What is Medication Assisted Treatment (MAT)
Medication-assisted treatment (MAT) is increasingly used in addiction treatment settings. MAT is a treatment track that uses medication paired with counseling to treat substance use disorders (SUDs).1, 2, 3
MAT has seen increasingly widespread acceptance in the medical community as an effective treatment for SUDs.2 The World Health Organization (WHO) recognizes some medications used in MAT as essential medications.1 Federal studies have demonstrated MAT’s effectiveness in treating SUDs and supporting sobriety. 4 Insurance companies recognize the benefits of MAT, and plans may offer coverage for medication-assisted treatment drugs.5
Medications may also be utilized during medical detox and the management of withdrawal associated with certain types of substance dependence. During the detoxification process, patients may experience uncomfortable and potentially harmful withdrawal symptoms that can be alleviated by certain medications. When seeking treatment, it’s important to understand how medication assisted treatment may also factor into the detox portion of early recovery.
How is Medication Assisted Treatment Used?
Medication-assisted treatment can be used during detox to ease symptoms of withdrawal and later, during the ongoing recovery process to maintain sobriety by reducing cravings.6 A recent study showed that treatment centers use MAT in nearly 80% of detox cases. Cravings may also persist long after detox, but certain medications can ease cravings to help people to better maintain their recovery progress.
Studies have shown that MAT is effective in treating SUDs.3, 4 The potential benefits of MAT include:
- MAT can offer relief from uncomfortable and possibly life-threatening symptoms of withdrawal.8, 9
- Increased likelihood of staying in treatment1, 3, 8
- Reduced rates of relapse and overdose for people on MAT for opioid use disorders 1, 3, 8
- MAT for opioid use disorder makes it about twice as likely that a person will stay sober during treatment compared with therapy alone.8
- The ability to receive outpatient detox treatment in some cases3
- Improved functioning, such as getting and keeping steady work1, 3
While MAT can be an extremely useful tool, it isn’t used in all cases. Medications have been developed and approved by the FDA specifically for alcohol and opioid addiction and withdrawal.9 However, MAT may not be used if you are unlikely to experience withdrawal, or if there are no FDA-approved medications to treat withdrawal symptoms resulting from the cessation of certain substance use.6 (p3) For example, there are currently no medications specifically approved to treat addiction to drugs other than alcohol and opioids.
Medication Assisted Treatment for Alcohol
The FDA has approved three medications to be used in MAT for alcohol use disorder.6 Acamprosate, disulfiram, and naltrexone can be used as part of a comprehensive treatment program. While there is no cure for alcoholism, medication can have a positive impact on sobriety and treatment outcomes.3
Acamprosate (brand name: Campral) may be helpful for people in recovery, particularly those with severe alcohol use disorder, who have already stopped drinking and wish to prevent relapse.3, 6, 9, 10 While Campral doesn’t affect acute withdrawal symptoms, it may ease symptoms of protracted alcohol withdrawal, such as anxiety, insomnia, restlessness, and feelings of malaise, unease, or unhappiness. Acamprosate is a pill that is taken three times daily, and generally takes 5-8 days before it is fully effective.3
Disulfiram (brand name: Antabuse) is most effective in people who have recently completed detox or are newly abstinent; it should not be used for at least 12 hours after ingestion of alcohol.3 It is a type of aversion therapy, since it interferes with the body’s ability to break down alcohol, leading to distressing and uncomfortable reactions if a person ingests even small amounts of alcohol.6, 9 Flushing, nausea, vomiting, headache, chest pain, shortness of breath, blurred vision, and palpitations can all be experienced after consuming alcohol while on Antabuse.11 Disulfiram is a tablet that is taken once daily, and the effects can last for up to two weeks after taking a dose.
Naltrexone (brand name: Vivitrol) is an opioid receptor antagonist. It helps treat alcohol use disorder by blocking some of the rewarding, euphoric effects associated with alcohol intoxication to reduce continued drinking behavior.3, 6, 9 It helps people stop drinking so that they can focus on recovery.3 Naltrexone is available in several formulations. As an oral tablet, it needs to be taken daily for best results.12 Naltrexone is also available as an extended-release monthly injection, which may make it easier for some people to remain compliant with their medication regimen.
