What is medication-assisted treatment?
MAT combines medication with counseling and recovery support. The medication handles the physical side of addiction, such as cravings and withdrawal. Counseling helps with the thoughts, habits and life stress that keep substance use going.
You may also see the term MOUD, which stands for "medications for opioid use disorder." Federal agencies now often use MOUD when talking about opioids, but the idea is the same. MAT is not a separate "level" of rehab. It can be part of almost any program, from a hospital stay to a monthly office visit.
Not sure whether MAT fits your situation? Call (877) 847-2855 to talk through options and check your insurance benefits. It's free and confidential.
Which medications are used in MAT?
Medications for opioid use disorder
- Buprenorphine is a partial opioid agonist. It activates opioid receptors enough to stop withdrawal and cravings, but with a "ceiling effect" that makes overdose less likely than with full opioids. It comes as a film or tablet under the tongue, or as a weekly or monthly injection.
- Methadone is a full opioid agonist taken once a day, usually as a liquid. For opioid use disorder, it can only be given through a federally certified methadone clinic, also called an opioid treatment program (OTP).
- Naltrexone blocks opioid receptors so opioids have little effect. It is available as a daily pill or a monthly injection. You generally need to be fully off opioids, often for 7 to 10 days, before starting it.
In early 2023, the Consolidated Appropriations Act, 2023 removed the federal "X-waiver" requirement. Before that, clinicians needed a special waiver and faced patient limits to prescribe buprenorphine. Now any clinician with a standard DEA registration that covers Schedule III drugs can prescribe it, as state law allows. This change has made buprenorphine easier to find in primary care offices, emergency departments and telehealth programs.
Medications for alcohol use disorder
- Naltrexone reduces the rewarding effect of alcohol and can cut down heavy drinking.
- Acamprosate helps people who have already stopped drinking stay stopped by easing lingering discomfort and cravings.
- Disulfiram causes an unpleasant reaction, such as flushing and nausea, if you drink. It works best for people who are highly motivated and have support taking it.
| Medication | Used for | How it's taken | Where you get it |
|---|---|---|---|
| Buprenorphine | Opioid use disorder | Daily film/tablet or weekly/monthly injection | Doctor's office, clinic, telehealth, OTP |
| Methadone | Opioid use disorder | Daily liquid, observed at first | Certified OTP only |
| Naltrexone | Opioid or alcohol use disorder | Daily pill or monthly injection | Doctor's office, clinic, OTP |
| Acamprosate | Alcohol use disorder | Pills taken several times a day | Doctor's office or clinic |
| Disulfiram | Alcohol use disorder | Daily pill | Doctor's office or clinic |
Who is MAT for?
MAT is for adults, and in some cases teens, diagnosed with an opioid or alcohol use disorder. It can help whether you are just starting treatment, leaving detox, or have tried to quit before without medication.
It may be a strong fit if you:
- Use opioids, including heroin, pills or fentanyl
- Have had an overdose or a return to use after a period of not using
- Struggle with intense cravings when you try to cut back on alcohol
- Are pregnant and use opioids (talk with your prenatal provider about safe options)
How does MAT work day to day?
Most people start with a medical assessment. A clinician reviews your substance use, health history and other medications, then recommends a medication and dose.
Starting buprenorphine usually means waiting until you are in mild to moderate withdrawal. Starting too soon can cause sudden, intense withdrawal. Some clinicians guide you through a home start by phone. After the first few weeks, visits often space out to every week or every month.
Methadone works differently. You visit the clinic daily at first to take your dose in front of a nurse. Over time, you may earn take-home doses.
Counseling is strongly encouraged, and many programs include individual or group therapy. Under updated federal rules for opioid treatment programs, however, turning down counseling cannot be the reason a program denies you medication.
Is MAT safe?
MAT medications are well studied and safe when taken as prescribed under medical care. Still, a few safety points matter:
- Don't mix with alcohol, benzodiazepines or sedatives without your prescriber's guidance. The combination can slow breathing.
- Tolerance drops fast. If you stop opioid medication and use again, your old dose could be fatal. Keep naloxone, the overdose-reversal medication, on hand.
- Alcohol withdrawal can be life-threatening. If you drink heavily every day, don't stop suddenly on your own. Get medically supervised detox first.
- Store medication safely, away from children and pets.
If someone is not breathing or won't wake up, call 911. If you or a loved one is in emotional crisis or thinking about suicide, call or text 988.
How does MAT fit with other levels of care?
MAT can be added to any level of care. The level is chosen based on your needs using the ASAM Criteria, a set of standards from the American Society of Addiction Medicine that clinicians use to match people with the right intensity of treatment.
| Level of care | How MAT fits |
|---|---|
| Detox | Medication is often started here to ease withdrawal and bridge into ongoing care. |
| Inpatient/residential | Medication is managed on site while you live at the facility. |
| Partial hospitalization (PHP) | Day treatment several hours a day, most days of the week, with medication management. |
| Intensive outpatient (IOP) | Several therapy sessions a week, usually 9 or more hours, with prescriptions continued. |
| Outpatient | Regular office or telehealth visits for medication and counseling. |
| Sober living | Many recovery homes allow residents to continue MAT. Ask before you move in. |
How much does MAT cost, and does insurance cover it?
Costs vary widely by medication, form (pill vs. injection), setting and insurance. Generic pills tend to cost less than long-acting injections.
Here is how coverage generally works:
- Under the Affordable Care Act, most individual and small-group plans must cover substance use disorder services as an essential health benefit.
- The Mental Health Parity and Addiction Equity Act (MHPAEA) means many plans can't put stricter limits on addiction care than on medical care.
- Medicaid programs cover medications for opioid use disorder, though prior authorization and preferred drug lists vary by state.
- Medicare covers opioid treatment program services and many MAT prescriptions.
- Plans may require prior authorization, and in-network providers usually cost less than out-of-network ones. Your deductible and out-of-pocket maximum also affect what you pay.
Learn more in our guide to whether insurance covers rehab.
How do you choose a quality MAT program?
Look for a program that:
- Offers more than one medication and explains the pros and cons of each
- Has licensed medical staff and is licensed by your state
- Bases dose and length of treatment on your needs, not a set timeline
- Includes or connects you to counseling and recovery support
- Coordinates with your other doctors and any mental health care
Red flags to watch for:
- Pressure to taper off medication by a fixed date regardless of how you're doing
- Cash-only visits with no exam, or prescriptions with no follow-up
- Promises of a "cure" or guaranteed results
- Refusing to treat co-occurring mental health conditions or to coordinate care
For more tips, read how to choose a rehab.
What are the next steps?
Start by writing down what you use, how often and any past treatment. Check your insurance card for a behavioral health number. Then browse the state listings below or start at the rehab directory to compare programs that offer MAT. If you want help sorting through options, our admissions helpline can walk you through MAT providers that fit your needs and budget. Call (877) 847-2855 any time. It's free and confidential.
