Medication-Assisted Treatment vs Abstinence-Based Treatment

Looking into treatment options for your opioid, narcotic or alcohol addiction is an important milestone. For many, it can also be overwhelming, with conflicting advice and so many programme options. We’re here to help you cut through the jargon and understand the choices available to you. 

Treatment programmes can take two main forms: MAT, medication-assisted treatment, or abstinence-based treatment.

As the names suggest, medication-assisted treatments rely on medications prescribed by medical professionals to ease withdrawal symptoms. MAT programmes also involve behavioural and psychological therapy. 

Abstinence-based treatment means abstaining from using substances altogether and relying on community support and counselling to develop the tools you need to handle the withdrawal process. 

Research shows that both approaches are effective routes to recovery when you are facing a narcotic, opioid or alcohol addiction. Which one is right for you depends on your support group, your history with addiction, your mental health, as well as your personal preferences. 

What Is Abstinence-Based Treatment? 

Abstinence is the most traditional form of addiction treatment and the one associated with the renowned 12 Step programmes of groups like Alcoholics Anonymous or Narcotics Anonymous.

Simply put, an abstinence-based treatment means going cold turkey: cutting out narcotics and alcohol completely. It is important to note that this approach includes abstaining from all substances, not only the ones to which you have an addiction. This is to prevent people from turning to other substances during rehab and becoming addicted. For example, if a person with an opioid abuse problem drinks to handle their withdrawal symptoms, this runs the risk of turning into alcohol use disorder.

Abstinence-based recovery programmes give an important place to community support, with discussion groups a key component. The active community provides a sense of accountability as well as mutual understanding and care.

There is also an emphasis on personal empowerment, participants are encouraged to take control of their lives and their recovery. The philosophy behind this approach is that, through abstaining, you build the necessary tools to handle the withdrawal process and your new life of sobriety.

What Is Medication-assisted Treatment (MAT)

Medication-assisted treatment acknowledges that addiction is a medical condition and that pharmaceuticals can play a role in recovery. MAT options use medication to prevent withdrawal symptoms and stabilise brain chemistry. The drugs used are opioids, which relieve cravings without giving patients the “high” or euphoric feelings associated with the substance of abuse.

However, medication-assisted treatments don’t end there – they take a multi-faceted approach that intertwines medications with counselling and behavioural therapies to tackle substance use disorders.

MAT has many merits. The doctor-prescribed medications reduce withdrawal symptoms, which research shows to be the most common reason for relapse. Removing the cravings associated with early recovery, MAT allows individuals to remain motivated and focused on their recovery without having to handle intense cravings. This can enable a more manageable recovery.

Harm reduction is also a pivotal aspect of MAT. Using medications to avoid relapse is intended to decrease the risk of an overdose or other harmful consequences of drug use, such as: 

  • Financial issues
  • Relationship difficulties
  • Legal repercussions 
  • Health problems 

Which Medications Are Used in Medication-assisted Treatment? 

Medication-assisted treatment is evolving rapidly as new medications enter the market. In the UK, the most commonly used opioid antagonists or blockers are Naloxone and Naltrexone. Naltrexone is prescribed for opioid use disorder and alcohol use disorder. 


Naloxone is an emergency treatment for opioid overdose. When taken, it binds to opioid receptors in the brain, displacing opioids and temporarily reversing the breathing problems caused by the overdose.

Naloxone can be administered through a vein, into a muscle, or sprayed into the nose. In recent years, naloxone has been made more widely available for non-medical professionals, including friends and family members of individuals at risk of opioid overdose.


Naltrexone is also an opioid receptor antagonist, this time used as a long-term treatment to help individuals maintain abstinence. For people who have already detoxified from opioids or alcohol, Naltrexone can be used to prevent relapse. It works by blocking opioid receptors, reducing the euphoria-inducing effects of these substances.

Naltrexone comes in two main types: pills you can swallow and an injection that slowly releases the medicine over a few weeks. The pill is taken every day, while the injection is given once a month. Most people take the treatment for at least 12 weeks.  

