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Medication-assisted treatment (MAT): definition, benefits, uses, and effectivity

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Medication-assisted treatment (MAT): definition, benefits, uses, and effectivity

Medication-assisted treatment (MAT) refers to the comprehensive approach to treating substance use disorders by using medications along with psychotherapeutic behavioral therapies and counseling. It is particularly used for treating addiction to opioids, alcohol, and nicotine. MAT effectively uses U.S. Food and Drug Association-approved medications. This combination has been more effective than medication alone, helping individuals develop strategies to manage symptoms and maintain recovery. Overall, MAT is a valuable treatment modality that provides individuals struggling with substance use disorders with the necessary tools to achieve long-term recovery.

Benefits of MAT include reduced risk of overdose, facilitates safer withdrawal, better outcomes for pregnant women, reduction in cravings, increased retention in treatment, improved quality of life, clinical effectiveness, address comorbidities, and protection against job discrimination.

Uses of MAT encompass treatment of opioid, alcohol, and nicotine addiction. MAT has been shown to be effective in reducing overdose, misuse, and relapse, and improving outcomes for patients with addiction.

The effectiveness of MAT in treating substance use disorders (SUD) has been well-documented, with numerous studies demonstrating its ability to improve treatment outcomes by reducing the risk of relapse, promoting safer withdrawals, and enhancing the overall quality of life for patients seeking recovery.

What is medication-assisted treatment (MAT)?

Medication-assisted treatment (MAT) is an evidence-based treatment that treats substance use disorders (SUD) with medications, counseling, and behavioral therapies.MAT is commonly used to treat addiction to opioids, alcohol, and nicotine. MATs are available at doctor’s offices, drug rehab centers, or healthcare facilities.

The medications used in MAT are U.S. Food and Drug Administration (FDA) approved. These include methadone, buprenorphine, commonly known as suboxone, and naltrexone for opioids. According to the article “Medication-Assisted Treatment (“MAT”) For Opioid Use Disorder” authored by Jennifer J. Carroll, published by the National Association of Counties, updated in June 2023, MAT requires continuous, long-term treatment with one of these three medications for the treatment of opioid use disorder (OUD).

The article “MEDICATION-ASSISTED TREATMENT IN THE COURTROOM A BENCHCARD FOR JUDICIAL PROFESSIONALS SERVING PARENTS AND CHILDREN AFFECTED BY OPIOID USE DISORDERS” published by the National Center on Substance Abuse and Child Welfare in 2021, advocates for MAT as a leading approach for treating OUD in pregnant women. MAT helps to normalize brain chemistry among opioid users by blocking the effects of opioids and reducing cravings.

The article “Nicotine and Opioids: a Call for Co-treatment as the Standard of Care” authored by Chad D. Morris and Christine E. Garver-Apgar, and published by the Journal of Behavioral Health Services and Research in 2020, emphasizes the importance of MAT in treating SUD’s. The article advocates for integrating behavioral interventions with medications, emphasizing MAT’s effectiveness for smoking cessation and opioid maintenance, underscoring the importance of FDA-approved medications in treatment plans for tobacco and opioid dependence to improve outcomes.

How does medication-assisted treatment (MAT) work for addiction treatment?

A Lady doctor giving pills bottle to a woman.

Medication-assisted treatment (MAT) works for addiction treatment by addressing two major challenges i.e., reducing cravings and controlling withdrawals. Cravings for opioids, alcohol, and nicotine pose a significant challenge for individuals seeking to reduce or quit the consumption. The withdrawal symptoms lead to fear and avoidance, which hinders the efforts to abstinence.

MAT does not involve replacing one drug with another. Unlike the extreme mood swings caused by fluctuating levels of short-acting opioids, MAT medications alleviate withdrawal symptoms and cravings, restoring a biochemical balance in the body. This approach helps individuals achieve physical and psychological stability, enabling them to lead normal lives.

