Should Medication-Assisted Treatment (MAT) Be Part of Your Recovery Plan?

Which Medications Treat Alcohol Use Disorder?

MAT medications are most effective² when people participate in a MAT program. While they’re not a remedy for alcohol misuse, they do temper withdrawal symptoms and help normalize brain and body functions.

Acamprosate

This medication is best for people already in recovery from alcohol use disorder.³ While acamprosate stops people from drinking, it won’t prevent withdrawal symptoms if they do drink alcohol. Acamprosate can be taken on the 5th day of sobriety, and it takes 5 to 8 days to be completely effective.

Pros:

• Acamprosate is not an addictive medication.
• There is almost no risk of overdose.
• Other medications won’t interact with acamprosate.

Cons:

• Patients may experience diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping when taking this medication. However, these are usually mild and often go away after a few weeks.
• In rare cases, acamprosate can cause suicidality.

Where can you find it? Patients must see a medical doctor to obtain a prescription.

Is acamprosate effective? While research suggests mixed results, most studies show that acamprosate decreases the likelihood of drinking⁴ and increases lengths of abstinence.

Disulfiram

Disulfiram causes an uncomfortable reaction to alcohol,³ which discourages patients from drinking. Because of this, only people who have stopped drinking alcohol should take this medication. It should also be avoided for 12 hours after alcohol use.

Pros:

• Because of the negative interactions with alcohol, patients are less likely to drink.

Cons:

• Disulfiram can cause dangerous side effects like nausea, chest pain, and difficulty breathing just 10 minutes after drinking—at severe levels, these can even be life-threatening. Because of this, it’s important that people avoid alcohol entirely while using disulfiram.
• People with impaired judgment or high impulsivity should not take disulfiram.

Where can you find it? Patients can take this prescription medication at home.

Is disulfiram effective? People are more likely to continue taking disulfiram for alcohol use disorder⁴ when doing so under supervision. This is because the unpleasant interaction with alcohol may deter people from taking this medication. Being aware of this consequence does stop some people from drinking.

Which Medications Treat Opioid Use Disorder?

MAT medications treat dependence on several different types of opioids,² including heroin, morphine, codeine, oxycodone, and hydrocodone. You can use these medications long-term if necessary—some patients even do so indefinitely.

Methadone

The goal of methadone treatment is to reduce opioid withdrawal symptoms and desire to use. Patients can work with their prescribing doctor to determine the right dosage and frequency. Methadone is usually most effective when used for at least 12 months.

Pros:

• Methadone is safe and effective if taken properly.⁵
• You can begin using methadone anytime during recovery—even before withdrawal symptoms begin.

Cons:

• Uncomfortable and dangerous side effects may occur. These include, but aren’t limited to: intense sweating, slow or difficulty breathing, restlessness, chest pain, and hallucinations.
• Accidental overdose is possible. This is because methadone’s potency and benefits never plateau and its active ingredients are long lasting.
• Other medications can interact with methadone and cause serious health risks, like heart problems.
• People’s reactions to methadone are variable, and it may have very different effects on different people.
• Patients need to go to a specialized clinic to take this medication.
• It can take time to find the ideal dosage for patients, which may lead to higher rates of relapse.
• Methadone can cause dependency.

Where can you find it? Patients need a prescription for methadone, and must begin taking it in the presence of a medical professional. However, after a period of progress, patients can use it at home.

Is methadone effective? According to experts, methadone is the current “gold standard” in MAT for opioids.⁶ However, this might just be because it’s been in use the longest (for the past 50 years). Regardless, research shows that methadone does work for many people. According to one study, methadone has a 60% success rate in helping people stay abstinent from opioids,⁶ along with the “greatest results in retention rates” as compared to buprenorphine and naltrexone.

Buprenorphine

This medication stops or minimizes the desire to use opioids.⁷ It does this by mimicking some of the effects of opioids. However, these effects are weaker than drugs like heroin, for example.

Patients must stop using opioids 12 to 24 hours before starting buprenorphine. It’s possible to lower dosage from every day to alternate days after seeing improvements. Studies show that patients who use buprenorphine for longer amounts of time⁸ at a higher dosage (at least 16mg) are less likely to relapse.

Pros:

• Buprenorphine is safe if taken as instructed, and less likely to cause an overdose than opioids like heroin or oxycodone.
• Unlike other opioid use disorder treatments, people can take this medication at home.

Cons:

• The opioid-like effects are not as strong as those of methadone. While this doesn’t necessarily make it less effective (and many studies show that methadone and buprenorphine work equally well),⁸ some people may prefer methadone for this reason.
• Buprenorphine comes with many different possible side effects, ranging from mild to serious. They can include dizziness, insomnia, fever, headache, nausea, vomiting, among many others.
• People can also become dependent on, or overdose from, buprenorphine.

Where can you find it? Patients can get a prescription for buprenorphine from a doctor, and take it in a clinic or the comfort of their own home.

