same parts of the brain but with a weaker effect. 

Buprenorphine can potentially cause euphoria and respiratory depression, particularly in opioid-naïve people, giving it some abuse potential. However, for people who have OUD, it can be an effective way to control their drug cravings and withdrawal symptoms when taken as prescribed. Buprenorphine has a ceiling effect, so it won’t cause increasing euphoria with high doses.

It is also often mixed with the drug naloxone, which reduces its potential for abuse and prevents certain methods of misuse, such as injection, from working.

Methadone

Methadone is a long-acting full opioid agonist. It is one OUD treatment option that surprises some people, as it is the same class of drug as several commonly abused opioids. Methadone itself has significant abuse and addiction potential if misused. 

However, regular administration of methadone at prescribed, controlled doses can help control a person’s drug cravings and help them avoid dangerous drug use. 

Under current regulations, methadone can also only be administered by professionals at specialized sites, meaning people who have been prescribed methadone also don’t really have any opportunity to misuse methadone even if they wanted to. Some experts argue this limitation is unnecessary and should be altered since it makes it very difficult for people who need to take methadone regularly. People have to visit specialized methadone clinics on a daily basis, which reduces access for those who need it.

Naltrexone

Similar to how naltrexone can help with AUD cases, naltrexone blocks opioid receptors in the brain, which prevents the sedative and euphoric effects of opioids that generally cause a person to misuse those drugs. By binding to and blocking opioid receptors, a person’s drug cravings are also reduced. 

Similar to how people use it for AUD, naltrexone should only be used after a period of sobriety to prevent opioid withdrawal symptoms. Otherwise, naltrexone can throw a person into precipitated withdrawal, which can be incredibly painful and potentially dangerous. 

The length of time a person has to wait before taking naltrexone depends on if they were using short-acting or long-acting opioids. They should wait 7 days after last using a short-acting opioid or 10 to 14 days since last using a long-acting opioid before starting on naltrexone.

Clear communication with your doctor is needed to ensure you don’t take naltrexone too early.

How to Start MAT

If you think you may benefit from MAT, talk to an addiction treatment professional about your options. 

Medication alone generally isn’t the ideal way to receive addiction treatment. Medication can be an important part of your treatment plan, but it won’t be the only part. 

It’s also important to identify what drew you to use drugs and equip yourself with the tools you need to better avoid drug use in the future. This will come from the work you do in therapy.

Some addiction treatment professionals are unnecessarily wary about MAT, and this stigma impedes the quality of their care. If they sound definitively against MAT, especially if they mention “trading one addiction for another,” seek out a different professional to get a second opinion. 

While there are legitimate reasons a person might not benefit from certain MAT options, disregarding MAT altogether is not based in science. It’s a sign that you may be working with a person who isn’t current on the latest addiction knowledge.

Oftentimes, MAT is best given as part of a comprehensive addiction treatment program. This ensures you’ll have care throughout the entire process, including supervision of your medication dosing and also management of your full treatment plan, including individual therapy and other forms of therapy that are critical to your sustained recovery. 

Finding Medication-Assisted Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a government organization that provides a number of useful drug treatment references and tools on their site. Among these tools is their MAT treatment finders which can help you find several different treatment options that may interest you in your area.

You can also often just search “MAT providers near me” or similar terms to see what options are available, although make sure to research any options you find to make sure they’re well-regarded and accept your insurance plan.

Your primary care physician is also a good resource. They may be able to refer you to quality treatment providers or at least point you in the right direction to access other resources.

Alternatives to MAT

If you don’t have access to local MAT options, such as if you live in a remote area, there are still other addiction treatment options available to you. 

In this digital age, you can potentially access medication-assisted treatment via telehealth services. Counseling and talk therapy are also available via telehealth services, making them accessible to almost anyone as long as you have an internet connection and home computer or smartphone. 

There are many different types of treatment programs worth considering, depending on your needs, but most addiction treatment plans will include individual therapy and support group participation. 

Individual therapy focuses on setting and achieving short-term behavioral goals related to overcoming addiction. Support groups help to reinforce your drug-free lifestyle as you meet and talk with individuals who are dealing with similar issues to your own. In these groups, you’ll have the opportunity to learn from others as you build an important support network in recovery.

Most treatment options aren’t inherently exclusively “non-MAT” treatments. Most often, these other treatment approaches complement the use of medication. For example, therapy is included in every MAT program. 

In most cases, combining talk therapy with medication is the best way to maximize your chance of recovery. For many addictions, such as opioid use disorder, medication-assisted treatment is the gold standard of care.

References

MAT Medications, Counseling, and Related Conditions. (March 2022). Substance Abuse and Mental Health Services Administration.

Acamprosate. (May 2016). National Library of Medicine.

Disulfiram. (August 2017). National Library of Medicine.

Buprenorphine. (July 2022). Substance Abuse and Mental Health Services Administration.

Effect of Buprenorphine Dose on Treatment Outcome. (December 2011). Journal of Addictive Diseases.

Methadone. (June 2022). Substance Abuse and Mental Health Services Administration.

Methadone Barriers Persist, Despite Decades of Evidence. (September 2019). HealthAffairs.

Naltrexone. (April 2022). Substance Abuse and Mental Health Services Administration.

What Is Naltrexone? UAMS Psychiatric Research Institute.

Find Medication-Assisted Treatment (MAT). (April 2022). Substance Abuse and Mental Health Services Administration.

Types of Treatment Programs. (January 2018). National Institute on Drug Abuse.

Stigma, Misunderstanding Among the Barriers to MAT Treatment. (September 2019). American Psychiatric Association.

“You Are Not Clean Until You’re Not on Anything”: Perceptions of Medication-Assisted Treatment in Rural Appalachia. (March 2020). International Journal of Drug Policy.

Reducing Stigma Toward Medication-Assisted Treatment. Utah State University.

The Stigma of MAT: Can You Protect Patients From Discrimination? (July 2019). Alcoholism & Drug Abuse Weekly.