What Is Medication-Assisted Treatment (MAT)?

Medication-assisted treatment combines FDA-approved medication with counseling and psychosocial support, and three medications hold FDA approval for opioid use disorder while three separate medications hold FDA approval for alcohol use disorder.

Federal agencies have retired the term. NIDA now lists medication-assisted treatment among the terms to avoid, recommending medication for opioid use disorder instead, and SAMHSA’s own regulations use that newer term throughout.

Key Takeaways

• Three medications hold FDA approval for opioid use disorder: methadone, buprenorphine and naltrexone.
• Three hold FDA approval for alcohol use disorder: naltrexone, acamprosate and disulfiram, and their evidence is not equal.
• Per NIDA, the term medication-assisted treatment implies medication plays a supplemental or temporary role, which is why MOUD is now preferred.
• Federal regulation states that patient refusal of counseling shall not preclude them from receiving medication for opioid use disorder.
• Per CDC, 25.1 percent of US adults who needed opioid use disorder treatment in 2022 received medication for it.

Why Do Federal Agencies No Longer Say MAT?

Federal agencies retired the phrase medication-assisted treatment because the phrase implies medication plays an accessory role in treatment. NIDA’s Words Matter guidance lists opioid substitution replacement therapy and medication-assisted treatment under terms to replace.

NIDA recommends five alternatives: opioid agonist therapy, pharmacotherapy, addiction medication, medication for a substance use disorder, and medication for opioid use disorder. NIDA gives two reasons. The first addresses the substitution objection: it is a misconception that medications merely substitute one drug or one addiction for another. The second addresses the word assisted: the term MAT implies that medication should have a supplemental or temporary role in treatment, whereas using MOUD aligns medication with the way other psychiatric medications are understood, such as antidepressants and antipsychotics, as critical tools central to a patient’s treatment plan.

The shift has reached binding regulation. SAMHSA’s rewrite of the federal rules governing opioid treatment programs uses Medications for Opioid Use Disorder as its defined term throughout rather than MAT. MAT remains in wide use across treatment providers, insurers and search results, so both terms appear together throughout. The medications themselves are the same three.

Which Medications Treat Opioid Use Disorder?

Three medications hold FDA approval for opioid use disorder, and federal regulation names them: methadone, buprenorphine including its combination products, and naltrexone. Each acts on the mu-opioid receptor differently.

• Methadone is a long-acting full agonist. Per NIDA, methadone activates the same receptors as heroin and fentanyl but more slowly, and remains in the body longer. Federal rules restrict methadone dispensing to certified opioid treatment programs.
• Buprenorphine is a partial agonist that activates the same receptors to a lesser degree and blocks other opioids from attaching to them. Its ceiling effect limits respiratory depression. Suboxone is the buprenorphine and naloxone combination most often prescribed in office-based treatment.
• Naltrexone works solely by blocking opioid receptors so opioids no longer produce pleasure, and naltrexone requires full opioid clearance first.

Lofexidine sits outside that list. Lofexidine treats the acute symptoms of opioid withdrawal rather than the disorder, and grouping lofexidine with the three is a common error.

Per the extended-release naltrexone label, an opioid-free duration of a minimum of 7 to 10 days precedes the first dose, to avoid precipitating opioid withdrawal severe enough to require hospitalization, and patients transitioning from buprenorphine or methadone remain vulnerable for as long as two weeks. The label also warns that after naltrexone treatment, opioid tolerance falls from baseline and patients become vulnerable to potentially fatal overdose at the end of a dosing interval, after a missed dose, or after discontinuing. Alcohol use disorder has its own three.

Which Medications Treat Alcohol Use Disorder?

Three medications hold FDA approval for alcohol use disorder, and their evidence differs enough that treating them as interchangeable is wrong. Jonas and colleagues reviewed 122 randomized trials covering 22,803 participants.

• Acamprosate modulates GABA-A and NMDA receptor transmission to restore neuronal balance. Number needed to treat to prevent a return to any drinking: 12.
• Naltrexone, an opioid receptor antagonist, interferes with the rewarding aspects of alcohol. Number needed to treat at 50 mg daily: 20 to prevent a return to any drinking, and 12 to prevent a return to heavy drinking.
• Disulfiram works by deterrence rather than by reducing craving, producing an unpleasant physiological reaction if a person drinks. Its trial evidence is the weakest of the three, and disulfiram performs better under supervised administration.

