Alcohol & Health
Treatment
Helping Alcoholics
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Medically Reviewed by Annamarie Coy, BA, ICPR, MATS
Medication-assisted treatment (MAT) uses medications, counseling, and behavioral therapies to treat substance use disorders (SUDs). It treats opioid addiction and alcohol use disorder.
MAT is commonly combined with counseling and addiction treatment. They create a “whole patient” approach to manage SUDs and sustain recovery. It can also treat mental health issues related to substance abuse.
Medication-assisted treatment can be used to:
Treatment programs are designed to meet each person's needs.
There are different medications used in MAT.
These include:
Naltrexone blocks the effects of opioid drugs. People who relapse while taking naltrexone don’t feel the usual high when using opioids. It also blocks the effects of alcohol.
Acamprosate helps people with alcohol dependence by reducing substance withdrawal symptoms. It can prevent relapse by regulating neurotransmitter malfunction caused by alcohol.
Antipsychotics are most effective for treating psychosis rooted in mental illness. However, they're still useful for managing alcohol and drug use linked to mental illness.
Anticonvulsant medications aren’t FDA-approved for treating alcohol use disorder. However, doctors can prescribe them for co-occurring psychiatric illnesses. These include topiramate, levetiracetam, and gabapentin.
Beta-blockers treat and prevent heart issues and migraines. Some doctors prescribe them for drug and alcohol rehabilitation with co-occurring disorders.
Clonidine blocks brain chemicals triggering involuntary responses to stressful situations. It can also reduce withdrawal symptoms, but it has a risk of dependence.
It's only used as a supplementary drug in supervised treatment programs for alcohol or opioid addiction.
Naloxone is used to treat opioid overdoses, but it can also treat alcohol use disorder.
Naloxone can counter the effects of an opioid overdose. However, the person needs to receive it early enough during the overdose. It can also put them into withdrawal.
Methadone is one of the most popular drugs used in MAT. It's a full opioid agonist, tricking the brain into thinking it's the "real thing." This reduces cravings and withdrawal symptoms.
Methadone doesn't produce the high that leads to addiction when it's used under supervision. It's the only drug approved for pregnant or breastfeeding women using MAT.
Buprenorphine is a partial opioid agonist. It produces less intense effects than heroin or methadone.
People are unlikely to abuse buprenorphine because of its “ceiling effect.” When a person reaches a certain dose, the effects plateau so the person doesn't require higher doses.
Disulfiram deters the consumption of alcohol by disrupting the body’s usual way of processing the substance. Drinking alcohol while using this drug triggers headaches, nausea, and vomiting.
MAT was first used for treating tobacco use disorder. Today, it primarily treats opioid use disorder and alcohol use disorder. MAT for stimulant use disorder is still in development.
The most commonly prescribed medications for MAT are methadone, buprenorphine, and naloxone. They're classified as opioids, but don't trigger euphoria when used properly.
Common brand names are Suboxone, Subutex, and Zubsolv, which are examples of buprenorphine and naloxone. Another is Vivitrol, an injectable form of naltrexone. It lasts for 30 days.
MAT drugs for alcohol use disorder include disulfiram, acamprosate, and naltrexone. These medications do not cure alcohol use disorder but are most effective in people who participate in a MAT program.
Disulfiram has been used for decades. It makes the body unable to metabolize alcohol. If a person taking Disulfiram drinks alcohol, they'll likely vomit.
Naltrexone and acamprosate reduce cravings for alcohol. This, combined with therapy produces longer-lasting recovery.
Many with alcohol use disorders also suffer from mental health issues. This is known as a co-occurring disorder.
One major study found that one-third of participants with alcohol use disorder also had a co-occurring mood disorder.12
Having a co-occurring disorder requires an integrated treatment, which means treating both disorders at the same time. It's also called dual diagnosis treatment.
Acamprosate and naltrexone may be used for alcohol use disorder.11 A combination of antipsychotics and cognitive behavioral therapy may be used to treat mood disorders like bipolar disorder.11
Some people wonder if it’s possible to be sober with MAT. The answer is yes.
Medications used in MAT help patients avoid relapse and manage their addiction. It's similar to how we control blood pressure, diabetes, or any other chronic condition.
MAT medications are safe, controlled, and effective. Used properly, they don't trigger euphoria.
Built on the basis of complete sobriety, some aren’t sure if they can participate in 12-step programs when using MAT. Some AA and NA members even discourage it.
This is misleading and incorrect. There is no official stance in AA or NA literature for or against MAT.
However, if you feel unwelcomed by traditional 12-step programs, you have other group options, including SMART Recovery, Secular Organizations for Sobriety (SOS), or LifeRing.
The cost of Medication-Assisted Treatment varies depending on the drug and other factors.
For example:
The Mental Health Parity and Addiction Equity Act of 2008 requires insurance providers to offer the same level of benefits for mental illness and substance abuse as for medical and surgical care.
Insurance providers will more likely cover MAT if it's used for co-occurring mental health conditions.
Medicaid programs and what they cover vary from state to state. For example, most state Medicaid plans cover Methadone treatment. Arkansas, Idaho, Kansas, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, and Wyoming do not.
Most states cover suboxone treatment, but there are specific rules surrounding amounts and how it's given.
The best way to determine what financial support is available is to contact a specific state’s Medicaid office.
MAT is effective for helping people overcome substance abuse disorders.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT is “clinically effective” and greatly reduces the need for inpatient substance abuse treatment.
The use of medication-assisted treatment for drug and alcohol use disorders:
Long-term benefits of MAT include:
Some professionals believe MAT is underused due to concerns about substituting one drug for another. Patients are also reluctant about using drugs in their recovery.
More training and education are needed to change opinions in the addiction community.
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