Medication Assisted Treatment (MAT): Definition, Application, Medications Used, Misconceptions, and Effectiveness

Medication Assisted Treatment (MAT) is an evidence-based practice that combines the use of medications with counseling and behavioral therapies to provide a “whole-patient” approach to the treatment of substance use disorders, particularly opioid addiction.

Medication Assisted Treatment (MAT) is applied through a personalized approach that combines the use of FDA-approved medications, behavioral therapies, and coordinated care to comprehensively address substance use disorders and support long-term recovery.

According to the FDA, in a publication titled, “Information about Medications for Opioid Use Disorder (MOUD),” three medications are approved for the treatment of OUD: buprenorphine, methadone, and naltrexone. These medications have been demonstrated to be safe and effective in reducing opioid cravings and withdrawal symptoms.

Misconceptions of Medication-Assisted Treatment (MAT) include the belief that it merely substitutes one addiction for another, that it is a form of “quick fix” without the need for additional therapy, and that it is less effective than complete abstinence.

According to a publication by the National Center for Biotechnology Information titled, The Effectiveness of Medication-Based Treatment for Opioid Use Disorder, patients on methadone had 33% fewer opioid-positive drug tests and were 4.44 times more likely to stay in treatment compared to controls. Patients maintained on 16 mg of buprenorphine daily were 1.82 times more likely to stay in treatment than placebo-treated patients, and buprenorphine decreased the number of opioid-positive drug tests by 14.2%.

What is Medication Assisted Treatment (MAT)?

Medication Assisted Treatment (MAT) is a type of treatment for people struggling with opioid addiction or substance use disorders. It combines the use of medications, like buprenorphine or methadone, together with counseling and behavioral therapies.

The medications help reduce cravings and withdrawal symptoms, making it easier for people to focus on their recovery. The counseling and therapies then address the psychological and social aspects of addiction.

The key idea behind MAT is to provide a comprehensive, personalized approach that supports people throughout their recovery journey. The medications, coupled with therapy and other support services, help people regain control of their lives, prevent relapse, and achieve long-term sobriety.

History and Development of Medication-Assisted Treatment

The origins of MAT traces back to the 1940s and 1950s, when researchers and clinicians began exploring the use of pharmacological interventions to treat opioid addiction. One of the earliest and most influential figures in this field was Dr. Vincent Dole, a physician and researcher at Rockefeller University.

In the 1960s, Dr. Dole and his colleague, Dr. Marie Nyswander, conducted groundbreaking research on the use of methadone maintenance therapy for the treatment of heroin addiction. They found that methadone, a long-acting opioid agonist, could effectively reduce the cravings and withdrawal symptoms associated with opioid dependence, allowing individuals to stabilize their lives and engage in rehabilitation and recovery efforts.

The Dole-Nyswander model of methadone maintenance therapy, which provided a comprehensive approach that included not only medication but also counseling and social services, was a significant milestone in the development of MAT. This approach was widely adopted in the United States and other countries, leading to the establishment of methadone clinics and the recognition of methadone as an effective treatment for opioid addiction.

In the 1970s and 1980s, the use of MAT continued to expand, with the development of additional medications, such as buprenorphine, an opioid partial agonist, and naltrexone, an opioid antagonist. These medications provided alternative options for the treatment of opioid use disorders, catering to different patient needs and preferences.

Another important milestone in the history of MAT was the passage of the Drug Addiction Treatment Act (DATA) in 2000, which allowed for the prescription of buprenorphine in office-based settings by qualified healthcare providers. This expanded access to MAT and helped to destigmatize the treatment of opioid use disorders.

Over the past two decades, the use of MAT has continued to evolve and adapt to the changing landscape of substance use disorders. This includes the incorporation of newer medications, such as extended-release formulations of naltrexone, as well as the integration of MAT into a wider range of healthcare settings, including primary care, emergency departments, and criminal justice systems.

Throughout the history of MAT, influential figures have included not only the pioneering researchers like Dole and Nyswander but also policymakers, public health advocates, and clinicians who have championed the use of evidence-based, compassionate, and comprehensive approaches to the treatment of substance use disorders.