Medication Assisted Opioid Treatment
Three medications are FDA-approved for treating opioid use disorder.2, 3 Buprenorphine (Suboxone, Probuphine), methadone, and naltrexone are all approved for use as part of a treatment program that includes behavioral therapy and can be safely used long-term if needed.6
Suboxone is a medication that combines the partial opioid agonist buprenorphine with the opioid antagonist naloxone to help reduce or eliminate symptoms of opioid withdrawal and reduce opioid cravings, all while minimizing the abuse potential of the treatment drug itself.3, 6, 9 Suboxone is available as films that are dissolved under the tongue once a day and should be started only after a person has begun to experience mild to moderate symptoms of withdrawal (to avoid precipitating severe withdrawal in instances of significant opioid dependence).8, 13 If Suboxone is started while a person is under the influence of opioids, it can bring on severely unpleasant symptoms of withdrawal. This formulation reduces the likelihood of misuse and makes it a good option for outpatient treatment.
Methadone has historically been a widely-used medication for treating opioid use disorders, but it is only available in highly regulated settings.4 It is a long-acting opioid that relieves withdrawal symptoms during detox, lessens cravings and, due to the building of significant cross-tolerance, can block the effects of other opioids.3 , 6, 9 Methadone has been used for many years to help with detox and maintenance of long-term sobriety and is taken orally once daily, in a supervised setting.14 Methadone can be used for a short-term detox or to support long-term recovery.15
Naltrexone also works to treat opioid use disorder in people who have successfully completed detox by blocking the reinforcing effects of opioids if they are taken.1 , 3 In some instances, should it be used within 7 days of ingesting opioids, it can bring on symptoms of withdrawal.4 , 8 People on naltrexone may not notice any effects other than that it blocking the reinforcing effects of opioids.9, 12
Medication Assisted Treatment for Other Addictions
An MAT approach may be used in clinical settings for other addictions, even though FDA- approved medications are not currently available. For example, clonidine may be used off-label to help manage alcohol and opioid withdrawal, and benzodiazepine withdrawal management may necessitate the use of anticonvulsant medications.14, 16 Currently, the protocol when detoxing from benzodiazepines is to wean off the medication slowly or substitute another benzodiazepine, but this might not always be an option, or additional management (for withdrawal complications such as seizure and agitation) may be required. Medications may be used off-label and others are being studied as possible options for MAT to manage symptoms of benzodiazepine withdrawal.17 Some facilities may prescribe medications to manage more troublesome symptoms as they arise.
Is Medication Assisted Treatment Safe?
When treating SUDs, abuse of the treatment medications themselves is always a concern.9 However, when taken as directed, even the opioid agonist medications shouldn’t result in a reinforcing high, thus lowering their inherent abuse potential.12
The majority of medications used to block the effects of the substance they are intended to treat have a low risk of overdose when used according to prescribed parameters.8 , 9 Suboxone, which is used to alleviate the withdrawal symptoms from the cessation of opioid use, is formulated with an opioid receptor antagonist (naloxone) so that if it is intentionally misused by injecting the drug, it can bring on intense withdrawal symptoms. Methadone, though a full opioid agonist, has been used safely for managing opioid addiction for many years by being carefully dispensed and monitored. Like Suboxone, it is generally safe to use under medical supervision.14 Both of these medications are effective for detox and long-term treatment.4 Suboxone in particular is well-known as a safe medication with a lower risk of side effects and medication interactions.8, 14
Before deciding to start MAT, it is always advisable to discuss your options with your doctor. They can help you understand your options, weigh the pros and cons, and decide on the best course of treatment to meet your needs.
Can I do Medication Assisted Treatment from Home?
It is important to have medical supervision during MAT, especially during medical detox. This ensures that prescribers can monitor how well the medication is working, adjust the dose as needed, and watch for potential complications.
