Medication-assisted treatment involves using specific medications to help people establish and maintain sobriety from opioids and alcohol. The use of medications in combination with therapy can manage drug cravings, withdrawals, and reduce the risk of relapse.1 Like all forms of treatment, medication-assisted treatment isn’t right for everyone and requires a careful assessment of the pros and cons.
What Is Medication Assisted Treatment (MAT)?
Medication-assisted treatment (or MAT) is a form of addiction treatment that involves a combination of therapy and prescribed medication. MAT addresses certain types of substance use disorders, including alcohol and opioid use disorders.1
MAT medications for opioids work by blocking certain opioid receptors in the brain, helping to prevent drug cravings and withdrawals, usually while limiting the intoxicating effects of the drug.2
MAT drugs for alcoholism work differently, helping some people maintain sobriety by blocking the pleasurable effects of alcohol or creating unpleasant side effects if someone drinks. MAT for alcohol use disorder is often recommended for people with more severe addictions or when other forms of alcohol treatment have been ineffective.3
Medication is not effective as a standalone treatment for addiction, which is why MAT always involves a combination of medication and psychotherapy. It can be very effective in helping people with alcohol or opioid addictions establish and maintain their sobriety. These medications can help to address the physical aspects of addiction, like cravings and withdrawals, while the psychological and behavioral aspects are addressed in group or individual therapy. Combined, this is considered a ‘whole-person approach’ that can help people overcome their addictions.3,4
6 Types of Medication-Assisted Treatments for Addiction
There are different forms of medication-assisted treatment that can be used to treat addiction. A number of factors should be considered when determining whether MAT addiction treatment is right for a person in recovery and, if so, which specific medications should be used. It may take some trial and error to determine which medication will work best, as the effects can vary from person to person.
Here are the six FDA-approved medications used in MAT drug and alcohol treatment:
Methadone is a long-acting opioid agonist, which means it binds to opioid receptors in the brain to reduce opioid cravings and prevent relapse. It is an FDA-approved medication for opioid dependency and has been used for decades to help people overcome addictions to heroin, painkillers, and other opioids. Less commonly, it is also used to help people manage pain related to chronic medical conditions.1,2,4
Methadone is administered as an oral medication taken daily. However, it is possible to abuse or even overdose on the drug.5 Because of this, methadone is a tightly regulated controlled narcotic that is usually administered in clinics that require a person to come daily to get their dose. Over time, patients may be allowed to come to the clinic less often and given extra doses to take at home.2,4
Buprenorphine is an FDA-approved medication used to treat addictions to opiates and opioids by reducing cravings and preventing withdrawals. Buprenorphine is an opioid agonist, which means it binds to opioid receptors in the brain and blocks other opioids from working. While it can be abused, it has a built-in quality that prevents overdose, making it a safe and effective treatment for opioid addiction.6
Buprenorphine can be administered in a number of different ways, including orally, as a sublingual film that dissolves in the mouth, or as an injection or implant.6 It is a controlled medication that’s closely regulated, and only prescribers with special DEA licenses can prescribe it. Also, clinics that prescribe this medication often have strict protocols, including regular urine drug screenings and a requirement for people taking the medication to attend regular therapy sessions.4
Suboxone is a variation of buprenorphine that includes the addition of naloxone, which is an opioid antagonist that further improves the safety of the medication.6Adding naloxone to buprenorphine reduces the likelihood that a person will overdose on the drug. Naloxone is a medication that is also used to reverse the effects of a fatal opioid overdose when administered quickly enough.
