Medication for addiction — often called medication-assisted treatment, or increasingly medications for opioid use disorder and medications for alcohol use disorder — is among the best-supported interventions in the entire addiction field. It is also among the most underused, and the reasons are largely cultural rather than clinical: some treatment programs and communities still treat medication as a lesser form of recovery.
This guide is informational, not medical advice. Prescribing decisions belong with a qualified prescriber who knows your history. What follows is intended to help you understand the landscape well enough to ask good questions of the people providing your care.
For opioid use disorder, the evidence for medication is unusually strong. Large cohort studies and systematic reviews consistently find that treatment with methadone or buprenorphine substantially reduces mortality — including overdose deaths — compared with treatment without medication. The National Academies of Sciences, Engineering, and Medicine concluded in 2019 that withholding these medications from people with opioid use disorder is not supported by evidence.
For alcohol use disorder, meta-analytic evidence supports naltrexone and acamprosate for reducing heavy drinking and supporting abstinence, with modest but real effect sizes. Both are FDA approved, and both remain considerably less prescribed than the evidence would suggest.
The main medications
For opioid use disorder
- Buprenorphine (often combined with naloxone) — a partial opioid agonist that reduces cravings and withdrawal with a ceiling effect that lowers overdose risk. Prescribed in office-based settings by qualified clinicians.
- Methadone — a full agonist with the longest evidence base, dispensed in the United States through federally regulated opioid treatment programs rather than ordinary prescriptions.
- Naltrexone (extended-release injectable) — an opioid antagonist that blocks the effect of opioids. Requires a period of abstinence before starting to avoid precipitated withdrawal.
For alcohol use disorder
- Naltrexone — reduces the reinforcing effect of alcohol and cravings; available orally or as a monthly injection.
- Acamprosate — supports abstinence maintenance, often used after detoxification.
- Disulfiram — produces an aversive physical reaction if alcohol is consumed; most effective where dosing is supervised.
For stimulant use disorder, no medication currently has comparable FDA-approved support, and behavioral treatment — particularly contingency management, which has strong evidence — remains the primary approach.
Who can prescribe
This is the distinction that most often causes confusion. Therapists, counselors, and social workers do not prescribe medication. Psychiatrists, psychiatric nurse practitioners, physician assistants, addiction medicine physicians, and in many cases primary care clinicians do.
One regulatory note worth knowing: the federal requirement in the United States for a separate waiver to prescribe buprenorphine — the so-called X-waiver — was eliminated by the Consolidated Appropriations Act of 2023. Any clinician with a standard DEA registration that includes Schedule III authority may now prescribe it. This widened access substantially, though many clinicians have not taken it up. Methadone for opioid use disorder remains restricted to federally certified opioid treatment programs.
How therapy fits
A therapist who is medication-informed
You want a clinician who understands the medications, treats them as a full and legitimate part of recovery, and is glad to coordinate with your prescriber. The evidence on long-term maintenance with buprenorphine or methadone is strong, and a medication-informed therapist will say so plainly.
Behavioral treatment alongside
Medication addresses craving and physiology. It does not address the situations, relationships, and coping patterns around use. CBT for substance use, motivational interviewing, contingency management, and relapse prevention all have supporting evidence and are commonly delivered alongside medication.
Attention to co-occurring conditions
Depression, PTSD, ADHD, and anxiety are highly prevalent alongside substance use disorders. Treating only the substance use, or only the mental health condition, tends to produce worse outcomes than treating both, and integrated treatment is the current standard.
A release of information in place
Coordination between prescriber and therapist requires a signed release. A clinician who proposes one early is planning to actually communicate with your prescriber rather than work in isolation.
Questions worth asking
- "What is your position on medication for addiction?"
- "Do you coordinate with prescribers? Would you set up a release?"
- "What behavioral approach do you use alongside medication?"
- "Do you treat co-occurring conditions, or work with someone who does?"
- "If I am on buprenorphine or methadone long term, is that a problem in your program?"
That final question is worth asking directly of any program, including residential ones. Admission policies on medication vary, and knowing a program's policy in advance lets you pick one that fits the plan you and your prescriber have made.
- Medication for opioid use disorder substantially reduces overdose mortality.
- Naltrexone and acamprosate are supported for alcohol use disorder.
- Therapists do not prescribe; prescribers do — look for coordination between them.
- The federal X-waiver requirement for buprenorphine ended in 2023.
- Ask about a program's medication policy before enrolling, so it fits your plan.
References
- National Academies of Sciences, Engineering, and Medicine. (2019). Medications for Opioid Use Disorder Save Lives. The National Academies Press.
- Sordo, L., et al. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis. BMJ, 357, j1550.
- Jørgensen, C. H., Pedersen, B., & Tønnesen, H. (2011). The efficacy of disulfiram for the treatment of alcohol use disorder. Alcoholism: Clinical and Experimental Research, 35(10), 1749–1758.
- 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.
- Substance Abuse and Mental Health Services Administration. Medications for Substance Use Disorders. Retrieved from samhsa.gov.