The research report “Medications to Treat Opioid Use Disorder Research Report: How do medications to treat opioid use disorder work?” published by the National Institute on Drug Abuse in 2021 explains that medications for opioid use disorder (OUD) work by reducing withdrawal symptoms and cravings without causing euphoria. Methadone, a synthetic opioid agonist, and buprenorphine, a partial opioid agonist, target the same receptors as opioids but in a slower, non-euphoric way. Naltrexone, an opioid antagonist, blocks the effects of opioids. Each medication has its unique benefits and works differently with individual patients considering the patient’s unique history and circumstances.

What are the benefits of medication-assisted treatment (MAT)?

A doctor with his patient.

The benefits of medication-assisted treatment (MAT) are listed below.

  1. Reduced risk of overdose: MAT medications prevent overdose by blocking the effects of opioids if someone relapses and uses again. The research article “Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk?” authored by Vivian Y.O. Au et al., published in the Harm Reduction Journal in 2021, highlights the life-saving potential of MAT in reducing opioid overdose risk. Research demonstrates significantly lower mortality rates among individuals receiving MAT compared to those not in treatment. This outcome is attributed to how MAT medications like methadone and buprenorphine interact with opioid receptors, reducing withdrawal symptoms and cravings. As a result, the likelihood of turning to dangerous illicit opioids is decreased, enhancing overall safety during recovery.
  2. Facilitates safer withdrawal: MAT plays a significant role in facilitating safer withdrawal from substances. When individuals with substance use disorder (SUD) attempt to withdraw, they experience severe withdrawal symptoms, which are extremely challenging to manage. For opioid use disorder (OUD), MAT uses medications like naltrexone, methadone, or buprenorphine which helps ease these symptoms, making the withdrawal process more manageable and comfortable.
  3. Better outcomes for pregnant women: MAT helps pregnant women with SUDs to have better outcomes, lowering the risk of complications for both the mother and the baby. The Centers for Disease Control and Prevention in their article “Treatment for Opioid Use Disorder Before, During, and After Pregnancy” last reviewed in November 15, 2022, offers a comprehensive guide to treating OUD before, during, and after pregnancy. It recommends starting MAT like methadone or buprenorphine before pregnancy for a healthy gestation. During pregnancy, it is advised to continue the medication, alongside therapy and medical care. After delivery, MAT typically continues as prescribed. Discontinuing MAT requires careful planning. MAT is continued for as long as necessary, potentially for a lifetime.
  4. Reduction in cravings: Cravings are a major trigger for relapse. MAT medications help curb psychological and physical cravings for a substance. Behavioral therapies complement MAT by addressing underlying issues and developing healthy coping mechanisms.
  5. Increased retention in treatment: By making the initial stages of recovery more manageable, MAT increases the likelihood of people staying in treatment long enough to benefit from counseling and behavioral therapies. When withdrawal symptoms and cravings are reduced or eliminated, individuals are more likely to stay engaged in treatment. This increased retention allows them to benefit more from counseling and behavioral therapies, which are essential components of addiction treatment. By staying in treatment longer, individuals have a better chance of achieving and maintaining recovery.
  6. Improved quality of life: MAT helps individuals regain control of their lives by reducing dependence on substances and managing withdrawal symptoms. This leads to improvements in a patient’s physical and mental health, relationships, and overall well-being.
  7. Clinical effectiveness: The chapter “The Effectiveness of Medication-Based Treatment for Opioid Use Disorder” in the book Medications for Opioid Use Disorder Save Lives published by the National Academies of Sciences, Engineering, and Medicine in 2019 asserts that all medications reduce cravings and break the connection between opioid use and triggers. It emphasizes that these medications are effective and staying on medication for OUD long-term is linked to better outcomes.
  8. Address comorbidities: MAT helps manage comorbid symptoms from underlying mental health issues, enhancing the effectiveness of behavioral interventions. These techniques lead to long-term functional improvements in areas like psychiatric, legal, interpersonal, and occupational functioning. The study “The Association of Psychiatric Comorbidity with Treatment Completion among Clients Admitted to Substance Use Treatment Programs in a U.S. National Sample” by Noa Krawczyk et al., published in the journal Drug and Alcohol Dependence in 2017, confirms that MAT is effective for individuals with and without psychiatric comorbidity.
  9. Protection against job discrimination: The book “Know Your Rights: Rights for Individuals on Medication-Assisted Treatment” published by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration states that federal law protects individuals in MAT from job discrimination. These laws, like the Americans with Disabilities Act (ADA) and the Rehabilitation Act, stop most employers from firing or refusing to hire someone because of a disability. Courts agree that people in MAT are protected by these laws.

