Medication-Assisted Treatment for Alcohol & Opioid Use Disorder

Experts recommend medication-assisted treatment (MAT) for severe alcohol or opioid addiction to help prevent relapse and increase the chance of long-term recovery.

When someone uses drugs or alcohol over the long term, their body can become dependent on the substance to feel normal. When they try to cut back or quit the substance, they often have uncomfortable withdrawal symptoms that may lead to relapse. 

Medication-assisted treatment (MAT) helps prevent withdrawal symptoms that can hamper addiction recovery. MAT can also dissuade a person from taking a substance by blocking the euphoric high or causing unpleasant side effects when the person uses the substance. 

MAT has the potential to reduce relapse and the number of overdose deaths from alcohol or opioids. For this reason, MAT is the gold standard therapy for severe opioid addiction, and experts recommend it for alcohol addiction treatment.

What Is Medication-Assisted Treatment (MAT)?

Medication-assisted treatment (MAT) is a treatment strategy for alcohol and opioid addiction. In MAT, a person takes medications to either block cravings or act as an opioid or alcohol substitute. Relapses in recovery are common, especially in those who do not attend at least 90 days of rehab. By helping fight cravings that often cause relapse, MAT helps people with substance use disorders maintain long-term recovery.

MAT is not prescribed on its own. Instead, MAT is one part of a comprehensive rehab program. A rehab treatment plan often includes multiple components, such as:

• Medical detox: the person rids their body of the substance while receiving medical supervision and support.
• Rehab: the person attends therapy to learn coping mechanisms to prevent psychological cravings after treatment 
• MAT: helps a person with alcohol or opioid addiction prevent cravings or discourage substance use.

Medications for Alcohol Abuse

Drinking alcohol has many effects on the chemical balance of the brain and body. Drinking triggers the release of dopamine, a feel-good chemical involved in the brain’s reward pathway. Alcohol also causes the release of gamma-aminobutyric acid (GABA), which slows down the brain, causing sedation and relaxation. 

The FDA has approved three drugs to treat the chemical imbalance from chronic, severe alcohol use: naltrexone, disulfiram, and acamprosate. 

Naltrexone 

Although naltrexone (ReVia, Vivitrol) is an opioid-receptor antagonist, it is often prescribed to treat alcohol abuse. It is most effective in those who have stopped drinking completely at the start of treatment.

Naltrexone reduces alcohol’s pleasurable effects on the brain by preventing the unregulated release of dopamine. This prevents a person from getting euphoric feelings from drinking, helping them become less psychologically dependent on alcohol. Naltrexone is available both as an oral tablet and as a long-acting injectable.

Disulfiram

Disulfiram (Antabuse) is an oral tablet that not only blocks euphoria from alcohol consumption but also makes people feel sick when they drink alcohol. It can be useful for those who want extra motivation to stay abstinent.

When you drink, alcohol is converted into acetaldehyde and then into acetic acid. Disulfiram works by blocking the enzyme acetaldehyde dehydrogenase, which changes acetaldehyde into acetic acid. Keeping alcohol in the acetaldehyde phase can make you feel ill, leading to common symptoms that can last for hours, like:

• Dehydration
• Sweating
• Severe headaches
• Vomiting
• Chest pain
• Weakness
• Dizziness
• Reduced vision

You should not take disulfiram if you have had alcohol within the past 12 hours. Mixing the two can cause serious side effects, including death in some cases.

Acamprosate

Acamprosate (Campral) helps maintain sobriety by reducing the amount of glutamate in the brain. Glutamate’s actions are the opposite of GABA’s: it makes the brain excitable when someone stops drinking. By reducing glutamate in the brain, acamprosate helps a person avoid alcohol.

Side effects of acamprosate include:

• Anxiety
• Depression
• Diarrhea
• Dizziness
• Trouble sleeping
• Appetite loss
• Nausea
• Sweating
• Weakness

Medications for Opioid Abuse

Opioids work on the brain’s mu-opioid receptors to release neurotransmitters like dopamine. This causes euphoria and triggers the brain’s reward pathway. MAT medications for opioid addiction are often long-acting opioids that prevent cravings while blocking an opioid high. 

The FDA has approved several medications to treat opioid addiction and ease opioid withdrawal symptoms. The most common MAT drugs for opioid addiction are:

• Methadone
• Buprenorphine
• Naltrexone

Methadone

Methadone (Dolophine, Methadose) is one of the most commonly used opioid-replacement medications for opioid use disorder. It is available in oral formulations only and usually comes as a liquid when used for MAT.

As an opioid itself, methadone works on the brain’s mu opioid receptors the same way other opioids do. However, methadone is a long-acting opioid that does not cause a high like other opioids. Methadone can prevent both withdrawal symptoms and cravings, as well as prevent a person from getting high if they slip up and take an illicit opioid.

