Medication-Assisted Treatment (MAT)
In This Article
What is Medication-Assisted Treatment (MAT)?
MAT involves using FDA-approved medications in combination with therapy to treat substance use disorders (SUDs).
This treatment approach is primarily used for opioid and alcohol addictions. Combining medications and behavioral therapies provides a "whole patient" approach to managing substance use disorders.
“Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery.”
- Substance Abuse & Mental Health Services Administration
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How Does Medication-Assisted Treatment Work?
The use of medication-assisted treatment in treating drug and alcohol use disorders (AUD) can help:
- Prevent relapse
- Normalize brain chemistry
- Block the euphoric reaction of substances
- Alleviate withdrawal symptoms
- Reduce cravings
- Help facilitate therapy
- Allow patients to focus on personal obligations during recovery
Long-term benefits of MAT include:
- Improved survival rates
- Increased treatment retention
- Decreased illicit opioid use and criminal activity among those with a SUD
- Higher patient employment rates
- Improved birth outcomes in women with SUDs
- Less risk for HIV and hepatitis C
Types of Substance Addictions MAT Treats
MAT is currently approved to treat opioid use disorder and alcohol use disorder. Medication-assisted therapy for stimulant use disorder is still under development.
Tobacco use disorder can also be treated with MAT.
Types of MAT Medications
The following medications have been approved by the FDA in MAT:
- Methadone
- Buprenorphine
- Naltrexone
- Naloxone (Narcan)
- Disulfiram
- Acamprosate
Off-Label Medications Used to Treat Drug Addiction
In some cases, a doctor may prescribe a medication that is not approved by the FDA to treat SUDs. This is known as “off-label use.”
These drugs include:
Antipsychotics
Antipsychotics treat psychosis rooted in mental illness rather than substance use. However, they're still effective in managing alcohol and drug use linked to mental illness.
Anticonvulsants
Anticonvulsants include topiramate and gabapentin, which have shown promising results in treating alcohol use disorder. They're not FDA-approved.
Beta-Blockers
Beta-blockers are primarily used to prevent heart attacks, angina, and migraines.
They're also used off-label for drug and alcohol rehab, including in cases of co-occurring disorders.
Clonidine
Clonidine is an antihypertensive medication. It blocks chemicals in the brain that trigger sympathetic nervous system activity. Sometimes it can treat opioid dependence by reducing withdrawal symptoms.
Clonidine also reduces anxiety and might shorten the time it takes to detox. It doesn't cure addiction but does make relapse less likely.
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MAT for Opioid Addiction
The medications used in MAT don't cure opiate dependence but do help people abstain. Some block withdrawal symptoms, while others block euphoria.
The following medications may be used to treat opioid use disorder:
Methadone
Methadone is one of the most commonly prescribed medications used in the treatment of opioid dependence.
It's a full opioid agonist, meaning it activates the opioid receptors in the brain. This alleviates cravings and withdrawal symptoms and blunts the effects of opioids.
Methadone should only be used under a doctor's direct supervision. It's the only MAT drug approved for pregnant or breastfeeding women.
Buprenorphine
Buprenorphine is a partial opioid agonist. It produces effects similar to other opioids. However, the effects are much weaker.
People are unlikely to abuse it because of its “ceiling effect.” This means more doses don’t trigger additional side effects.
Like methadone, it reduces cravings, withdrawal symptoms, and effects of other opioids.
Naltrexone
Naltrexone works differently than methadone and buprenorphine because it is an opioid antagonist. This means it blocks the effects of drugs.
If someone relapses while taking it, they will not experience the euphoria that they did in the past. Naltrexone can also treat AUD.
Naloxone (Narcan)
Naloxone is used to treat someone who has overdosed on heroin, morphine, oxycodone, and other types of opioids. It works by blocking their effects.
Naloxone can be administered as either a nasal spray or an injection. When administered, it counters the effects of an opioid overdose.
Administering naloxone also puts a person into withdrawal, which can trigger vomiting, shaking, and sweating.
MAT for Alcoholism
These medications don't cure AUD. But they can be very effective at controlling cravings and blocking its euphoric effects.