This enhanced formulation makes it more difficult for someone to abuse suboxone in order to get high. Suboxone is usually prescribed as a sublingual film that dissolves under the tongue.6 It is a controlled substance and has similar restrictions and regulations as buprenorphine for prescribers and patients. Suboxone is often preferred over methadone because it is safer, less likely to be intoxicating, and has fewer adverse effects.5
Naltrexone is a prescription medication that is used in MAT drug treatment for people with addiction. It is FDA-approved to treat both alcohol use disorder as well as opioid use disorder and works by blocking opioid receptors in the brain. This makes it effective in helping to reduce opioid cravings, as well as preventing a person from being able to experience pleasurable effects from both alcohol and opioids.3,7
Naltrexone can make it easier for people to remain motivated to stay clean and sober, reducing the risk of relapse. When used for opioid addiction, naltrexone can only be prescribed after the person completely detoxes opioid drugs from their system, which can take 7-10 days. It is usually prescribed as a pill that people take daily, but a long-acting version of the medication is available as an injection, which is sometimes recommended when treating alcohol use disorder.7
Disulfiram is an FDA-approved medication used to treat alcohol dependence and is given to people who have already stopped drinking, detoxed, and are no longer having alcohol withdrawals.2,3,8 Disulfiram interacts with alcohol, causing people to have nausea, flushing, and other unpleasant symptoms if they drink. These symptoms are intended to keep someone motivated to avoid alcohol when taking the medication, helping to reinforce sobriety.8
Disulfiram is often known as Antabuse, which is a brand-name version of the medication that comes in oral tablets taken daily. Unlike many of the other medications used in MAT, disulfiram isn’t a controlled substance and has fewer restrictions and regulations on who and when it can be prescribed. It’s often recommended for people who are highly motivated to refrain from drinking, as less motivated people aren’t likely to take it daily.8
Acamprosate is another MAT medication that has been FDA-approved for addiction treatment and is used to help people recover from alcohol dependence.1,3 Acamprosate is also known as Campral, which is the brand name version of the drug. It comes as an oral tablet that is taken daily to reduce alcohol cravings in people who have already stopped drinking and want to remain sober.9
Acamprosate is often one of the preferred medications for the treatment of alcohol dependence because it is not metabolized by the liver. Many people in recovery from alcoholism have liver damage that prevents them from being able to take certain medications.9 Also, acamprosate is not a controlled medication, which makes it a safe and accessible option for many people trying to recover from alcohol use disorder.
How Effective is MAT?
The effectiveness of MAT varies significantly depending on the type of addiction. It is most effective in treating opioid addictions, according to the research. MAT for opioid addiction has been shown to improve rates of sobriety and treatment adherence and significantly lower the risk of relapse and fatal overdoses.1,2,4 If someone stops taking suboxone or methadone or skips a dose, they will experience withdrawal symptoms, which provides a strong incentive to adhere to treatment and boost the success rate for MAT for opioids.2,5
The use of MAT medications for stimulant and alcohol addictions has provided mixed results, suggesting that MAT is not as universally helpful to people with these kinds of addictions. There are no FDA-approved medications used for addictions to stimulants like meth or cocaine, which means that medications are only prescribed ‘off-label’.
MAT medications used for alcohol do not help reduce cravings or prevent withdrawals and only work by producing unpleasant symptoms if or when someone drinks alcohol. Because of this, people don’t always take the medication regularly. The lower treatment compliance for MAT alcohol treatment makes it less effective and practical. People with strong alcohol cravings, more severe alcohol addictions, and a history of unsuccessful attempts to get sober may benefit more from MAT medications for alcohol.3
Pros & Cons of MAT
Some of the potential benefits of MAT include increased chances of being able to establish and maintain sobriety and reduce uncomfortable cravings and withdrawals. Medication-assisted treatment for opioid addiction can even save lives by significantly lowering rates of illicit opioid use, relapse, and fatal overdose. Many people who have tried and failed to quit using opioids or alcohol describe MAT as the only thing that has kept them clean and sober.