After detox, certain MAT medications, such as Suboxone or naltrexone, may be used on an outpatient basis when closely monitored by a medical professional. For MAT to be effective, it is important to follow a treatment plan involving consistent therapeutic appointments and close follow-up. Since several medications used in MAT tracks are controlled substances or require prescriptions, providers may be reluctant to prescribe take-home doses until the patient has reached certain treatment milestones.
Medication Assisted Treatment and Detox
As stated, medications are an important component of many medical detox protocols used to help alleviate withdrawal symptoms that occur after the cessation of substance use. Withdrawal symptoms can vary in length, severity, and type depending on the substance used and how long it was used. The severity of withdrawal symptoms can range from mild and uncomfortable to severe and fatal.7 People experience withdrawal differently based on the type(s) of substances being used, as well as other physiological factors. For example, alcohol withdrawal symptoms may include:7
- Racing pulse.
- Visual, tactile, or auditory hallucinations.
People in acute opioid withdrawal may experience: 7
- Strong cravings.
- Muscle aches.
- Runny nose.
- Teary eyes.
- Nausea or vomiting.
Some of the more dangerous withdrawal complications include rapid heart rate, agitation, seizures, delirium that may involve hallucinations, and altered consciousness and cognition.7 MAT can reduce or eliminate these symptoms and make detox safer. MAT can also reduce the impact of these symptoms by helping a patient taper off of a given substance.
Continued Care with Medication Assisted Treatment
MAT commonly extends beyond the detox phase of treatment. For example long-term opioid agonist maintenance treatment may benefit those in recovery from opioid use disorders. Certain medications have no limit for treatment duration and some can be used for years or even over the course of a person’s life.2, 3 MAT is different for each person and should be discussed with your provider. The length of time a person is on MAT is decided on an individual basis.
MAT & Detox at American Addiction Centers
American Addiction Centers is a leading provider of medical detox and supervised withdrawal management and all other levels of care. Evidence-based treatment methods that are thoroughly researched and shown to be effective are used at all facilities. MAT is offered at all of our 12 facilities.
Still Have Questions about MAT & Detox?
At American Addiction Centers, our mission is to help people access treatment. That doesn’t start only when people walk in the doors of the facility. If you have any questions, you can call our confidential helpline at any time. It’s free and always staffed. This will connect you with an Admissions Navigator, who can help you start treatment at one of our facilities or answer any questions you might have about treatment, including “how can I find medication-assisted therapy near me?” When you are ready for help, we’ll be waiting. You can reach us at 1-888-935-1318
- National Institute on Drug Abuse. (2020). Effective treatments for opioid addiction.
- S. Food and Drug Administration. (2019). Information about medication-assisted treatment (MAT).
- Substance Abuse and Mental Health Services Administration. (2020). Medication and counseling treatment.
- Kresina, T.F., & Lubran, R. (2011). Improving public health through access to and utilization of medication assisted treatment. International Journal of Environmental Research and Public Health, 8(10), 4102-4117.
- Illinois Department of Healthcare and Family Services. (2019). Recommendations page.
- National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
- Connery, H.S. (2015). Medication-assisted treatment of opioid use disorder. Harvard Review of Psychiatry, 23(2), 63-75.
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).
- S. Food and Drug Administration. CAMPRAL (acamprosate calcium) delayed-release tablets.
- S. National Library of Medicine. (2012). Label: ANTABUSE — disulfiram tablet.
- S. Food and Drug Administration (2013). Revia (naltrexone hydrochloride tablets USP).
- S. Food and Drug Administration. (2018). SUBOXONE (buprenorphine and naloxone) sublingual tablets for sublingual administration CIII.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- S. Food and Drug Administration. (2014). DOLOPHINE (methadone hydrochloride) tablets, for oral use CII.
- Fluyau, D., Revadigar, N., & Manobianco, B.E. (2018). Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation. Therapeutic Advances in Psychopharmacology, 8(5), 147-168.
- Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152-155.