What are the cons of medication-assisted treatment (MAT) for addiction?

The cons of medication-assisted treatment (MAT) for addiction are listed below.

  • Addictive nature of medicine: MAT medications themselves are addictive, they are typically considered safer than illicit opioids. The article“Medications, Counseling, and Related Conditions”published by Substance Abuse and Mental Health Services Administration (SAMHSA), last updated in March, 2024, discusses the risk of misuse associated with MAT, noting that certain medications used in this approach are classified as controlled substances because of their potential for misuse. The Drug Enforcement Administration (DEA) has classified drugs into five distinct categories or schedules based on their acceptable medical use and potential for abuse or dependency. For example, buprenorphine is classified under Schedule III. The chapter in the book “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings,” published by the World Health Organization in 2009, mentions that methadone has addictive properties. In MAT for opioid use disorders (OUD), methadone is carefully administered to reduce addiction risk. If methadone is used improperly or in excessive doses beyond prescribed guidelines, patients develop dependency, leading to withdrawal symptoms upon cessation.
  • Side effects: The article “Medication-Assisted Treatment for Opioid Dependence” published by Drug and Alcohol Services South Australia in November 2021, underscores the potential side effects of MAT drugs like buprenorphine and methadone. These side effects include sedation, lethargy, dry mouth, sleep disturbances, constipation, eyesight problems, headaches, nausea and vomiting, weight gain, fluid retention, excessive sweating, and decreased libido. Additionally, the article mentions that naltrexone causes side effects like nausea, sleep disturbances, headaches, anxiety, loss of energy, and muscle aches.
  • Challenges in supervision: MAT typically requires close medical supervision to ensure proper use and dosage. This is inconvenient or inaccessible for patients, especially in areas with limited treatment availability.
  • Risk of shifting dependence: This refers to the concern that individuals receiving MAT become dependent on the prescribed medication used in treatment, potentially leading to a new form of addiction. While the medications used in MAT are specifically chosen for their ability to reduce withdrawal symptoms and cravings without producing the euphoric effects of the original drug of abuse, there is still a risk of physical dependence. Proper medical supervision and adherence to the prescribed treatment plan helps mitigate this risk.

What are the uses of medication-assisted treatment (MAT)?

A doctors proving pills to a woman patient.

The uses of medication-assisted treatment (MAT) are listed below.