Some of the potential downsides to MAT include the possibility of experiencing unwanted side effects and interactions with other medications. Also, some people prefer to avoid MAT options because they don’t want to be dependent on any drug, even one that’s prescribed by a doctor. Also, tapering off MAT medications can cause opioid withdrawals that are even longer and stronger than the withdrawals after quitting heroin or prescribed painkillers.5
Pros and Cons of Alcohol MAT
The pros and cons of MAT for alcohol use disorder and opioid use disorder aren’t the same. For alcohol use disorder, MAT is not considered a standard treatment recommended for everyone trying to stop drinking. Instead, MAT is usually reserved for people with more severe addictions, signs of physical dependence on alcohol, or people who have had several unsuccessful attempts to get sober in the past.1,3
Below are some of the known benefits of MAT for alcohol dependence:3,6,7
- Safe and FDA approved: There is a lengthy, involved, and rigorous process involved in getting any medication FDA approved, which can be reassuring to people who are concerned about whether a drug is safe. All three medications approved for alcohol use disorder have undergone this process and are safe and proven effective in clinical trials.
- Blocks rewards of alcohol consumption: Drugs like disulfiram & naltrexone prevent people from being able to experience the pleasurable effects of alcohol. These medications can help rewire addiction pathways in the brain and reduce the desire to drink.
- Forms negative alcohol associations: Disulfiram causes people to feel nauseous, dizzy, and ill if they drink alcohol when taking the medication, creating negative associations with alcohol that can reinforce sobriety.
- Reduces alcohol cravings: Taking MAT medications for alcohol dependence can help to reduce cravings by either removing incentives for drinking, causing unwanted consequences if a person drinks, or working in the brain to reduce alcohol cravings
- Lowers risk of relapse: Many relapses are unplanned and occur when someone in recovery from alcoholism finds themselves in a situation where alcohol is offered or available, but they’re much less likely to give into temptations to drink if they’re on a medication that blocks or counteracts the pleasurable effects of alcohol.
- Alternative to other alcohol treatments: Some people who struggle with alcohol addictions have tried to get sober many times using other treatments like inpatient or outpatient rehab, 12-step groups, or psychotherapy. When these options don’t work, MAT can provide another option for those who have not found other alcohol treatments helpful.
- Can be used short-term: Often, the medications used in MAT for alcohol use disorder aren’t designed to be used long-term, and most people can stop taking them within 4-6 months without any problems. This is relieving to many people who aren’t interested in being prescribed a medication long-term.
Below are some of the known drawbacks and downsides of MAT for alcohol dependence:1,3,6,7
- Limited effectiveness for mild or moderate alcohol use disorder: While MAT is a frontline treatment for opioid use disorder, this is not the case for alcohol use disorder. Those with less serious addictions may not see a direct benefit from taking medications, especially if they don’t experience strong cravings for alcohol or struggle more with psychological dependence vs physical dependence.
- May only benefit people if they relapse: Two of the medications used for alcohol use disorder (disulfiram and naltrexone) are designed to counteract the effects of alcohol, which means they only have an effect if or when someone drinks. People who are able to remain sober will not see a direct effect or benefit from these medications.
- Need to take medication regularly for benefits: In order for MAT medications for alcohol dependence to have any positive effects, they usually need to be taken regularly. Skipping or forgetting to take a dose of the medication will often nullify their effects and cause either a return of cravings or a loss of a safeguard against relapse.
- Potential side effects: All medications have the potential for side effects, including the three FDA-approved MAT medications used to treat alcohol use disorder. Some of the known side effects of these drugs include GI problems, fatigue, brain fog, depression, reduced libido, and insomnia. Rare and more serious side effects include psychosis, seizures, liver failure (disulfiram), and even death.eat.
Pros and Cons of MAT for Opioid Use Disorder
The pros and cons for opioid use disorder often weigh more in favor of using MAT, which is why it’s considered a standard and frontline treatment option. The vast majority of fatal overdoses are caused by opioids, which makes the need for addiction treatment even more urgent for people abusing these kinds of drugs. Because of this, most healthcare professionals will recommend MAT because it has a higher rate of adherence and success than treatments without a medication component.
Still, there are several pros and cons to consider when determining whether or not MAT is right for you, and it’s important to know that there are many people who have overcome their opiate addiction without medications. Understanding the pros and cons of MAT for opioid addiction and talking with a licensed clinician about your options can help you make a more informed decision.
