Understanding Medication-Assisted Treatment: Your Complete Guide to MAT

Medication-Assisted Treatment (MAT) is a well-known treatment that utilizes prescription drugs under the care of a medical provider to help treat substance addictions and dependence. Is MAT effective, and if so, how does MAT treatment work? What are the pros and cons of medically-assisted treatments? Understand more in this in-depth article.

Last Edited: 04/02/2021

Author: Angeline Gormley Angeline Gormley

Clinically Reviewed:

04/16/2021

Medical Reviewer:

Dr. Neil Shah

Dr. Neil Shah

There are multiple methods to treat substance use disorders and one of them is through Medication Assisted Treatment (MAT). What is this process and does it provide better chances of recovery?

Addiction is known as a complex condition. There are a multitude of causes and triggers for each individual going through this condition; for some, going to support groups or making changes in their environments are enough to curb their substance use disorder. But not everyone achieves successful recovery with these methods, this is the main reason why rehab centers offer various treatment options such as Medicament Assisted treatment.

What Is Medication Assisted Treatment?

Medication-assisted treatment (MAT) is the use of medications, approved by the Food and Drug Administration (FDA), in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

When it comes to medication, the most commonly used are antagonist drugs, they are sometimes called “blockers”, which main function is to interfere on the receptors where a substance do its action. As an example, Narcan (Naloxone), is a medication used to block the effects of opioids.

An agonist drug activates the same sites that an addictive substance would bind to. Drugs used in MAT are usually partial agonists, providing only partial efficacy relative to a full agonist and often producing side effects similar to opioids misuse; for this reason combined drugs are frequently used, such as Suboxone, which is a combination of Buprenorphine and Naloxone. Buprenorphine reduces the opioids withdrawal symptoms while the Naloxone prevents the “high” effects of Buprenorphine.

What is MAT in Substance Use Disorder Treatment?

Substance use disorder treatment centers routinely use MAT for many patients, especially for those who have created more addiction and dependence. When it comes to MAT in Substance Use Disorders, the main ones are:

  • MAT of opioids use disorder.
  • MAT of alcohol use disorder.
  • MAT of tobacco use disorder.

MAT of Opioids Use Disorder

Opioid dependency may develop from prescription or illicit drugs use. Many patients use MAT for addictions to short-acting opioids such as heroin, morphine, or codeine; unlike Buprenorphine, these opioids are full agonists and thus give stronger, fuller effects that can cause drug addiction and dependency.

MAT for opioids use disorder often utilizes drugs such as Methadone, Buprenorphine, or Naltrexone. These drugs allow people to taper from the full-effect opioids of their addiction and help them lessen their dependency. Health care professionals provide partial agonist drugs on a regular basis until their patients’ withdrawal symptoms are easily managed.

Where to go for medication assisted treatment of opioids use disorder?

As stated previously, some MAT drugs can cause a “high” effect, this is a problem by itself. The best way to proceed is to look up for a high-quality rehab center assistance, where you can be provided with good prescribing guidelines and a place where you can get full assessment of your opioid use disorder, and your mental health disorder (if you have one).

MAT of Alcohol Use Disorder

Alcohol use disorder is one of the most common addictions and it is also one of the most dangerous when left untreated. Severe alcohol withdrawal can cause life-threatening symptoms, especially when a person stops drinking abruptly.

In these cases, MAT is recommended. The process includes the use of drugs such as benzodiazepines for acute withdrawal and drugs such as Disulfiram, Acamprosate, or Naltrexone for long-term abstinence. For many people, these latter drugs are effective when used after detox, days after withdrawal, and during the period of abstinence. When taken according to instructions, these medications may reduce cravings for alcohol or create adverse side effects when alcohol is consumed to encourage abstinent behavior.

Where to find MAT of alcohol use disorder?

If you have moderate to severe alcohol dependence, it is not recommended that you stop drinking completely right away without medical assistance as this may be dangerous. Rehab centers with medication-assisted treatment for alcohol may help you with the process of alcohol detox, treatment, and relapse prevention and help you create a long-lasting recovery.