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What to Consider When Choosing Between Medication-Assisted and Abstinence-Based Treatments

Both approaches have their merits and proven success in helping people overcome their addictions. The best approach always depends on the situation and the individual. It is worth considering the unique advantages of each option when you are making your decision. 

Medication-Assisted Treatments Take a More Personalised Approach 

By combining pharmaceutical, behavioural and psychological treatments, Medication-Assisted Treatments can be easily tailored to individual needs based on factors such as the type of substance use disorder, its severity, and the individual’s relapse history. 

This personalised approach recognises the diversity of addiction experiences and plans interventions accordingly.

Abstinence-based treatments, on the other hand, tend to adopt a more generalised model. This one-size-fits-all approach can favour peer-to-peer mentoring and a sense of community. However, it can overlook the unique challenges and needs of individuals on their recovery journey. For instance, abstinence-based programmes may not take into account co-occurring mental health issues, such as depression or anxiety, that an MAT approach would handle at the same time as the addiction. 

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Medical-Assisted Treatments Have a Better Overall Effectiveness 

Scientific findings indicate that Medication-Assisted Treatment is more effective than abstinence-only methods, particularly in reducing relapse rates and promoting sustained recovery from opioid and alcohol addiction. 

According to one study, nearly half (49%) of individuals utilising MAT successfully controlled their opioid dependence, compared to only 7% of those participating in abstinence-based programmes.

Abstinence-based approaches, while widely embraced and beneficial for many, may not be equally effective for everyone. Success in these programmes often depends on an individual’s commitment and the availability of a supportive community. 

Abstinence-based programmes have more prerequisites for success, most notably a strong support system. 

MAT Addresses Co-occurring Mental Health Issues 

Since medications can be prescribed both for tackling your addiction and other mental health symptoms, MAT can be particularly beneficial for individuals with a dual diagnosis. 

Abstinence-based approaches may require additional mental health interventions to address co-occurring disorders. Peer-to-peer counselling sessions cannot provide the same level of expertise as a professional therapist. 

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Medical-Assisted Treatments and Abstinence-Based Treatments Take a Different Approach to Counselling 

In MAT, counselling is seen as key to addressing the psychological aspects of addiction. Cognitive-behavioural therapy (CBT) helps individuals identify and modify negative thought patterns and foster healthier coping mechanisms. Contingency management, another behavioural therapy often included in MAT, uses positive reinforcement to encourage abstinence.

Abstinence-based programmes explore the root causes of addiction and teach coping strategies for a sober lifestyle. Common therapeutic techniques include motivational enhancement therapy (MET), which is focused on enhancing your inner motivation for change. Dialectical behaviour therapy (DBT) develops skills to deal with emotional distress, which can be applied to the challenges of recovery. 

Your Personal Preferences Matter

Many recovering addicts prefer abstaining from medications during rehab. If you want to take an approach that doesn’t include opioids, that is completely understandable. 

On the other hand, if you are wary of withdrawal symptoms and wish to make the detoxification process more manageable, MAT is an equally valid choice. 

Your motivation and long-term goals are crucial components of your recovery, so your treatment plan must align with your preferences. 

Overcoming the Stigma of Medication-Assisted Treatment 

Sadly, MAT continues to face stigma, including from some treatment providers. A 2019 study of 997 participants found that one-third believed that “medication-assisted-treatment. substitutes one addiction for another.”

This is a harmful misconception. Addiction is a medical condition, and medications that alleviate symptoms and restore brain chemistry have proven efficient in helping patients achieve long-term sobriety. There is no shame in using medication as part of your recovery journey – no more so than taking an aspirin for a headache or a Gaviscon for heartburn.  

Can I Do Both? Integrating MAT and Abstinence-Based Approaches

Recognising the strengths of both MAT and abstinence-based approaches, some treatment providers are exploring integrated programmes that combine elements of both. 

This hybrid approach aims to combine the benefits of medication with the all-encompassing philosophy and supportive community of abstinence-based programmes. The idea is to provide a more comprehensive and flexible framework that can be adapted to individual recovery journeys.

If you’re unclear about which treatment fits your situation or would like to discuss your options further, get in touch with Smarmore Castle today. Our clinic is completely confidential, non-judgemental, and here to give you the resources you need on your recovery journey. 

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