  • Treatment of opioid addiction: Methadone and buprenorphine are considered highly effective in MAT for opioid addiction, as noted in the article Medication-Assisted Treatment (MAT) for Opiate Dependence—It’s Not “Giving Drugs to Drug Addicts” published by the American Nurses Association, these medications are long-acting and, when taken as directed, do not produce a euphoric high. They interact with the body’s natural opiate receptors like other opioids and are less addictive. These medications effectively reduce narcotic cravings, prevent withdrawal symptoms, and block the euphoric effects of narcotic drugs. Other approved medication for opioid use disorders (OUD) include naltrexone. Naltrexone binds strongly to opiate receptors, reversing the effects of opiates and reducing drug use by preventing a high if opiates are consumed. The research article “Review of medication-assisted treatment for opioid use disorder” by Nessreen Ghanem et al., published in the Journal of Osteopathic Medicine, discusses the superior efficacy of MAT treatment compared to abstinence-based approaches. Increasing MAT implementation is important as it helps in combating opioid addiction, which brings devastating consequences like overdoses, prenatal misuse, neonatal abstinence syndrome, and increased infectious diseases from injection drug use. According to the article, naltrexone, like buprenorphine, is prescribed as an outpatient treatment for opioid addiction. In contrast to buprenorphine, naltrexone is prescribed as an outpatient medication for the treatment of alcohol use disorders (AUD) as well.
  • Treatment of alcohol addiction: MAT for alcohol addiction involves the use of various medicines, including acamprosate, disulfiram, and naltrexone. Medications used to treat alcohol addiction aim to restore the balance of brain chemicals affected by long-term drinking. The article “Safety and Efficacy of Acamprosate for the Treatment of Alcohol Dependence” by Stephanie L. Yahn et al., published in Substance Abuse: Research and Treatment journal in 2013, discusses how acamprosate helps in alcoholic addiction by normalizing brain chemical imbalances caused by chronic alcohol use, reducing the urge to drink. It aids in rebalancing certain brain chemicals disrupted by chronic alcohol use by altering glutamate’s function, a neurotransmitter crucial for brain signaling, and enhancing the release of taurine, another neurotransmitter that promotes brain calming. This rebalancing helps reduce the craving for alcohol. Acamprosate is typically safe and well-tolerated, with diarrhea being its most common side effect. The 2013 study “Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?” by Natalya C. Maisel et al., published in the journal Addiction in 2013, concludes that medications are effective in treating alcohol addiction. Acamprosate was found to be more effective in promoting abstinence, while naltrexone was more successful in reducing heavy drinking and cravings. MAT not only provides immediate relief from alcohol cravings but also provides long-term benefits. It helps develop healthier habits, enhances overall well-being, and supports sustained recovery. These lasting improvements significantly enhance quality of life and aid in maintaining abstinence from alcohol. Another study by Allison G. Robertson et al., titled “Medication-assisted treatment for alcohol-dependent adults with serious mental illness and criminal justice involvement: effects on treatment utilization and outcomes” published in The American Journal of Psychiatry in 2018, discovered that that 20–50% of adults with serious mental illnesses like schizophrenia and bipolar disorder have AUD. Alcohol misuse worsens psychiatric symptoms, reduces treatment adherence, and complicates medical conditions. Alcoholic addiction is strongly linked to involvement in the criminal justice system. The study discovered that a significant percentage of patients benefited from acamprosate and naltrexone for alcohol dependence treatment, with acamprosate being more prevalent throughout the treatment period.
  • Treatment of nicotine addiction: According to the article “Current Cigarette Smoking Among Adults in the United States”, last reviewed on May 4, 2023, published byCenters for Disease Control and Prevention, cigarette smoking continues to be the primary cause of preventable disease, disability, and death in the United States. It is responsible for more than 480,000 deaths annually. MAT has been shown to be an effective approach for stopping the use of substances like nicotine. MAT helps initiate the recovery process by addressing the physical and psychological aspects of nicotine addiction such as reducing cravings and withdrawal symptoms. The FDA-approved medications for nicotine addiction are nicotine replacement therapy (NRT), bupropion, and varenicline. These medications help reduce cravings and promote a smoother withdrawal process. Combining medications for smoking cessation enhances the effectiveness of treatment.

What are the medications used in medication-assisted treatment (MAT) for addiction?

The medications used in medication-assisted treatment (MAT) for addiction are listed below.