MAT of Tobacco Use Disorder

Nicotine dependency may be treated by prescription drugs as well. Nicotine replacement medications such as Varenicline, Bupropion, or Clonidine can be used to lessen withdrawal effects and cravings.

Commonly, people will be instructed to use a drug for a week before total abstinence from smoking. The dose and length of treatment with nicotine replacement such as nicotine patches during MAT depends on the severity of smoking dependency, including the amount of smoking done per day and the length of time an individual has been smoking for, and the recommendations of health care professionals.

What Does Medication-Assisted Treatment (MAT) Include?

Although MAT means medication-assisted treatment, this does not mean that prescription drugs are the only part of this type of addiction treatment. According to the Substance Abuse and Mental Health Services Administration, the goal of medicament-assisted treatment in substance use disorder is to provide a “whole-patient” approach. By considering the physiological, psychological, and contextual issues surrounding the individual, it is possible to treat many angles of addiction causes and triggers.

MAT is used in combination with counseling and behavioral therapies, including:

  • Drug detoxification: The first portion of medication-assisted treatment usually involves some form of detox. There are two main objectives in drug detoxification: to safely manage withdrawal symptoms and to lessen the dependency on the addictive substance. Drug detox may involve the use of agonist or antagonist drugs, or require users to taper from using addictive substances over a period of time.
  • Behavioral therapy: These are the various treatment options aimed to cover the psychological and environmental factors of addiction. After the detox process, the individual can undergo psychotherapy, holistic approaches, faith-based treatment, and substance use disorder treatment options. In some instances, medication-assisted treatment will continue during this phase, as people need to take some medications after a period of abstinence from the abused drugs.
  • Continued MAT and aftercare: It is possible to continue taking antagonist or agonist drugs even after the period of intensive rehab ends. MAT aftercare programs may include the regular use of prescription medications until the dependency is no longer observed. People take the medications while participating in relapse prevention programs, counseling, support groups, and continued behavioral therapies.

If you’re wondering how to manage a MAT program, the best way is to consult an addiction specialists who can help you arrange a custom rehab treatment program suitable for your needs. The steps mentioned above are part of a general process, but the treatment options for each part of the program will be customized according to your unique background and preferences.

What Drugs Are Used In Medication-Assisted Treatment?

As previously mentioned, there are designated anti-craving drugs for each type of addiction. Here is a brief overview of common drugs used for opioid, alcohol, and smoking abuse problems:

Opioids use disorder

Methadone

The goals of Methadone treatment are suppression of opioid withdrawal symptoms and opioid craving and cessation of illicit opioid use. Methadone has potential to be habit-forming and thus should be taken according to the instructions of a medical provider.

Buprenorphine

Buprenorphine is a drug that was approved by the Food and Drug Administration (FDA) in 2002 to help curb opioid dependency. Compared to methadone, which is distributed at highly specialized settings such as clinics and hospitals, buprenorphine is more accessible. Many rehab centers offer buprenorphine as a part of their MAT program. This drug is a partial agonist, which means it can produce the similar effects as opioids but to a lesser extent.

Naltrexone

Naltrexone is used to block opioid receptors in the central nervous system. The blockages dampen the effects of fast-acting opioids in the body. People can take Naltrexone to treat opioid overdose or may take it in combination with buprenorphine for acute detox as well as longer term treatment of opioid dependence. Using Naltrexone can be part of the treatment and relapse prevention program, as the drug stops the feeling of being high that heroin, codeine, and morphine may provide.

Alcohol use disorder

Acamprosate

Acamprosate (brand name: Campral) was first introduced in 1989 and is deemed safe and effective to treat problems related to alcohol abuse. This prescription drug aims to balance irregularities in the neurochemical composition of the brain that may occur due to alcohol addiction. It is offered to patients with moderate to severe Alcohol Use Disorder, having the goal of reducing alcohol consumption and achieving abstinence, and they can be used in acute withdrawal syndrome treatment.

