Key Takeaways
- MAT combines FDA-approved medications with counseling and behavioral therapies to provide a whole-patient approach to addiction treatment.
- Three primary medications for opioid use disorder are buprenorphine (Suboxone), methadone, and naltrexone (Vivitrol), each working through different mechanisms.
- For alcohol use disorder, naltrexone, acamprosate, and disulfiram are FDA-approved medications that reduce cravings and support sobriety.
- MAT is not replacing one drug with another. These medications normalize brain chemistry and reduce the physiological drive to use substances.
- Research shows MAT reduces opioid overdose deaths by 50 percent and significantly improves treatment retention rates.
What Is Medication-Assisted Treatment?
Medication-assisted treatment, commonly known as MAT, is the use of FDA-approved medications in combination with counseling and behavioral therapies to treat substance use disorders. This integrated approach addresses both the biological and psychological aspects of addiction, providing a more comprehensive treatment than either medication or therapy alone. MAT is endorsed by the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the World Health Organization as a first-line treatment for opioid use disorders.
Despite overwhelming evidence supporting its effectiveness, medication-assisted treatment remains misunderstood and stigmatized. Some people believe that using medication to treat addiction is simply replacing one drug with another. This misconception fails to recognize that MAT medications work differently from addictive substances. They stabilize brain chemistry, reduce cravings, and block the euphoric effects of opioids or alcohol without producing intoxication, allowing clients to engage fully in the therapeutic process.
At Trust SoCal in Orange County, our medical director oversees all MAT protocols to ensure clients receive the most appropriate medication at the optimal dosage. We view MAT as one essential component of a comprehensive treatment plan that includes individual therapy, group counseling, family involvement, and aftercare planning.
FDA-Approved Medications for Opioid Use Disorder
Three medications are currently approved by the FDA for the treatment of opioid use disorder: buprenorphine, methadone, and naltrexone. Each works through a different pharmacological mechanism, and the choice between them depends on individual factors including the severity of the opioid use disorder, medical history, patient preference, and treatment setting.
Buprenorphine (Suboxone)
Buprenorphine is a partial opioid agonist that activates opioid receptors at a much lower level than full agonists like heroin or oxycodone. It reduces cravings and withdrawal symptoms without producing significant euphoria at therapeutic doses. Suboxone, the most commonly prescribed formulation, combines buprenorphine with naloxone to deter misuse. Buprenorphine can be prescribed in office-based settings, making it more accessible than methadone.
Clinical trials have consistently demonstrated that buprenorphine reduces opioid use, improves treatment retention, and decreases overdose risk. Many clients remain on buprenorphine for months or years as part of a long-term maintenance strategy, though some eventually taper off under medical supervision. The decision about treatment duration should be made collaboratively between the client and their physician.
Methadone
Methadone is a long-acting full opioid agonist that has been used to treat opioid addiction since the 1960s. It eliminates withdrawal symptoms, reduces cravings, and blocks the effects of other opioids when taken at appropriate doses. Methadone must be dispensed through federally regulated opioid treatment programs, which requires daily visits during the initial phase of treatment. While this can be logistically challenging, methadone remains highly effective for individuals with severe opioid use disorders.
Naltrexone (Vivitrol)
Naltrexone is an opioid antagonist that blocks opioid receptors entirely, preventing any opioid from producing euphoric effects. The extended-release injectable form, marketed as Vivitrol, is administered once monthly, eliminating daily adherence concerns. Unlike buprenorphine and methadone, naltrexone requires complete opioid detox before initiation, as administering it while opioids are still in the system can trigger severe precipitated withdrawal.
FDA-Approved Medications for Alcohol Use Disorder
Alcohol use disorder also has several FDA-approved pharmacological treatments that can significantly improve outcomes when combined with behavioral therapy. Despite their effectiveness, these medications remain vastly underutilized, with fewer than ten percent of individuals with alcohol use disorder receiving medication as part of their treatment.
