Medication-Assisted Treatment (MAT): A Complete Breakdown of Every Medication

What MAT is — and what it is not

MAT (also called MOUD when it specifically treats opioid use disorder) uses medication to normalize brain chemistry, block the rewarding effects of substances, relieve cravings, and stabilize the body so a person can engage in recovery. It is not 'trading one drug for another.' At a stable, prescribed dose, these medications do not produce intoxication — they restore function, the way insulin restores function for diabetes. MAT works best alongside counseling, peer support, and treatment for any co-occurring conditions.

Part 1: Medications for Opioid Use Disorder

There are three FDA-approved medications for opioid use disorder. They work in different ways, and the 'best' one depends on the individual.

Methadone (full opioid agonist)

Methadone fully activates opioid receptors but in a slow, steady, long-acting way. At the right dose it eliminates withdrawal and cravings without producing a high. It is one of the most studied and effective treatments for opioid use disorder.

• How it is taken: a daily liquid or tablet dispensed through federally regulated Opioid Treatment Programs (OTPs). Patients often visit daily at first and earn take-home doses as they stabilize.
• Best for: people with significant tolerance or long opioid-use histories, or those who have not stabilized on other medications.
• Things to know: the structure of daily dosing provides accountability and regular contact with care. Because it is a full agonist, dosing must be managed carefully, and combining it with alcohol or sedatives (like benzodiazepines) is dangerous.

Buprenorphine (partial opioid agonist)

Buprenorphine partially activates opioid receptors and has a 'ceiling effect' — beyond a certain dose its opioid effects level off, which substantially lowers the risk of overdose and misuse compared with full agonists. It is frequently combined with naloxone in a single product to further discourage misuse.

• Forms: sublingual film or tablet (dissolved under the tongue), a long-acting monthly injection, and (less commonly) an implant.
• Where to get it: it can be prescribed in regular doctors' offices and clinics, not only specialty programs — which has greatly expanded access.
• Important timing: you generally must already be in mild-to-moderate withdrawal before the first dose. Starting too early can trigger 'precipitated withdrawal' — sudden, intense withdrawal. Your prescriber will guide the timing.
• Best for: many people, including those who want office-based treatment and a lower overdose-risk profile.

Naltrexone (opioid antagonist)

Naltrexone is the opposite of the others: it blocks opioid receptors entirely, so opioids cannot produce an effect. Because it is not an opioid, it has no misuse potential and causes no withdrawal when stopped.

• Forms: a daily pill, or an extended-release injection given about once a month (often the preferred form for adherence).
• Critical timing: a person must be fully detoxed and opioid-free for roughly 7–10 days before starting, or it will trigger precipitated withdrawal. This waiting period is the main practical hurdle.
• A key safety note: because naltrexone blocks opioids, tolerance drops while on it. If someone stops the medication and relapses, their overdose risk is very high. This is one reason ongoing support matters.
• Best for: people who are already detoxed and motivated to maintain an opioid-free state, including some who cannot or prefer not to take agonist medications.

Part 2: Medications for Alcohol Use Disorder

Alcohol use disorder is also treatable with medication — an option many people do not know exists. There are three FDA-approved medications, and they can be very effective combined with counseling.

Naltrexone (for alcohol)

The same naltrexone used for opioids also reduces the craving for alcohol and blunts the pleasurable 'reward' of drinking, which helps people drink less or stop. It comes as a daily pill or monthly injection and can often be started even before a person has fully stopped drinking. It cannot be used by someone currently taking opioids.

Acamprosate

Acamprosate helps the brain rebalance after long-term alcohol use, easing the lingering restlessness, anxiety, and sleep problems that can drive relapse. It is typically started after a person has stopped drinking and is most useful for maintaining abstinence. It is taken several times a day and is cleared by the kidneys, so it requires caution in people with kidney problems.

Disulfiram

Disulfiram works as a deterrent: if a person drinks alcohol while taking it, they experience a strongly unpleasant reaction (flushing, nausea, rapid heartbeat). It only works if taken consistently, so it suits highly motivated people, often with support or supervised dosing. Users must also avoid hidden sources of alcohol, such as some mouthwashes and cooking wines, and it is not appropriate for everyone (for example, certain heart conditions).

Part 3: Naloxone — the overdose reversal medication

Naloxone (often known by the brand name Narcan) is not a maintenance treatment, but it belongs in any discussion of these medications because it reverses opioid overdoses and saves lives. It is an opioid antagonist that knocks opioids off their receptors within minutes, restoring breathing. It is now available over the counter, is safe to give even if you are not sure opioids are involved, and everyone connected to opioid use — including family members — should keep it on hand. See our dedicated guide on recognizing an overdose and using naloxone.

How a medication is chosen

There is no single 'best' medication — the right choice depends on the substance, the person's history and health, their access to different types of care, their preferences, and their goals. A good prescriber will discuss the options, explain the trade-offs, and revisit the plan over time. What matters most is that effective medication is offered at all: programs that provide MAT are following the evidence.

Myths that cost lives

• Myth: 'Real recovery means being medication-free.' Reality: staying on medication is a valid, often life-saving form of recovery; stopping prematurely raises relapse and overdose risk.
• Myth: 'You should detox first and try willpower before medication.' Reality: for opioid use disorder especially, medication started early protects against overdose; detox alone has high relapse rates.
• Myth: 'Medication is only for severe cases.' Reality: medication helps across the spectrum and earlier treatment generally works better.