Jonas found no statistically significant difference between acamprosate and oral naltrexone head to head. Injectable naltrexone showed no effect on return to any drinking while reducing heavy drinking days. Two substance classes have no approved medication at all.

Are There Medications for Stimulant or Cannabis Use Disorder?

No FDA-approved medication exists for stimulant use disorder or cannabis use disorder. Per SAMHSA TIP 33, there currently are no FDA-approved pharmacologic treatments for patients with stimulant use disorders, and NIDA’s strategic plan states the same for stimulant, cannabis and polysubstance use disorders.

Behavioral treatment carries the evidence for those disorders, specifically cognitive behavioral therapy and contingency management. Anyone offered a medication marketed as treating methamphetamine or cocaine use disorder should know that no such approval exists. For opioid use disorder the evidence runs the other way entirely.

How Well Does Medication for Opioid Use Disorder Work?

Medication for opioid use disorder reduces all-cause mortality from 36.1 to 11.3 deaths per 1,000 person-years and overdose mortality from 12.7 to 2.6. Sordo and colleagues pooled 19 cohorts covering 122,885 people on methadone and 15,831 on buprenorphine, followed for up to 13.9 years.

Outcome	In treatment	Out of treatment	Rate ratio
All-cause mortality, methadone	11.3 per 1,000 person-years	36.1	3.20 (2.65 to 3.86)
Overdose mortality, methadone	2.6 per 1,000 person-years	12.7	4.80 (2.90 to 7.96)
All-cause mortality, buprenorphine	4.3 per 1,000 person-years	9.5	2.20 (1.34 to 3.61)

Retention shows the same direction. Cochrane’s review of 11 randomized trials covering 1,969 participants found methadone significantly more effective than non-pharmacological approaches at retaining patients and suppressing heroin use, at a risk ratio of 0.66 with a 95 percent confidence interval of 0.56 to 0.78.

One precision point matters for anyone quoting these numbers. That same Cochrane set of randomized trials did not show a statistically significant mortality effect, so the mortality case rests on the cohort meta-analysis, and attributing each figure to the right study design keeps the claim defensible. Whether counseling is compulsory is answered just as precisely.

Is Counseling Required Alongside the Medication?

Opioid treatment programs must provide counseling, and a patient’s refusal of counseling cannot cost that patient their medication. Federal regulation states: “Patient refusal of counseling shall not preclude them from receiving MOUD.”

The same regulation requires programs to provide adequate substance use disorder counseling and psychoeducation as clinically necessary and mutually agreed, including harm reduction education and recovery-oriented counseling. That resolves a question often answered wrongly in both directions: medication is not conditional on counseling attendance, and counseling is not optional for the program to offer.

Per TIP 63, many patients taking medication for opioid use disorder benefit from counseling as part of treatment. The regulation frames services as tailored to each patient through shared decision making between the patient and the clinical team rather than as a fixed requirement. Duration works the same way.

How Long Does Treatment Last?

Treatment continues for varying lengths of time, including lifelong. Per TIP 63, many people with opioid use disorder benefit from treatment with medication for varying lengths of time, and continued treatment with buprenorphine or methadone produces better outcomes than medically supervised withdrawal.

The TIP 63 expert panel considers arbitrary time limits on methadone treatment to be medically unwarranted and inappropriate. Stable patients continue on their selected medication indefinitely, and patients taking medication for opioid use disorder count as being in recovery. Most people who need that medication never receive it.

How Many People Who Need Medication Receive It?

One quarter of US adults who needed opioid use disorder treatment in 2022 received medication for it. Per CDC’s analysis of National Survey on Drug Use and Health data, 3.7 percent of US adults aged 18 and over needed opioid use disorder treatment, 55.2 percent received some form of treatment, and only 25.1 percent received medications for opioid use disorder.

Per NIDA, the barriers are structural rather than clinical: no nearby opioid treatment program for methadone in rural and small-suburban areas, pharmacies that do not carry or dispense buprenorphine, stigma, and racial and ethnic disparities in access. Two beliefs about these medications sustain part of that gap.

Which Beliefs About Addiction Medication Are Wrong?

Two widely held beliefs about medication for opioid use disorder fail against the primary sources, and both keep people out of the treatment with the strongest mortality evidence in addiction medicine.