Naltrexone, available in both oral and injectable forms, reduces the pleasurable effects of alcohol and decreases cravings. It works by blocking the opioid receptors involved in the reinforcing effects of alcohol consumption. Acamprosate helps restore the balance of neurotransmitter systems disrupted by chronic alcohol use, reducing the persistent discomfort and cravings that often drive relapse after detox. Disulfiram causes an unpleasant reaction when alcohol is consumed, serving as a deterrent for individuals who are motivated to maintain abstinence.
Naltrexone can be used for both opioid and alcohol use disorders, though it works through different mechanisms for each. For alcohol, it reduces the reward pathway activation, while for opioids, it blocks receptor binding entirely.
How MAT Integrates with Behavioral Therapy
Medication alone is not sufficient to treat addiction, just as therapy alone may be insufficient for individuals with significant physiological dependence. The power of medication-assisted treatment lies in the combination of both approaches. Medication reduces cravings and stabilizes brain chemistry, creating a physiological foundation that allows clients to engage more effectively in the psychological and behavioral work of recovery.
When a client is not consumed by cravings or withdrawal symptoms, they can participate more fully in individual therapy, group counseling, and skill-building activities. They can focus on identifying triggers, processing trauma, developing coping strategies, and building a meaningful life in recovery. The medication supports the therapy, and the therapy provides the tools for long-term change that medication alone cannot deliver.
At Trust SoCal, MAT is seamlessly integrated into our treatment programming. Clients on MAT participate in the same evidence-based therapies as all other clients, with additional psychoeducation about their medication, its effects, and long-term management. Our medical team works closely with therapists to ensure that medication adjustments align with therapeutic progress.
Addressing Stigma Around Medication-Assisted Treatment
One of the greatest barriers to MAT adoption is stigma, both from the general public and, unfortunately, from some sectors of the recovery community itself. The notion that a person is not truly sober if they take medication for their addiction is both scientifically inaccurate and clinically harmful. Addiction is a chronic brain disease, and using medication to manage it is no different from using insulin for diabetes or antihypertensives for high blood pressure.
Some 12-step communities and treatment programs have historically discouraged MAT, but this stance is increasingly recognized as outdated and dangerous. Refusing medication for ideological reasons puts individuals at higher risk of relapse and overdose death. Progressive recovery communities and evidence-based treatment centers in Southern California actively support MAT as a valid and life-saving component of recovery.
If you or someone you love is considering MAT, it is important to seek out providers and communities that embrace this evidence-based approach rather than stigmatize it. Recovery comes in many forms, and the pathway that keeps you alive and engaged in treatment is always the right one.
Medication-assisted treatment is not a crutch. It is a clinically proven intervention that saves lives and gives people the stability they need to do the hard work of recovery.
— Dr. Michael Navarro, Medical Director, Trust SoCal
Duration of MAT: How Long Should You Stay on Medication?
The optimal duration of medication-assisted treatment varies by individual and should be determined through ongoing collaboration between the client and their medical provider. Current clinical guidelines recommend a minimum of one year on medication for opioid use disorder, with many experts advocating for even longer maintenance periods. Discontinuing medication prematurely is associated with significantly higher relapse rates.
Some individuals benefit from long-term or indefinite medication maintenance, similar to how someone with chronic depression might take an antidepressant for years. Others eventually taper off medication under medical supervision after establishing stable recovery with strong support systems in place. The decision to continue, adjust, or discontinue MAT should never be rushed and should always involve your treatment team.
Accessing MAT in Orange County
Orange County offers numerous options for medication-assisted treatment, from specialized opioid treatment programs to office-based buprenorphine prescribers and comprehensive treatment centers like Trust SoCal. If you are seeking MAT services, look for providers who integrate medication with behavioral therapy, maintain proper DEA waivers and licensure, and develop individualized treatment plans.
Trust SoCal provides MAT as part of our full continuum of care, from medical detox through residential treatment and outpatient programming. Our board-certified addiction medicine physician evaluates every client for medication appropriateness and monitors progress throughout treatment. We believe that every evidence-based tool should be available to every client who can benefit from it.
Rachel Handa, Clinical Director
Clinical Director & Therapist