Some of the potential benefits of MAT for opioid dependence are:1,4,5
- Safe and FDA approved: There is a lengthy, involved, and rigorous process involved in getting any medication FDA approved, which can be reassuring to people who are concerned about whether a drug is safe. All of the medications approved for opioid use disorder have undergone this process and are both safe and also proven to be effective in clinical trials.
- Prevents or greatly reduces withdrawal symptoms: The medications used to treat opioid use disorder can prevent or greatly lessen the uncomfortable withdrawal symptoms from opioids. For many opioid users, the fear of withdrawal is a significant barrier to recovery, and medication provides a safe solution. This benefit is the main reason why many people overcoming an opioid addiction opt for MAT.
- Lessens cravings for opioids: Medications for opioid use disorder can greatly reduce the intensity of cravings for opiates like heroin or prescription painkillers. Because these medications work on opioid receptors in the brain, most people taking one of these medications do not experience the intense cravings that come when stopping an opioid.
- Improves treatment adherence: By reducing the risk of relapse, people who receive MAT are more likely to remain in treatment than people who stop opioids cold turkey. This has been demonstrated in several studies and is another one of the reasons why people receiving MAT are more likely to remain clean and sober than people who try to stop on their own.
- Can help people with unsuccessful past attempts: Some people who struggle with opioid use disorder have tried to get sober many times and may have tried inpatient or outpatient rehab, 12-step groups, or psychotherapy. When these options don’t work, MAT can provide another option that helps to address the problem of withdrawals and cravings, which is often the main barrier to opioid addiction recovery.
- Lowers the risk for overdose & death: There is an extremely high risk of overdose when abusing heroin, morphine, fentanyl, or other opioids. Accidentally taking too much can lead to respiratory depression and death, and this risk is significantly lower when someone takes an MAT medication. Most MAT medications (except methadone) have built-in mechanisms that prevent overdose, even if someone were to relapse when taking them.
Below are some of the potential drawbacks of MAT for opioid dependence:2,4,5,10
- Physically addictive in nature: One of the main drawbacks of MAT for opioid addiction is that it makes people dependent upon a prescription medication. While this is usually safer than being dependent on an illicit drug, many people don’t like the idea, and some even feel like using an MAT medication is just ‘replacing’ their addiction with another kind of drug.
- Similar side effects as opioids: Because all of the FDA-approved medications for opioid addiction mimic the effects of opioids and bind to the same receptors in the brain, they can also cause similar side effects. For example, most people who take one of these medications experience problems with insomnia, constipation, and drowsiness, and methadone can be intoxicating in the same ways as traditional opiates.
- High cost of the medication: Many MAT medications for opioid addiction are very expensive. Depending on a person’s financial situation and insurance benefits, this could mean that they have to pay hundreds of dollars out of pocket each month for their medication.
- Frequent office appointments: If someone is prescribed methadone, they often need to go to the clinic daily or at least several times a week to get their medication. This can become problematic for many reasons, including the cost of gas, needing to arrange transportation, and having to fit frequent appointments into their schedule. For suboxone and buprenorphine, office visits are usually less frequent but still might pose a problem for those with busy schedules, transportation problems, or who need to travel.
- Painful withdrawals when stopping medication: One of the main drawbacks to MAT medications for opioid use disorder is that when someone tapers down on their dose or stops, they will experience withdrawal symptoms. These can even be stronger and longer-lasting than the withdrawals related to heroin or traditional opiates, and some people remain on MAT for years or even for life in order to avoid experiencing them.
- Mandated therapy or treatment required: Most clinics that prescribe suboxone, methadone, or buprenorphine require their patients to actively engage in therapy or addiction treatment. The clinic may provide some of these additional services, or they may refer patients to outside organizations. Being required to engage in therapy in order to get a prescription is not a problem for everyone, but can become expensive, inconvenient, or frustrating for others.