Theoretical Foundations of Medication-Assisted Treatment

The theoretical foundations underpinning Medication-Assisted Treatment (MAT) for substance use disorders are rooted in the principles of pharmacotherapy combined with psychotherapy, as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Pharmacotherapy Principles

• Substance use disorders are characterized by neurobiological changes in the brain’s reward, motivation, and memory systems.
• Medications used in MAT work by targeting specific neurotransmitter systems and receptors in the brain.
• These medications help restore balance to the dysregulated brain circuits, reducing cravings, withdrawal symptoms, and the euphoric effects of the abused substance.
• The pharmacological stabilization provided by these medications creates a foundation for patients to engage more effectively in psychosocial interventions.

Psychotherapy Principles

• Substance use disorders are complex, multifaceted conditions that involve behavioral, psychological, and social factors.
• Evidence-based psychosocial therapies, such as cognitive-behavioral therapy, contingency management, and peer support, are essential for addressing these non-pharmacological aspects of addiction.
• These therapies help patients develop coping mechanisms, improve decision-making skills, rebuild relationships, and achieve personal goals – all of which are crucial for long-term recovery.
• The combination of pharmacotherapy and psychotherapy creates a synergistic effect, where the medications provide physiological stability and the psychosocial interventions address the psychological and social components of addiction.

Integrated Approach

• MAT is based on the principle that substance use disorders require a comprehensive, integrated treatment approach to be most effective.
• The combination of medication management and psychosocial support addresses the multifaceted nature of addiction, targeting both the neurobiological and behavioral factors that contribute to the disorder.
• This integrated approach is consistent with the chronic, relapsing nature of substance use disorders and the need for long-term, individualized care.

By leveraging the complementary mechanisms of pharmacotherapy and psychotherapy, MAT provides a holistic, evidence-based framework for treating substance use disorders and supporting long-term recovery.

How Does MAT Work for Addiction (Application)?

MAT is applied in addiction treatment through a comprehensive, multifaceted approach, including medication management, behavioral therapies, coordinated care, and ongoing support.

According to the paper by Kampman and Jarvis (2015) titled “American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use”, the key conclusions were:

• Medications are a critical component of effective treatment for opioid use disorder. The three FDA-approved medications – methadone, buprenorphine, and naltrexone – have all been shown to be effective in reducing opioid use and improving treatment outcomes.
• Medication treatment is combined with behavioral therapies and psychosocial support for a comprehensive, patient-centered approach to care. This combination of pharmacological and psychosocial interventions is more effective than either approach alone.
• Providers consider the individual patient’s needs, preferences, and treatment history when selecting the most appropriate medication. The guideline provides detailed recommendations on dosing, treatment duration, and transitioning between different medications.
• Access to MAT is underutilized, especially in criminal justice and other high-risk settings. Efforts are needed to expand access and remove barriers to this evidence-based treatment.
• Ongoing monitoring, care coordination, and long-term support help to sustain recovery and prevent relapse among patients with opioid use disorder.

The ASAM guideline emphasizes that a comprehensive, medication-assisted approach, tailored to individual patient needs, is the most effective way to treat opioid addiction and support long-term recovery.

Psychological and Physiological Mechanisms of Medication-Assisted Treatment

Medication-assisted treatment (MAT) for substance use disorders works by targeting the psychological and physiological mechanisms underlying addiction, such as reducing cravings, minimizing withdrawal symptoms, and restoring balance to the brain’s reward and stress systems that have been disrupted by chronic substance use.

1. Physiological Mechanisms

The medications used in MAT (e.g. methadone, buprenorphine, naltrexone) work by targeting the opioid receptors in the brain. This helps to:

• Reduce or eliminate cravings for the abused opioid
• Blunt the euphoric effects if the abused opioid is used
• Prevent or reduce the severity of withdrawal symptoms
• This physiological effect helps to stabilize the patient and reduce the compulsive drive to use the abused substance.

2. Psychological Mechanisms

The medications provide a “ceiling” effect, blocking the ability to get high from opioids. This disrupts the reward pathway that fuels addictive behaviors.

• Patients experience greater control over their impulses and cravings, allowing them to better engage in behavioral therapies.
• The stability provided by the medications enables patients to focus on the psychological and social aspects of recovery, such as:
• Developing healthy coping mechanisms
• Improving decision-making and problem-solving skills
• Rebuilding relationships and social support networks
• Achieving educational, vocational, and life goals

The combination of physiological stabilization and the ability to meaningfully participate in psychosocial interventions is what makes MAT an effective, comprehensive approach to treating substance use disorders. The synergistic effects of the medications and behavioral therapies are crucial for long-term recovery.

