Medication-Assisted Treatment (MAT)

Medication-assisted treatment, or MAT, treats substance use disorders by combining FDA-approved medications with counseling and behavioral therapies. You may also hear the term medications for opioid use disorder (MOUD). Medication is one part of the plan; therapy and support are the other.

Substance use can change how the brain works, which is part of why withdrawal and cravings can feel so powerful. The medications used in MAT work in different ways. Some ease withdrawal and cravings, some block the effects of a substance, and some make drinking unpleasant.

Three medications are FDA-approved to treat alcohol use disorder: naltrexone, acamprosate and disulfiram. They are used to help people stop drinking or cut back and stay on track, alongside counseling.

Naltrexone blocks some of the rewarding effects of alcohol, which can reduce cravings and heavy drinking. It is available as a daily tablet and as a monthly injection.

Vivitrol is the brand name for extended-release injectable naltrexone. A medical provider gives it as an injection about once a month, so there is no daily pill to remember. It is usually started once a person has stopped drinking. Because naltrexone blocks opioids, a person must be free of all opioids for about 7 to 10 days before starting it, or it can bring on sudden withdrawal.

Acamprosate may help people who have already stopped drinking stay stopped. Disulfiram causes an unpleasant reaction if you drink, which some people use as a deterrent.

Three medications are FDA-approved to treat opioid use disorder: buprenorphine, methadone and naltrexone.

Buprenorphine eases withdrawal and cravings and lowers the risk of overdose. It is sometimes combined with naloxone in a single medication. Methadone for opioid use disorder can only be given through a specially certified opioid treatment program. Extended-release naltrexone blocks the effects of opioids and is started only after opioids have fully cleared the body.

MAT is mainly used for opioid and alcohol use disorders, where FDA-approved medications exist. There are currently no FDA-approved medications for stimulant use disorder, so treatment for stimulants relies on behavioral therapies.

Medication works best as part of a fuller plan. Counseling helps with the thoughts, situations and relationships that medication can't reach.

Stopping a medication suddenly can raise the risk of relapse, and after time without opioids, the risk of overdose. Changes to medication should be planned with a prescriber.