Disulfiram

Disulfiram is a drug approved by the FDA to treat alcohol use disorder (AUD) and is often known by the brand name Antabuse. The primary mechanism by which disulfiram promotes alcohol abstinence is through causing unpleasant side effects when alcohol is consumed. There is also research supporting disulfiram’s modulation of dopamine activity in the brain to reduce cravings. Dopamine is a neurotransmitter or chemical messenger that is responsible for the euphoric feelings with addiction.

Topiramate or Gabapentin

These are offered to patients with moderate to severe Alcohol Use Disorder, having th goal of reducing alcohol comsumption and achieving abstinence. Prefer Topiramate or Gabapentin if patients are intolerant to or have not responded to Naltrexone and Acamprosate.

Tobacco use disorder

Naltrexone

Similar to treatments for opioid addiction, naltrexone may also be used to treat nicotine addiction and dependence. Naltrexone blocks opioid receptors which appears to play a role in nicotine dependence and helps reduce nicotine cravings.

Varenicline

Varenicline is a partial agonist drug that treats nicotine dependency. It produces effects that are similar to nicotine but the effects are weaker, thereby reducing withdrawal symptoms and cravings while still allowing an individual to ween off nicotine. Although generally safe, medical professionals need to review an individual’s medical history and risk factors as the drug can infrequently cause serious side effects such as seizures.

Bupropion

Bupropion is a class of antidepressants that are also used to target smoking dependency in addition to depression and other mental health disorders. It works by modulating dopamine activity in the brain. Dopamine is responsible for the euphoric feelings with addiction thus Bupropion can reduce cravings for nicotine.

Clonidine

Clonidine is a drug used to treat nicotine dependence as well as symptoms of ADHD and high blood pressure. It relaxes the heart rate and lowers the blood pressure, which may reduce discomfort related to smoking withdrawal.

How Effective is Medication-Assisted Treatment (MAT) for Substance Use Disorder?

Medication-Assisted Treatment (MAT) is not the usual first line of treatment for mild substance use disorders. This treatment method can be done in an outpatient or inpatient setting although in more severe cases, inpatient residence may be required to safely administer MAT.

Many studies support the effectiveness of MAT to prevent relapse. An article in Stat News cites studies from peer-review academic medical journals supporting the effectiveness of MAT in individuals with moderate to severe addictions.

MAT is generally safe and highly effective in the treatment of substance addictions, both in the detox phase as well as in long term recovery. MAT can reduce withdrawal symptoms and cravings.

Myths Surrounding Medication-Assisted Treatment (MAT)

Issues on potential dependency on another drug

Some people question the safety and effectiveness of prescription drugs used as a part of the rehab program. They cite a number of cases where people became dependent on replacement drugs. They acknowledge that replacement drugs may reduce the substance misuse but note that the unsupervised use of replacement prescriptions can create addictions themselves.

It is important to note that the main purpose of these medications is not to start a new addictive habit but to aid in substance abuse cessation. Prescription medications work in various ways, but all aim to reduce the discomforts of withdrawal or to prevent substance dependency by blocking its effects. To reduce misuse and risk of developing an addiction to MAT, individuals should follow the directions of their medical providers. If an individual feel like he or she needs more MAT treatment, he or she should consult with the prescribing medical provider rather than adjust the dosing themselves.

The impression that MAT is only for opioids use disorder

MAT can have other several purposes aside from opioid addiction. It can also be an effective method for alcohol addiction, as a way to prevent the potentially deadly symptoms of alcohol withdrawal.

In essence, medication-assisted treatment is any substance use disorder treatment program that utilizes prescription drugs to improve the condition of patients. It is not simply about substance replacement, but also a way to battle the effects of alcohol or drug withdrawal. Some medications are also used to treat other co-occurring mental health conditions that are diagnosed within the facility, such as anxiety, depression, PTSD, or personality disorders.

Many may be hesitant to undergo MAT, but with the right approach and adherence to professional advice it can be effective. However, it is important not to outrightly oppose medically assisted treatment facilities; such treatments could be a vital part of successful addiction recovery for many people.