Is buprenorphine effective? While experts consider buprenorphine the “second-best choice” in MAT after methadone, it’s still very effective for many people. For example, one study found that 60% of people remained abstinent from opioids when using buprenorphine⁶ as compared to no medication or a placebo.

Do Any Medications Treat Both Opioid and Alcohol Use Disorders?

One medication, naltrexone, treats both alcohol and opioid misuse.² This newer medication was originally just for opioid use disorder. However, after 2 different studies determined that it also reduced the number of drinking days and relapse rates, the FDA also approved it for alcohol use disorder.⁴

Naltrexone

People won’t feel the euphoric effects of alcohol or opioids with naltrexone,⁹ and it decreases their desire to engage in substance use. Because of this, people are less likely to drink or use opioids, and more likely to continue treatment. Patients taking naltrexone for opioid misuse need to wait 7 days after taking short-acting opioids and 10 to 14 days for long-acting opioids.

Pros:

• Naltrexone does not cause dependency.
• Patients don’t experience withdrawal symptoms when they stop taking this medication.

Cons:

• Naltrexone might elicit mild to severe side effects. Serious risks include liver damage, allergic reactions, pneumonia, and depression.
• People can accidentally overdose on naltrexone. Because it blocks opioid effects, people may take more to try and get the desired feeling. Naltrexone also lowers tolerance to opioids, meaning someone who’s relapsing can accidentally take too much.
• Starting naltrexone treatment may be more difficult since patients must complete medical detox beforehand. This is uncomfortable for most people, and may impact motivation and delay treatment.

Where can you find it? Healthcare providers prescribe naltrexone.

Is naltrexone effective? Naltrexone results vary. One study determined that naltrexone was the least successful overall⁶ as compared to methadone and buprenorphine. Another study concluded that naltrexone only had a “moderate effect” on decreasing alcohol use.⁴ However, another study found that it significantly reduced the number of days of alcohol usage and relapse rates.

Do Any Medications Prevent Opioid Overdose?

Naloxone is a medication that reverses opioid overdose.¹⁰ This medicine doesn’t work for non-opioid overdoses. The patient may require more than 1 dose of naloxone¹¹ if they used large quantities of opioids, or stronger opioids like fentanyl. While all naloxone devices are effective,¹² research suggests that FDA-approved units administer greater blood levels of naloxone.

Pros:

• Naloxone is usually safe, with little risk of side effects.
• Naloxone is not addictive.
• In many states, people close to someone at risk of an opioid overdose can learn to use naloxone with proper training.¹³ A pharmacist or medical professional can either explain procedures or tell you where to go for instruction.
• Insurance may cover naloxone, making it more cost-effective. Some programs even offer it for free.

Cons:

• Although rare, people may experience an allergic reaction from naloxone, such as hives or swelling of the face, lips, or throat.
• The effects of naloxone only last 30 to 90 minutes, but opioids often stay in the body for a longer time. Because of this, people might still experience overdose effects after that time period, so it’s important to seek medical help immediately after using naloxone.
• Naloxone can also cause opioid withdrawal symptoms, like headaches, vomiting, and rapid heart rate. However, these are not usually life threatening.

Where can you find it? Naloxone is widely available, and most pharmacies carry it. Many states don’t require a prescription. Community programs and local public health organizations may also have naloxone.

Is naloxone effective? Naloxone is highly effective.¹⁴ Research shows that naloxone successfully reverses overdose in 75 to 100% of cases, even when it’s not administered by medical professionals.

Are MAT Medications Safe?

For the most part, yes—as long as they are used as directed. But unfortunately, it is possible to misuse them. People can take too much, or not enough, for them to be effective.

And, medications like methadone and buprenorphine can be habit-forming. Some people even take MAT medications for opioid dependency for their entire lives. This begs the question: is MAT just substituting one drug with another?

Does MAT Just Replace One Addiction With Another?

Unfortunately, the answer to this question is complicated. Addiction experts have widely different opinions on the matter. Alex Azar, the U.S. Health and Human Services Secretary from 2018 to 2021, was very much in favor of MAT.¹⁵ According to Azar, “Medication-assisted treatment works. The evidence on this is voluminous and ever-growing.” He added that failing to offer MAT to patients is “like treating an infection without antibiotics.”

However, Tom Price, U.S. Health and Human Services Secretary in 2017, argued the opposite. According to Price, “If we’re just substituting one opioid for another, we’re not moving the dial much.”

Regardless of this dispute, many medical professionals believe that MAT is an essential part of the recovery process. Your answer will depend on your own personal beliefs and experiences—and what advice makes the most sense for you.

Is Medication-Assisted Treatment For You?

A good starting point for determining your course of action is to get an assessment. You can do this through your primary care physician or via a treatment center. Together, you can evaluate your options, weigh the pros and cons each, and decide what’s best for your situation.

Find out more about rehab facilities that offer MAT, including insurance coverage, reviews, contact information, and more.

Reviewed by Rajnandini Rathod

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