What are the Medications Used in MAT?

The three main medications used in Medication-Assisted Treatment (MAT) for opioid use disorder are methadone, buprenorphine, and naltrexone.

1. Methadone

Methadone is a long-acting opioid agonist that reduces opioid cravings and withdrawal symptoms. Several research works have shown methadone maintenance treatment to be highly effective in reducing opioid use, overdose, criminal activity, and HIV risk behaviors.

For example, the systematic review and meta-analysis by Mattick et al. (2009) titled, “Methadone maintenance therapy versus no opioid replacement therapy,” found that methadone maintenance treatment was associated with significantly reduced illicit opioid use compared to non-pharmacological approaches.

Methadone’s effects are gradual and sustained, helping to stabilize brain chemistry, reduce the physical and psychological cravings, and allow individuals to function normally in daily activities. It is typically administered in a controlled clinic setting due to its potential for abuse and the need for precise dosing.

Another meta-analysis by Sordo et al. (2017), titled, “Mortality risk during and after opioid substitution treatment,” demonstrated methadone treatment reduced the risk of death among people with opioid dependence by up to 50%.

2. Buprenorphine

Buprenorphine is a partial opioid agonist, meaning it activates opioid receptors in the brain but to a much lesser extent than full agonists like heroin or methadone. Suboxone is a combination of buprenorphine and naloxone (an opioid antagonist), designed to prevent misuse by causing withdrawal symptoms if injected. (Mattick et al., 2014).

Buprenorphine helps alleviate withdrawal symptoms and cravings without producing significant euphoria, making it safer and less addictive. It is prescribed in an outpatient setting, offering more flexibility and accessibility for patients.

A study by Larochelle et al. (2018) has shown that buprenorphine treatment is effective in reducing opioid use, improving retention in treatment, and decreasing opioid-related overdose and mortality. In the study, it was revealed that buprenorphine treatment was associated with a significantly lower risk of opioid-related overdose compared to no treatment.

3. Naltrexone

Naltrexone is an opioid antagonist that blocks the effects of opioids, reducing cravings and the risk of relapse (Lee et al., 2018).

According to multiple research by research by Lee et al., (2018) and Jarvis et al., (2018), both oral and extended-release injectable naltrexone are effective in preventing relapse and supporting long-term recovery from opioid use disorder.

Naltrexone is effective in preventing relapse for individuals who have already detoxed from opioids. It is available in an extended-release injectable form (Vivitrol) that provides protection for up to a month, or as a daily oral tablet (ReVia). It is also used to treat alcohol use disorder by reducing the rewarding effects of alcohol.

Specifically, the systematic review and meta-analysis by Jarvis et al. (2018), titled, “Extended‐release injectable naltrexone for opioid use disorder,” highlighted the benefits of extended-release injectable naltrexone in improving treatment retention and reducing opioid use among individuals with opioid use disorder.

These three medications – methadone, buprenorphine, and naltrexone – have been extensively studied, proven, and approved by the FDA as an effective part of a comprehensive, evidence-based approach to Medication-Assisted Treatment for opioid use disorder.

What are Some Misconceptions about MAT?

Some misconceptions about Medication-Assisted Treatment (MAT) include the beliefs that it simply substitutes one addiction for another, that it is not a valid form of treatment, and that it does not support long-term recovery.

1. MAT just substitutes one opioid for another:

This misconception fails to recognize that medications like methadone and buprenorphine are long-acting opioid agonists or partial agonists that help reduce cravings and withdrawal symptoms, rather than producing the same euphoric high as illicit opioids.

2. MAT is just replacing one addiction with another:

While it’s true that patients on MAT are taking prescription medications, research shows these medications help stabilize brain function and allow individuals to focus on their recovery, rather than constantly seeking out and using illicit opioids.

A study published in the “Journal of Clinical Psychiatry” reported on a 40-year-old man with severe alcohol use disorder who was treated with Medication-Assisted Treatment (MAT) involving monthly injections of extended-release naltrexone combined with cognitive-behavioral therapy. 

Over a 6-month period, the patient experienced a significant reduction in alcohol cravings and consumption, which was accompanied by improvements in his social and occupational functioning.

