Medically Assisted Treatment, or MAT, is the practice of treating substance abuse by using medication. Ideally, it would be part of an overall treatment plan that involved counseling and life skills education, but that is becoming less and less important. More often than not, the dispensing of medications is the totality of an individual’s treatment. Other behavioral reformation actions are encouraged but are not required. This point is controversial and has been debated, leaving the addiction recovery field divided.   

First, let’s evaluate the effectiveness of MAT. The most popular MAT medications are methadone and suboxone. Methadone is an opiate, and suboxone is a synthetic opioid. They are usually started at the beginning of an individual’s treatment to help them get through the withdrawal process, as these drugs ease symptoms. 

It’s important to note that even those who do not support the long-term use of these drugs agree that they can be beneficial in the early stages of recovery. What many do not agree with is continuing this medication once an individual is safely through withdrawal. These drugs were initially used to mitigate withdrawal symptoms and were tapered off after a few days until the person was completely drug-free. Now, people are rarely taken off these medications, even after many years.

Treatment modalities differ when it comes to MAT. Some are long-term programs that get individuals stable on their maintenance doses while providing counseling and introducing life skills. Others are medical detox centers. The totality of treatment is taking someone off whatever substance they are addicted to and transitioning them over to some form of MAT. The thinking is individuals will no longer have cravings or be tempted to engage in risky behavior to get their drug of choice. So, they can now go on with their lives no longer burdened by their addiction. But have they conquered it?

Addiction is complex, and there is more to it than just getting the individual to abstain from drug use. There are usually underlying issues that motivate behavior, causing them to use drugs as an avoidance mechanism.

Before the introduction of MAT, substance abuse was handled with different types of counseling and other practices that focused on managing the behavioral aspect of addiction. Though many view these practices as outdated, they had enough success to be the gold standard of addiction treatment for decades. Now, these practices weren’t perfect, but they touched on something that MAT fails to address; an individual’s responsibility.

Responsibility tends to be the most significant factor that has changed in addiction treatment. Traditional treatment drove home the point that the individual was responsible for their actions. Many of the therapeutic processes involved repairing broken relationships and finding ways to acknowledge wrongdoings of the past. It also found the individual to be the cause of bad decisions, relapse and their addiction. 

Many of those in favor of MAT feel those suffering from substance abuse are not responsible for their condition. They believe that genetics and chemical imbalances are the cause of an individual’s choice to use drugs. But this becomes confusing when the person is held accountable for some decisions and not others.  How can it be that people aren’t responsible for their decisions to use drugs, but are for virtually everything else? The only way this works is if they’re responsible for nothing.

And people on each side of this argument have taken a similar black and white stance.

So, who is right?

Being responsible for nothing is how most people wound up in bad shape on drugs. So, this likely isn’t an excellent approach to treatment. But blaming a person for everything doesn’t have a positive result either. Addiction treatment would ideally give the person back layers of responsibility until they can successfully manage their lives independently and without the use of drugs and alcohol. 

Given the current state of addiction in America, I think it’s safe to say that no one is doing this correctly. Substance abuse is such a complicated condition; it will be nearly impossible to handle it with such black and white thinking. The addiction recovery community needs to put its differences aside and start working together. They may find that a real solution lies somewhere in the middle. It’s time for everyone to stop taking a stand and start making a step into the gray. 


Joseph Kertis is an experienced healthcare professional specializing in substance abuse and addiction recovery. He is a regular contributor to the healthcare website Addicted.org. Contact him on Facebook or J.Kertis@ecdol.org.