Buprenorphine 

Buprenorphine (Belbuca, Buprenex, Butrans, Probuphine, Sublocade) works similarly to methadone. It is an opioid that can help prevent withdrawal symptoms and cravings, and stop a person from getting high if they take another opioid. 

Buprenorphine is sometimes combined with the opioid reversal agent naloxone and sold under the brands Bunavail, Suboxone, Subutex, and Zubsolv. The addition of naloxone helps prevent the drug from being misused because naloxone is inactive when the drug is taken orally as directed. However, if a person tries to misuse the drug and injects it, the naloxone becomes active in the bloodstream and blocks the opioid’s effects.

Buprenorphine is available orally as orally disintegrating tablets and strips. However, long-acting injectable forms (Probuphine, Sublocade) are also available.

Naltrexone

Naltrexone (ReVia, Vivitrol)  is an opioid antagonist, blocking opioids from mu-opioid receptors in the central nervous system. The drug does not ease withdrawal symptoms: on the contrary, it can trigger withdrawal if opioids are still in your system when you start taking it. For this reason, you should not start naltrexone until opioids are completely out of your system, which can take up to 14 days. Naltrexone comes both as oral tablets and as a long-acting injection.

Medication Management

You do not need to be admitted to an inpatient rehab facility to use MAT. Many people are able to take advantage of MAT even while being treated in an outpatient rehab setting.

All three of the common MAT treatments for alcohol addiction — naltrexone, disulfiram and acamprosate — are recommended to begin only after a person has become sober and wants to stay that way. This makes all three medications a good match for the outpatient setting, when a person has committed to sobriety and is seeking professional help.

Similarly, all three typical MAT treatments for opioid use disorder — methadone, buprenorphine, and naltrexone — can be used in the outpatient setting. Although methadone and buprenorphine are often started while a person is detoxing from opioids, they are frequently continued for at least a year and often indefinitely. 

How Denver Mental Health and Counseling Uses MAT

Denver Mental Health and Counseling at The Recovery Village believes that several evidence-based treatment options should be considered to develop a personalized treatment plan that’s best for you. After an initial assessment with your medical team, your unique treatment plan may include cognitive-behavioral therapy, individual and group therapy sessions, medical appointments, case management, education and MAT, if applicable. Your treatment plan may also evolve during your rehab experience to address your changing needs in recovery.

If you have an opioid or alcohol use disorder, you may be eligible to participate in the MAT program as medically appropriate. At Denver Mental Health and Counseling, our MAT program may provide Vivitrol (naltrexone) or Sublocade (buprenorphine) to support long-term recovery. Only treatment programs that are certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) are able to provide MAT treatment. 

Medication-Assisted Treatment FAQs

Is MAT Treatment Safe?

When used as directed, MAT medications are safe, effective and are all FDA-approved. They are even safe enough to be used for the rest of your life if needed. However, it is important to take your medications exactly as prescribed by your doctor, as any medication can be unsafe if you do not follow your unique prescription.

How Effective Is MAT Treatment?

MAT treatment is very effective, especially when combined with other types of addiction treatments like therapy and case management. Studies have shown there is a better chance of long-term recovery success in people who take part in MAT. 

What Are the Benefits of MAT Treatment?

The key benefit of MAT treatment is an increased rate of long-term abstinence from substance abuse. This means you’re reducing the health, infection, financial and legal risks of continuing the addiction. In addition, because many MAT drugs for opioid use disorder block the effects of opioids, they help protect against the risk of overdose if you slip up and take an illicit opioid.

Does Insurance Cover MAT Treatment?

Many insurance plans cover MAT treatment as part of their comprehensive coverage. Denver Mental Health and Counseling will work with you to verify your insurance coverage or explore different payment options that work for you so more people can get the help they need. 

How Long Does MAT Treatment Last?

MAT treatment can last different periods of time for different people. There are no hard and fast rules for how long a person must remain on MAT — some people may only need a year, while others may remain on MAT for the rest of their lives.

How Does Confidentiality Work for MAT Treatment?

Like any other medical condition, the privacy of your MAT treatment is legally protected under the Health Insurance Portability and Accountability Act (HIPAA). Although you can authorize your MAT provider to inform others about your MAT treatment, you are under no obligation to tell anyone that you are undergoing treatment.

Start MAT Treatment Today

If you or a loved one struggle with alcohol or opioid abuse, help is available. Denver Mental Health and Counseling by The Recovery Village provides evidence-based, comprehensive outpatient addiction treatment, which can include medication-assisted treatment if needed. Our facility is located just minutes from the heart of Denver. Contact our intake experts to learn how we can help. Don’t wait – contact us today.

Editor – Melissa Carmona

Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more