Medication-Assisted Treatment (MAT) Guide

Quick answer

Medication-assisted treatment uses FDA-approved medicines, combined with counseling and behavioral therapy, to treat opioid and alcohol use disorder. SAMHSA lists buprenorphine, methadone, and naltrexone for opioid use disorder, and acamprosate, disulfiram, and naltrexone for alcohol use disorder. A 2023 federal law removed the special waiver once required to prescribe buprenorphine.

Cravings are not a character flaw. For many people, they are brain chemistry doing what years of substance use taught it to do. Medication-assisted treatment, often shortened to MAT, uses FDA-approved medicines to steady that chemistry while you do the work of recovery. It is not a shortcut and it is not a substitute for therapy. It is one of the most studied tools in addiction medicine, and for opioid use disorder it saves lives.

If someone is unresponsive, breathing slowly, or turning blue, call 911 and give naloxone if you have it. For a mental health or substance use crisis, call or text 988.

What MAT is

SAMHSA describes the use of medications, combined with counseling and behavioral therapies, as a "whole-patient" approach to treating substance use disorders. The medication does part of the job: it reduces craving, eases withdrawal, and blunts the effects of the drug so that using stops paying off. Counseling and behavioral therapy do the rest.

This is the level of care for someone whose substance use has become a medical condition, not a willpower problem. It can stand alongside the other levels in this guide. Some people take medication while in residential or day treatment; others continue it for years while living and working in the community. As SAMHSA puts it, these medications can be safe for long-term use, ranging from months to a lifetime.

The medications for opioid use disorder

SAMHSA lists three FDA-approved medications for opioid use disorder:

Buprenorphine. A partial opioid agonist that reduces craving and withdrawal. It can be prescribed or dispensed in a doctor's office, which is why access widened so much. It is often combined with naloxone in a product designed to discourage misuse.
Methadone. A long-acting full opioid agonist taken daily. Under federal law it can only be dispensed through a SAMHSA-certified opioid treatment program, not a regular pharmacy, for opioid use disorder.
Naltrexone. An opioid blocker. The injectable, extended-release form is approved to treat both opioid use disorder and alcohol use disorder and is given about once a month. It requires you to be opioid-free first, so it is not used during acute withdrawal.

NIDA's research guide notes that for methadone maintenance, 12 months is considered the minimum, and some people continue to benefit for years. Length is a clinical decision, made with your prescriber.

The medications for alcohol use disorder

SAMHSA names three common medications for alcohol use disorder: acamprosate, disulfiram, and naltrexone. They do not cure the disorder. SAMHSA says they are most effective for people who also take part in a treatment program.

If you have been drinking heavily, do not try to stop suddenly on your own. Alcohol withdrawal can be dangerous, and a clinician should supervise the first stage. Medication for alcohol use disorder is usually started after that safety question is answered.

What changed in 2023

The rules for buprenorphine changed in a way that widened access. Section 1262 of the Consolidated Appropriations Act of 2023, often called the MAT Act, removed the federal requirement for practitioners to apply for a special waiver — a DATA waiver — before prescribing buprenorphine for opioid use disorder. SAMHSA says that, with this provision, it stopped accepting waiver applications and that any practitioner with a current DEA registration including Schedule III authority may now prescribe buprenorphine, if state law permits. The change also removed the old patient limits and the counseling certification tied to the waiver.

Methadone follows different rules. It is dispensed through an opioid treatment program certified under 42 CFR Part 8. SAMHSA notes that federal law under 42 CFR 8.12 requires OTP patients to be able to receive counseling through the program, along with medical, vocational, and other services, and that patients who stabilize may earn take-home doses over time.

Where it fits and what it costs

MAT is not a separate rung that replaces the other levels of care. It can be delivered through a doctor's office, an opioid treatment program, or an outpatient or residential program, depending on the medication and your situation. The right fit comes from an assessment, the same way any other level does.

Most health plans are covered by the Mental Health Parity and Addiction Equity Act of 2008, or MHPAEA. CMS explains that for covered substance use disorder benefits, plans and insurers generally cannot apply financial requirements or treatment limits that are more restrictive than the predominant ones for medical or surgical care, including prior authorization. The law does not require a plan to cover the medication or treatment, and it does not promise a number of months. Ask your insurer whether the specific medication is on the formulary, whether prior authorization is required, and whether the program is in network. If you have Medicaid, rules vary by state.

A next step you can take today

SAMHSA's National Helpline, 1-800-662-HELP (4357), is free, confidential, and available 24/7, and can point you to programs that offer medication treatment. You can also search at FindTreatment.gov.

Call or text (800) 653-9376 to talk through the medication options and what coverage looks like for you. The call is free, and the referral service is paid for by treatment providers.

If this is an emergency, call 911. Naloxone can reverse an opioid overdose and should be on hand. For a mental health or substance use crisis, call or text 988.

Sources

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Questions about Medication-Assisted Treatment (MAT)

Is MAT just swapping one drug for another?

No. NIDA addresses this directly, explaining that methadone and buprenorphine taken as prescribed have gradual onset and stable effects, allowing people to hold jobs, avoid street crime, and stay engaged in counseling. SAMHSA describes these medicines as helping normalize brain chemistry, reduce craving, and block euphoric effects. They are medical treatments, not a substitute high.

Which medications are FDA-approved for opioid use disorder?

SAMHSA lists three: buprenorphine, methadone, and naltrexone. Naltrexone is also approved for alcohol use disorder; the injectable form is given monthly. The right choice depends on your history, health, and what you can access.

Which medications treat alcohol use disorder?

SAMHSA names acamprosate, disulfiram, and naltrexone as the most common medications for alcohol use disorder. They do not cure the disorder, and SAMHSA notes they work best for people who also take part in a treatment program.

Do I still need counseling and therapy?

SAMHSA frames medication, counseling, and behavioral therapies as a whole-patient approach. For methadone, federal rules under 42 CFR Part 8 require that patients in an opioid treatment program be able to receive counseling through the program, along with medical and other services. Medication and therapy work together, not as rivals.

Did the rules for buprenorphine change?

Yes. Section 1262 of the Consolidated Appropriations Act of 2023, known as the MAT Act, removed the federal requirement for practitioners to have a special DATA waiver before prescribing buprenorphine for opioid use disorder. SAMHSA says any practitioner with a current DEA registration that includes Schedule III authority may prescribe it, if state law permits. Methadone rules are different: it is dispensed only through a SAMHSA-certified opioid treatment program.