  • Methadone: Methadone is a medication that has been licensed by the United States Food and Drug Administration (FDA) to treat opioid use disorder (OUD) and to control pain, according to an article titled, “Methadone” published by the Substance Abuse and Mental Health Services Administration (SAMHSA), last updated in March 2024. Methadone, classified as a schedule II drug, is a long-acting full opioid agonist. Only SAMHSA-certified Opioid Treatment Programs (OTPs) are legally allowed to provide methadone for treating OUD. The article “Opioid Use Disorder” by Alexander M. Dydyk et al., published by StatPearls, last updated in January 2024, discusses the advantages of methadone treatment. Methadone reduces euphoric effects, diminishes narcotic cravings, and lowers the risk of infectious diseases by discouraging intravenous drug use. The article notes methadone maintenance to be safe and non-sedating when used alone, without other prescription or illicit drugs.
  • Naltrexone: Naltrexone is a medication that blocks the effects of opioids by making it ineffective in producing euphoria or pain relief. According to the chapter “The Effectiveness of Medication-Based Treatment for Opioid Use Disorder” from the book Medications for Opioid Use Disorder Save Lives published by the National Academies of Sciences, Engineering, and Medicine in 2019, opioids rarely overcome naltrexone’s effects to produce feelings of reward. Patients on extended-release naltrexone typically learn to avoid the opioids that triggered their addictive behaviors, leading to reduced cravings over time. MAT with naltrexone involves medical supervision to manage withdrawals, followed by at least 4 to 7 days without opioids. Naltrexone is available in a once-daily pill or a once-monthly injection. It’s best for patients who need to avoid all opioids, have been off opioids for at least 2 weeks but are at risk of relapse, or use opioids infrequently.
  • Buprenorphine: Buprenorphine is commonly used in MAT for opioid addiction. It is a partial opioid agonist, which activates the same receptors in the brain that opioids do, though to a lesser extent. Buprenorphine is available in several forms, including sublingual tablets, buccal films, transdermal patches, and injectable solutions. The research article “A Comparison of Medication-Assisted Treatment Options for Opioid Addiction A Review of the Literature” authored by Spayde-Baker et al., and published in the Journal of Addictions Nursing in 2023, highlights buprenorphine’s effectiveness in reducing cravings, withdrawal symptoms, and stress reactivity, as well as its ability to block and reduce the effects of opioids.
  • Acamprosate: Acamprosate, a medication used in alcohol use disorder (AUD) treatment, helps individuals abstain from alcohol by reducing the desire to drink. The article Acamprosate: A Prototypic Neuromodulator in the Treatment of alcohol dependence” authored by Barbara J. Mason and Charles J. Heyser, published in the journal CNS and Neurological Disorders Drug Targets in 2010, highlights that acamprosate, when paired with psychosocial support, has been proven in numerous trials to extend periods of abstinence and decrease relapse rates in recently abstinent alcohol-dependent individuals. The article additionally highlights that acamprosate works as a neuromodulator, normalizing dysregulated glutamatergic neurotransmission, which helps reduce relapse triggers.
  • Disulfiram: Disulfiram is ideal for managing long-term alcoholism and works best for individuals who have ceased alcohol consumption or are in the early stages of abstinence. In the article “Medications, Counseling, and Related Conditions”, published by Substance Abuse and Mental Health Services Administration (SAMHSA), last updated in March 2024, it is advised that disulfiram, when administered as a daily tablet, is not to be taken while intoxicated and avoided for at least 12 hours after consuming alcohol. The 2018 article “State-of-the-Art Behavioral and Pharmacological Treatments for Alcohol Use Disorder” by Lara A. Ray et al. in the American Journal of Drug and Alcohol Abuse, review disulfiram, as the first approved medication for AUD in 1951. Disulfiram inhibits aldehyde dehydrogenase, causing an aversive reaction to alcohol intake. Despite its effectiveness, disulfiram’s clinical use is limited due to poor adherence and the risk of severe medical complications when combined with alcohol. Mild side effects of disulfiram are noted which include skin eruptions, allergic dermatitis, mild drowsiness, fatigue, headache, impotence, and garlic like after taste, as highlighted in Chapter 3 of the Treatment Improvement Protocol (TIP) Series, No. 49, titled “Disulfiram” published by Substance Abuse and Mental Health Services Administration (SAMHSA) in 2009.
  • Nicotine Replacement Therapy (NRT): Nicotine replacement therapy (NRT) helps smokers quit by providing controlled doses of nicotine, reducing withdrawal symptoms and cravings. NRT offers a safer way to manage nicotine dependence and improve smoking cessation outcomes under healthcare guidance. NRTs stimulate brain receptors affected by nicotine, reducing withdrawal symptoms and cravings. The article “Nicotine Replacement Therapy: An Overview” authored by Umesh Wadgave and L Nagesh, published in the International Journal of Health Sciences in 2016, outlines various forms of NRT, including gum, transdermal patch, nasal spray, oral inhaler, and tablets. The transdermal patch delivers nicotine slowly, while other forms provide immediate relief for craving through rapid nicotine release. Combining NRT with behavioral therapies enhances success rates. The article “Tobacco, Nicotine, and E-Cigarettes Research Report” published by the National Institute on Drug Abuse in 2021 indicates that NRT increases the likelihood of quitting tobacco by 50 to 70 percent. The research further mentions that using the patch for up to 24 weeks is deemed safe.
  • Bupropion: Bupropion, an antidepressant medicine, is now also used to help people quit smoking. The article “Bupropion” authored by Martin R. Huecker et al., published by StatPearls, last updated in April 2023, mentions that bupropion, which has been FDA-approved since 1985, is typically taken orally in the form of a hydrochloride salt. Bupropion is available as tablets, which come in regular or extended-release versions, and oral ingestion is the only method of administration. In their research study “How does bupropion work as a smoking cessation aid?” published in the journal Addiction Biology in 2005, authors Charlotte Warner and Mohammed Shoaib discuss the potential mechanisms through which bupropion aids in smoking cessation. They suggest that bupropion works by mildly affecting dopamine and norepinephrine levels in the brain, similar to nicotine. Additionally, it blocks certain nicotine receptors, reducing the temptation of cigarette smoking. Another possible mechanism is through its breakdown products, which play a role in aiding smoking cessation. Bupropion has been shown to enhance quitting rates of nicotine compared to a placebo in both short and long-term studies, and it is approved for smoking cessation, with similar effectiveness to NRT.
  • Varenicline: Varenicline reduces nicotine cravings and improves quit rates compared to unassisted quitting. A study by Jon O. Ebbert et al., titled Effect of Varenicline on Smoking Cessation Through Smoking Reduction: A Randomized Clinical Trial” published in the Journal of the American Medical Association in 2015 demonstrates that varenicline is effective and safe for smokers who prefer to reduce their smoking before quitting entirely, leading to more successful quitting.