Common misconception	What the evidence shows
“Medication just replaces one drug with another.”	Per NIDA, methadone and buprenorphine prevent drug cravings and withdrawal symptoms without causing the intense feelings of pleasure that other opioid drugs produce, which makes them less addictive. NIDA concedes both produce dependence and distinguishes dependence from addiction, noting withdrawal effects are milder and are managed by reducing the dose slowly. NIDA retired the term opioid substitution therapy for this reason.
“You have to attend counseling or they will stop your medication.”	Federal regulation states that patient refusal of counseling shall not preclude them from receiving medication for opioid use disorder. Programs must offer counseling; a patient’s refusal cannot be used to withhold the medication.

Both corrections point toward the same conclusion: the medication is the treatment rather than an adjunct to it.

Where Can You Get Medication for Addiction Treatment in Los Angeles?

New Spirit Recovery provides medication-assisted treatment at its Encino location, using buprenorphine and naltrexone with an on-site psychiatric provider setting the regimen and an assigned clinician integrating counseling alongside it.

Methadone is dispensed only through certified opioid treatment programs, so clinicians coordinate care with a licensed program where methadone fits the patient better. Medication-assisted treatment runs alongside detox.

The admissions process at New Spirit Recovery routes the patient to the on-site psychiatric provider who sets the regimen.

Crisis resources. A suspected overdose requires 911 and naloxone, even when in doubt. The 988 Suicide and Crisis Lifeline answers three ways: call 988, text 988, or chat at 988lifeline.org/chat. Spanish-language support answers by pressing 2, and the Lifeline’s videophone option serves ASL users.

“The medication and the therapy are not competing with each other. Integrated treatment means the psychiatric side and the clinical side are working from one plan, and a patient should never be made to choose between them.” Sean O’Neill, MS, LMFT, Clinical Director at New Spirit Recovery.

Frequently Asked Questions

What does MAT stand for?

MAT stands for medication-assisted treatment, meaning FDA-approved medication combined with counseling and psychosocial support. NIDA now recommends medication for opioid use disorder instead, because MAT implies medication holds a supplemental or temporary role.

What medications are used in MAT?

For opioid use disorder: methadone, buprenorphine including buprenorphine and naloxone combinations, and naltrexone. For alcohol use disorder: naltrexone, acamprosate and disulfiram. No FDA-approved medication exists for stimulant or cannabis use disorder.

Do you have to attend counseling to get the medication?

No. Federal regulation requires opioid treatment programs to provide counseling, and states that patient refusal of counseling shall not preclude them from receiving medication for opioid use disorder. Per TIP 63, many patients nonetheless benefit from counseling as part of treatment.

Does MAT just replace one drug with another?

No. Per NIDA, methadone and buprenorphine prevent craving and withdrawal without producing the intense pleasure other opioids cause, which makes them less addictive. Both produce dependence, and clinicians manage dependence by reducing the dose slowly rather than stopping abruptly.

How long do you stay on MAT?

Varying lengths of time, including lifelong. Per TIP 63, continued treatment produces better outcomes than medically supervised withdrawal, stable patients continue indefinitely, and arbitrary time limits count as medically unwarranted.

How effective is medication for opioid use disorder?

Across 19 cohorts covering 122,885 people, all-cause mortality ran 11.3 per 1,000 person-years in methadone treatment against 36.1 out of it, and overdose mortality 2.6 against 12.7. Retention improves against non-pharmacological approaches at a risk ratio of 0.66.

References

1. National Institute on Drug Abuse. Words Matter: Terms to Use and Avoid When Talking About Addiction; and Medications for Opioid Use Disorder.
2. Certification of Opioid Treatment Programs, 42 CFR Part 8.
3. Substance Abuse and Mental Health Services Administration. (2021). Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series, No. 63; and Treatment for Stimulant Use Disorders. TIP Series, No. 33.
4. Sordo, L., et al. (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ, 357, j1550.
5. Mattick, R. P., Breen, C., Kimber, J., Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews.
6. Jonas, D. E., et al. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 311(18), 1889-1900.
7. US Food and Drug Administration. Vivitrol (naltrexone for extended-release injectable suspension): Prescribing Information.
8. Centers for Disease Control and Prevention. (2024). Treatment for Opioid Use Disorder: Population Estimates, United States, 2022. MMWR, 73(25).