Pros and Cons of MAT

As with any other treatment program, there are also advantages and disadvantages of undergoing MAT. Before going into an assessment and treatment process within a facility, below are some pros and cons you should consider:

Pros of MAT:

  • Less risk of relapse.
  • Beneficial for those with moderate-to-severe dependency.
  • Close monitoring and assistance provided by a medical provider.
  • Reduced severity of withdrawals.
  • Can reduce cravings.

Cons of MAT:

  • A higher level of commitment due to inpatient care, although in many cases MAT can also be provided in outpatient care.
  • Risk of dependency when MAT drug is taken without supervision.
  • Costly without insurance.
  • Contraindications of MAT drugs if taking other medications for other health conditions.
  • Although generally safe, MAT drugs have their own side effects and risks.

MAT in Support Groups

Some wonder if it is possible to take MAT medications while joining support groups. This is absolutely possible, however, some cases may be limited. For example, a patient in acute detox for alcohol withdrawal may be receiving MAT with benzodiazepines, while benzodiazepines reduce the withdrawal symptoms, they may still have some discomfort such as tremors that make it difficult to participate in group activities. However, the detox period for substance use is generally short, lasting only a few days. MAT used for maintenance therapy, such as disulfiram to promote abstinence from alcohol may be taken for months. During this time, however, patients are not only able to go to support groups but are encouraged to.

Where to Get MAT

Getting medication-assisted treatment should only be done in a proper healthcare facility such as a hospital, patient care center, or an addiction treatment facility. Since MAT involves the use of prescription drugs, it is essential that the recommendations are only given by licensed healthcare professionals.

Accredited rehabilitation

It is important to find a state-accredited rehabilitation center with the right permits, licenses, and accreditation. Such recognition is a good sign that the center uses treatment approaches that are safe, effective, and evidence-based.

Top-notch facilities

A treatment facility with top-notch amenities means that you can receive the most from your program. If you are planning to enroll as an inpatient, consider finding a rehab with high-quality equipment, lodging amenities, and varied treatment options to experience the best that rehab has to offer.

Medical supervision

One indicator of a competent MAT center is the presence of experienced and certified medical professionals. Some replacement drugs such as Methadone require regulated and supervised use in order to avoid habit-forming tendencies. Medical staff must be present during medically assisted treatments to ensure client safety.

Treating a Drug Problem with Drugs? It’s Possible

Using drugs to treat a drug problem may sound counterintuitive to some individuals, however, studies have consistently shown that MAT can be effective in addiction treatment. Through the strategic use of partial agonist and antagonist medications, along with behavioral therapies, counseling, and holistic treatments, we can address substance abuse problems as a whole. It is possible to achieve long-term sobriety through medically-assisted treatment and other approaches.

Sources

  1. ncbi.nlm.nih.gov – Opioid agonist-antagonist Drugs in Acute and the Chronic Pain States
  2. samhsa.gov – Medication and Counseling Treatment
  3. nejm.org – Recognition and Management of Withdrawal Delirium (Delirium Tremens)
  4. mayoclinic.org – Naltrexone (Oral Route) Description and Brand Names
  5. samhsa.gov – Buprenorphine
  6. medlineplus.gov – Methadone
  7. ncbi.nlm.nih.gov – Chapter 3 — Disulfiram
  8. ncbi.nlm.nih.gov – Acamprosate: A Prototypic Neuromodulator in the Treatment of Alcohol Dependence
  9. drugbank.ca – Varenicline
  10. mayoclinic.org – Bupropion (Oral Route) Description and Brand Names
  11. medlineplus.gov – Clonidine
  12. apnews.com – Police: 2 Dead, Officer Hurt at Baltimore Methadone Clinic
  13. Statnews.com – How effective is medication-assisted treatment for addiction?
  14. Pharmacological and Behavioral Treatment of Opioid Use Disorder | Psychiatric Research and Clinical Practice (psychiatryonline.org)
  15. Medication-Assisted Treatment (MAT) | SAMHSA
  16. Medication-Assisted Treatment With Methadone: Assessing the Evidence | Psychiatric Services (psychiatryonline.org)
  17. Medication Assisted Treatment of Tobacco Use Disorders (psychiatry.org)

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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