- Potential side effects: MAT medications for opioid use disorder can also be a problem for some people and can include all of the side effects of traditional opiates listed above. In addition, other side effects include problems with memory and thinking, hypotension, urinary retention, headaches, nausea, abdominal pain, irritability, and mood changes. Cognitive challenges are among the chief complaints of people receiving MAT medication and can become a major issue affecting their functioning and quality of life.
- Cost-benefit analysis: For some people considering MAT, the risks and costs outweigh the potential benefits. Among the arguments against MAT for opioid abuse are that they make people dependent on pharmaceutical medications, do not treat underlying root causes of addiction, and causes undesired side effects. Also, coming off of medications like suboxone, buprenorphine, and methadone will cause the very withdrawals and cravings they aim to treat.
Insurance Coverage & Cost for MAT
The cost of MAT for opioid or alcohol addiction will vary depending on where you live and whether or not you have insurance. Even if you have insurance, the cost of treatment cant still fluctuate based on your particular plan and whether a clinic or provider is in-network or out-of-network with this plan. Some insurance plans will cover most or all of the costs related to treatment, while others have a copay or deductible you need to meet before the insurance benefits kick in.
If you have health insurance, the best way to determine your costs is to call the number on the back of your card to ask a representative to review your benefits. Sometimes, you can also use an online portal to estimate healthcare costs for a specific provider’s prescription drug. Also, some insurance plans will provide different coverage for brand-name drug versions, so make sure to inquire about generic versions as well.
According to the National Institute on Drug Abuse, the average yearly cost for MAT is about $6,552.00 for methadone, $5,980.00 for suboxone, and $14,112.00 per year for Naltrexone. These estimates include the costs of the medication, as well as an estimated cost for office visits associated with getting your medication.11 They do not include the costs of therapy you may be required to attend, like the cost of individual or group therapy sessions. If these are required in order to get your prescription, you may need to add an additional $100-$250 per session to estimate the total costs of treatment.
How Long Will Treatment Last?
The length of MAT will vary depending on your needs, preferences, and the kind of treatment you’re receiving. In most cases, the length of time you need to remain in treatment or on a specific medication isn’t set in stone and will depend on the progress you’re making. You can also advocate for yourself if there is a specific end date you need to complete treatment by, so make sure to communicate with your providers if this is the case.
What Therapies Will Be Involved?
There isn’t a specific kind of psychotherapy standard in MAT, but some prescribers will require you to prove you are attending some addiction treatment. They may offer individual or group therapy services at the clinic, or they may require you to find an external provider. Often, the staff at the clinic where you get medicine will be able to provide some options for counselors and addiction treatment centers in the area and can sometimes even help make a referral.
Several different kinds of therapy approaches can be effective in treating addiction, including cognitive behavioral therapy (CBT) or motivational interviewing. Also, there are different kinds of settings where treatments can be provided, including in outpatient office settings or inpatient rehab facilities. Some of these programs provide individual therapy, and others provide group therapy or a blend of both. It’s a good idea to look for a therapist who is knowledgeable about addiction and who you feel comfortable opening up to.
How to Find a MAT Provider That’s Right for Me?
The best way to begin your search for an MAT provider is often to explore online therapy options for the kind of provider you need. If you live in a smaller or more rural area, there may only be one or two options available, or you may need to drive to a nearby city for treatment. Once you’ve identified options, the best thing to do is to call the clinics and get more information about the services they provide.
Here are some of the questions you may want to ask:
- Are you accepting new patients?
- When is the first available appointment?
- Do you offer telehealth appointments or only in-person?
- What is the cost of treatment?
- Do you accept my insurance?
- What are the requirements of getting medication from your clinic?
- Do you offer on-site group or individual therapy?
Medication-assisted therapy is a form of addiction treatment that combines therapy with medication that can lower the risk of relapse, reduce cravings, or prevent withdrawal. MAT is sometimes recommended for people struggling with addictions to alcohol or opioids, especially for high-risk addictions that haven’t responded to other treatments. Understanding the pros and cons of MAT can help you understand your options, discuss them with your provider, and make a more informed decision about whether it’s right for you.