3. Patients on MAT are not truly “clean” or “sober”

The misconception that “Patients on MAT are not truly ‘clean’ or ‘sober'” stems from the belief that the use of any medication, even if it is part of a comprehensive treatment plan, means that the individual is not truly in recovery or has not achieved a state of sobriety. 

This view doesn’t recognize that abstinence is not the only measure of recovery and that MAT helps individuals regain control of their lives, improve their physical and mental health, and function better in their personal, social, and professional lives.

A 45-year-old veteran with chronic pain and opioid addiction was treated with buprenorphine in a VA hospital setting, receiving comprehensive pain management and psychological support as part of a Medication-Assisted Treatment (MAT) intervention. According to a case documented in the “Journal of Substance Abuse Treatment,” the veteran reported reduced opioid use, better pain management, and improved quality of life over the course of the MAT treatment.

4. Patients on MAT will be on these medications forever:

The misconception that “Patients on MAT will be on these medications forever” is based on the assumption that once someone starts taking medications like methadone or buprenorphine, they will be dependent on them for the rest of their lives. 

This view fails to recognize that the duration of MAT is individualized and that many patients gradually taper off the medications over time with the support of their treatment team.

5. MAT is not really treatment, it’s just a crutch:

The misconception that “MAT is not really treatment, it’s just a crutch” stems from the belief that using medication to manage opioid use disorder is a shortcut or an easy way out, rather than a legitimate form of treatment. 

Some view the use of medications like methadone or buprenorphine as simply replacing one addiction with another, rather than addressing the underlying issues that contributed to the addiction in the first place.

MAT is a comprehensive, evidence-based approach that combines medication, counseling, and behavioral therapies to treat the multifaceted nature of opioid use disorder. It is not simply a “crutch” but an effective way to support long-term recovery.

How Does MAT Differ from Other Treatment Options for Addiction? 

The main difference between MAT and other forms of addiction treatment is the use of medication in combination with other therapies. Research by Kleber, H. D. (2008), titled, “Outpatient detoxification from opioids,”  has shown that patients on MAT are more likely to remain in treatment, reduce their use of illicit opioids, obtain and maintain employment, and improve their social functioning compared to those who do not receive MAT.

MAT Utilizes FDA-Approved Medications

MAT involves the use of medications like methadone, buprenorphine, and naltrexone, which are approved by the FDA for the treatment of opioid use disorder. These medications help reduce cravings and withdrawal symptoms, stabilize brain function, and allow individuals to focus on their recovery.

However, according to a publication by the National Academies of Sciences, Engineering, and Medicine. (2019), titled, “Medications for opioid use disorder save lives,” while MAT utilizes FDA-approved medications, it is not a standalone treatment. Effective MAT programs integrate pharmacological treatment with behavioral therapies and other psychosocial supports to address the multifaceted nature of addiction.

MAT is Part of a Comprehensive Approach

MAT is not a standalone treatment, but rather part of a comprehensive approach that also includes counseling, behavioral therapies, and other supportive services. This integration of medication, behavioral interventions, and psychosocial support is key to addressing the multifaceted nature of addiction.

According to Fiellin, et al (2006), this comprehensive approach is more effective than medication or behavioral therapy alone in treating opioid use disorder.

MAT Focuses on Long-Term Recovery

The goal of MAT is to support long-term recovery, not just short-term abstinence. Patients on MAT will regain control of their lives, improve their physical and mental health, and function better in their personal, social, and professional lives.

MAT Allows for Individualized Treatment

The duration and dosage of MAT medications are tailored to each patient’s unique needs and goals. Some patients gradually taper off medications over time, while others require longer-term maintenance, depending on the severity and other factors.

MAT is Evidence-Based and Effective

Numerous studies have demonstrated the effectiveness of MAT in reducing opioid use, overdose risk, and criminal justice involvement, as well as improving social functioning and quality of life. 

In contrast, non-MAT treatment approaches, such as abstinence-only programs or traditional outpatient counseling alone, often have lower long-term success rates and higher relapse rates compared to comprehensive MAT programs.

How Effective is MAT?

MAT has been proven through various research works to be an effective treatment for reducing opioid use, reducing overdose risks, improving treatment retention, and serving as a comprehensive approach.

According to the NIDA in a study that explored the effects of MAT by separating patients into two groups, the extended-release injectable naltrexone (XR-NTX) group had 90% confirmed abstinent weeks compared to 35% in the placebo group. Treatment retention was also higher in the XR-NTX group (58% vs. 42%) [1].