Disulfiram
Disulfiram changes the way the body processes alcohol, causing vomiting when its consumed.
Other possible side effects of drinking alcohol while taking disulfiram include headaches and nausea. It's most effective in people who have already gone through detoxification or are in the first stage of abstinence.
Acamprosate
Acamprosate is for people who have already stopped drinking and want to continue sobriety.
It doesn't prevent withdrawal symptoms just after you stop drinking. It's prescribed five days after abstinence begins and is fully effective in another 5 to eight days.
Naltrexone
Naltrexone blocks the euphoric effects of alcohol. It helps people reduce their drinking and increases their motivation to stay in treatment and avoid relapses.
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How Effective is MAT?
MAT is effective for helping people overcome substance use disorders. It's an evidence-based form of treatment, which means there is research proving its effectiveness.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT is “clinically effective” and significantly reduces the need for inpatient detoxification.
MAT has also been shown to be effective in preventing overdoses.
For example, one study found that deaths from opioid overdoses reduced as treatment with buprenorphine became more popular in Baltimore.8
While there is plenty of evidence supporting the success and efficacy of MAT, there are still gaps in the scientific literature that must be addressed.
MAT is also not approved or recommended to treat every addiction.
Frequently Asked Questions (FAQs)
Does MAT mean I'm not sober?
Yes. MAT medications are safe, controlled, and effective and don't trigger euphoria like illicit drugs.
It's no different than using medication to control blood pressure, diabetes, or another chronic condition.
Can I be a member of Alcoholics Anonymous or Narcotics Anonymous during MAT?
There is no official stance in AA or NA literature for or against MAT.
If you feel uncomfortable or unwelcomed by traditional 12-step programs, you have other group options, including SMART Recovery, Secular Organizations for Sobriety (SOS), or LifeRing.
How much does MAT cost?
Medication-Assisted Treatment costs vary greatly from program to program, depending on which drug is administered and other factors.
Methadone treatment costs about $126.00 per week or between $4,000 and $7,000 per year.
Buprenorphine is approximately $115 per week or just under $600 per year.
Naltrexone is approximately $1,200 per month or $14,100 per year.
Does insurance cover MAT?
Sometimes. Treatment coverage for SUDs became more widely available following the passage of the Affordable Care Act.
The Mental Health Parity and Addiction Equity Act of 2008 also requires insurance providers to offer the same level of benefits for mental and/or substance use treatment as they do for medical and surgical care.
Does Medicaid cover MAT?
Medicaid programs and what they cover vary from state to state. For example, most state Medicaid plans cover Methadone treatment.
Arkansas, Idaho, Kansas, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, and Wyoming don't.
Most states cover suboxone treatment, but there are specific requirements regarding amounts and administration. The best way to determine what financial support is available is to contact a specific state’s Medicaid office.
What's Next?
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- Center for Substance Abuse Treatment. “Chapter 11. Treatment of Multiple Substance Use.” Nih.Gov, Substance Abuse and Mental Health Services Administration (US), 2020.
- Chanell.Baylor. “Medication-Assisted Treatment (MAT) | SAMHSA - Substance Abuse and Mental Health Services Administration.” Samhsa.Gov, 21 July 2015.
- Rinaldo, David. "The Cost Effectiveness of Medication-Assisted Treatment for Opiate Addiction." 2008.
- “Medicaid Behavioral Health Services: Methadone for Medication-Assisted Treatment (MAT).” The Henry J. Kaiser Family Foundation, 1 Feb. 2019.
- “Medicaid Behavioral Health Services: Suboxone Treatment.” The Henry J. Kaiser Family Foundation, 1 Feb. 2019.
- Lynne.Walsh. “Medication and Counseling Treatment | SAMHSA - Substance Abuse and Mental Health Services Administration.” Samhsa.Gov, 15 June 2015.
- Douaihy, Antoine B et al. “Medications for substance use disorders.” Social work in public health vol. 28,3-4 : 264-78. doi:10.1080/19371918.2013.759031.
- Schwartz, Robert P et al. “Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009.” American journal of public health vol. 103,5 .