Is medication-assisted treatment (MAT) effective for treating addiction?

A doctor giving pills to a male patient.

Yes, medication-assisted treatment (MAT) is effective for treating addiction. Major organizations like National Institute on Drug Abuse (NIDA) and American Society of Addiction Medicine (ASAM) endorse MAT as an evidence-based approach. MAT medications help manage withdrawal symptoms and cravings, improving treatment retention. They reduce the risk of overdose by blocking opioid effects. MAT supports long-term recovery by aiding in craving management and relapse prevention. However, MAT is most effective when combined with behavioral therapy, counseling, and support groups.

In the research report titled “Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado” authored by Claudia R. Amura et al., published in the Substance Abuse Treatment, Prevention, and Policy Journal in 2022, findings indicate notable improvements after six months of MAT. This included reduced substance use, enhanced physical and mental well-being, and alleviated symptoms.

The research report titled “Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment” prepared for the American Society of Addiction Medicine by Suzanne Gelber Rinaldo, and David W. Rinaldo in 2013, indicates that methadone, buprenorphine, and naltrexone are effective in reducing opioid use and symptoms of opioid use disorder (OUD). These medications lower the risk of infectious diseases and criminal behavior linked to drug use.

The research study “Medication-assisted treatment for alcohol-dependent adults with serious mental illness and criminal justice involvement: effects on treatment utilization and outcomes” authored by Allison G. Robertson et al., published in the The American Journal of Psychiatry in 2018, illustrates the positive impact of MAT on adults with serious mental illnesses and alcohol dependence. It shows a reduction in psychiatric hospitalizations and emergency visits, along with enhanced medication adherence.