Once treatment is initiated, XR-NTX and buprenorphine/naloxone combination are similarly effective in treating opioid use disorder 

Effectiveness in Reducing Opioid Use

A systematic review and meta-analysis by Mattick et al (2014), titled, “Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.” and published in JAMA in 2014 found that opioid agonist treatment with methadone or buprenorphine was associated with significantly reduced opioid use compared to non-medication-assisted treatments.

Reduced Overdose Risk

A study in the New England Journal of Medicine in 2018 showed that patients receiving MAT with buprenorphine had a 50% lower risk of overdose death compared to those receiving treatment without medication.

Improved Treatment Retention

The same JAMA review found that opioid agonist treatment was associated with improved treatment retention compared to non-medication-assisted approaches.

Better Long-Term Outcomes

Research published in the American Journal of Psychiatry by Bart, G. (2012), titled, “Maintenance medication for opiate addiction: the foundation of recovery.” 31(3), 207-225, demonstrated that patients with opioid use disorder who received MAT had better long-term outcomes, including lower rates of mortality and criminal justice involvement.

Comprehensive Approach

A study in the New England Journal of Medicine by Fiellin, et al (2006), titled, “Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence.” 355(4), 365-374 found that the combination of medication (buprenorphine-naloxone) and behavioral therapy was more effective than behavioral therapy alone in treating opioid dependence.

How Long Does MAT Last?

The duration of Medication-Assisted Treatment (MAT) varies widely, from several months to many years, depending on the individual’s needs and treatment goals. Research shows longer participation in MAT leads to better long-term outcomes, so treatment is typically continued for as long as clinically beneficial for the patient.

What Is The Role Of Counseling And Behavioral Therapies In Mat?

Counseling and behavioral therapies are essential components of effective Medication-Assisted Treatment (MAT) for substance use disorders. While the medications in MAT address the physiological aspects of addiction, psychosocial interventions are crucial for targeting the behavioral, psychological, and social factors that contribute to and maintain the addiction. 

Therapies incorporated into MAT include individual and group therapy, cognitive-behavioral therapy, contingency management, family therapy, and peer support groups.

What Should I Expect in a Medication-Assisted Treatment Session?

In a Medication-Assisted Treatment (MAT) session, expect a comprehensive approach involving a medical evaluation, prescription of FDA-approved medications to manage withdrawal and cravings, and integrated counseling or behavioral therapies to address the psychological aspects of addiction.

1. Initial Assessment: A thorough medical and psychological evaluation by a healthcare provider to understand your substance use history, overall health, and any co-occurring mental health conditions.
2. Medication Prescription: Based on the assessment, the provider will prescribe FDA-approved medications like methadone, buprenorphine, or naltrexone to help manage withdrawal symptoms, reduce cravings, and support long-term recovery.
3. Medication Administration and Monitoring: You will receive the medication on-site or through a prescription for home use, with regular monitoring to adjust dosages and ensure proper use.
4. Integrated Counseling: Sessions with a counselor or therapist to address underlying psychological issues, develop coping strategies, and provide support for behavioral changes. This includes individual therapy, group therapy, or both.
5. Support Services: Access to additional resources such as case management, peer support groups, and referrals to other healthcare services to address broader needs related to housing, employment, and social support.
6. Regular Follow-Ups: Scheduled follow-up appointments to monitor progress, make any necessary adjustments to the treatment plan, and provide ongoing support to maintain sobriety.
7. Educational Components: Information about addiction, relapse prevention strategies, and healthy lifestyle changes to support recovery.

Overall, MAT sessions are designed to provide a holistic and supportive approach to addiction treatment, combining medical and therapeutic interventions to enhance recovery outcomes.

How Does MAT Address Co-occurring Mental Health Conditions?

MAT addresses co-occurring mental health conditions by combining medication management with behavioral therapies that target both addiction and mental health issues. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), patients with co-occurring disorders benefit from a comprehensive treatment approach that includes medications to stabilize brain chemistry and reduce cravings, alongside therapies such as cognitive-behavioral therapy (CBT) and music therapy to address psychological and emotional needs.

In a partial hospitalization program, integrated care plans are developed to treat both addiction and mental health conditions simultaneously. This holistic approach ensures that all aspects of the patient’s health are addressed, leading to better treatment outcomes and improved overall well-being.