Exploring MAT & Alcoholism: Insights Into Medication-Assisted Treatment For Alcohol

Alcohol Use Disorder (AUD) is a chronic, relapsing condition characterised by compulsive alcohol consumption, loss of control over drinking, and negative emotional states when not drinking1. Alcoholism presents a profound global health challenge, affecting an estimated 400 million people worldwide2 – 7% of the global population over the age of 15 – and contributing to over 2.5 million deaths annually, according to the World Health Organization (WHO). 

Beyond physical health consequences – such as liver disease, cardiovascular complications, and neurological impairment – AUD is also associated with significant psychiatric comorbidities, including depression, anxiety disorders, and suicidality3.

Despite the availability of psychosocial interventions, achieving long-term abstinence remains difficult for many individuals. Relapse rates for AUD are high, with studies suggesting that up to 60-80% of individuals relapse within the first year post-treatment4. 

Medical assisted treatment (more commonly known as “medication-assisted treatment”) for alcohol (MAT) is an evidence-based intervention designed to improve recovery outcomes by integrating pharmacotherapy with behavioural and psychosocial support. Unlike traditional abstinence-only models, MAT targets the neurochemical dysregulation seen in AUD5, mitigating cravings, withdrawal symptoms, and the reinforcing effects of alcohol. 

Despite its clinical validity, MAT remains underutilised – a gap largely driven by stigma6, limited provider awareness, and systemic barriers to access. For healthcare professionals, improved understanding around the mechanisms, clinical applications, and best practices for integrating MAT can yield a significant and positive impact on patient outcomes. 

What is MAT? 

“Medication-Assisted Treatment (MAT) refers to the use of medication alongside psychological and social support in the treatment of people who are experiencing issues with their drug [or alcohol] use.”7

• Public Health Scotland 

Medication-Assisted Treatment (MAT) is an evidence-based therapeutic approach that integrates pharmacological interventions with psychological and social support to enhance recovery outcomes for individuals with substance use disorders (SUDs), including alcohol use disorder (AUD)8. 

Unlike traditional abstinence-only models, MAT recognises addiction as a complex medical condition with neurobiological, behavioural, and environmental components, requiring a multifaceted approach to treatment.

MAT for alcohol dependence focuses on three primary goals:

1. Reducing alcohol cravings and withdrawal symptoms: addressing the neurochemical imbalances caused by chronic alcohol use.
2. Blocking the reinforcing effects of alcohol: preventing the pleasurable or intoxicating effects that drive continued drinking.
3. Supporting long-term abstinence and relapse prevention: enhancing adherence to treatment plans through pharmacotherapy and behavioural interventions.

It’s worth noting though that medication alone is insufficient for sustained recovery9. 

MAT must be combined with psychotherapy, counseling, and social support systems to address the underlying psychological and behavioural factors contributing to alcohol dependence.

The clinical perspective

From a clinical standpoint, MAT represents a paradigm shift in the treatment of alcohol use disorder, moving away from purely behavioural models toward integrated, evidence-based interventions. The primary advantage of MAT is its ability to address the neurobiological underpinnings of addiction10, particularly the dysregulation of dopaminergic, glutamatergic, and opioid pathways that contribute to alcohol dependence.

Key clinical considerations include:

• Neurobiological mechanisms: chronic alcohol use disrupts neurotransmitter homeostasis, increasing dopamine release in the mesolimbic pathway (reinforcement) while impairing inhibitory control11. MAT targets these pathways to restore balance and reduce cravings.
• Patient-centered treatment plans: the selection of pharmacotherapy must be individualised, considering factors such as comorbid conditions (bipolar disorder, schizophrenia, serious mental illness), liver function, medication adherence, and treatment goals.
• MAT & behavioural therapies: cognitive-behavioural therapy (CBT), contingency management, and motivational enhancement therapy (MET) are commonly used alongside MAT to address psychosocial triggers, emotional regulation, and behavioural reinforcement patterns.
• Efficacy & clinical outcomes: studies have shown that patients receiving MAT for alcohol dependence have higher rates of abstinence, fewer heavy drinking days, and improved psychosocial functioning12 compared to those receiving behavioural interventions alone.

Despite compelling evidence, MAT remains underutilised in both primary care and specialist addiction services13. Expanding its role in clinical practice requires education, policy reform, and the destigmatisation of pharmacological treatments in addiction care.

Medication-assisted treatment for alcohol addiction

Which medications are effective?

Several medications are licensed for Alcohol Use Disorder (AUD) treatment in the UK, with strong clinical evidence supporting their role in reducing alcohol cravings, withdrawal symptoms, and relapse rates:

• Naltrexone (available in oral form in the UK) is an opioid antagonist that helps reduce the reinforcing effects of alcohol14, making drinking less rewarding. Clinical studies indicate that naltrexone can reduce heavy drinking episodes by 25-30% in treatment-seeking individuals. However, it is not suitable for patients with significant liver impairment and is typically prescribed alongside psychological support.
• Acamprosate (Campral) works by modulating glutamatergic neurotransmission, helping to restore the brain’s chemical balance following prolonged alcohol use. It is particularly effective for maintaining abstinence, with research showing a marked improvement in relapse prevention compared to placebo15. Acamprosate is best suited for patients who have already stopped drinking and are committed to long-term recovery.
• Disulfiram (Antabuse) is an aversive agent that blocks aldehyde dehydrogenase, causing unpleasant physical reactions – such as nausea, flushing, and palpitations – if alcohol is consumed16. While its effectiveness depends on adherence, supervised administration has been shown to improve compliance and treatment outcomes.
• Baclofen and Topiramate are occasionally used off-label in the UK for alcohol dependence as anticraving agents, particularly in individuals who do not respond to first-line treatments17. Baclofen, a GABA agonist, has been investigated for its role in reducing alcohol cravings, while topiramate, originally an anticonvulsant, has demonstrated potential in reducing heavy drinking episodes. However, neither medication is routinely recommended under NICE guidelines for alcohol dependence.

How are these medications integrated into a treatment plan?

“Medications are an indispensable element of MAT methods – but they aren’t the only component of such treatment […] MAT combines pharmacological treatment (medications) with behavioural treatment (eg., evidence-based therapies) that is tailored to a patient’s unique needs.”18

• American Addiction Centers

Successful Medication-Assisted Treatment (MAT) requires a multidisciplinary approach, incorporating medical, psychological, and social support to maximise treatment outcomes. Adopting a whole-person perspective, clinicians should conduct a comprehensive assessment, considering:

1. Medical history and liver function – this is particularly important when prescribing naltrexone, which is contraindicated in significant liver disease.
2. Severity of withdrawal symptoms – in some cases, acute withdrawal may require the short-term use of benzodiazepines in a medically supervised detox setting.
3. Co-occurring mental health conditions – many individuals with AUD experience depression, anxiety, or severe psychiatric disorders, necessitating integrated psychiatric care.
4. Patient motivation and adherence – the choice between daily oral medications (acamprosate, naltrexone, disulfiram) and potential long-acting formulations (which are not widely available in the UK) depends on individual patient factors and support systems.
5. Ongoing monitoring and support – regular follow-ups are essential to track treatment progress, side effects, and adherence. Many patients benefit from structured addiction services, where MAT is combined with counselling, relapse prevention therapy, and peer support.

Which behavioural treatments complement MAT? 

While medications modulate neurochemical pathways, behavioural interventions work in tandem to target maladaptive cognitive and emotional patterns that perpetuate alcohol dependence. Some evidence-based modalities include:

• Cognitive-Behavioural Therapy (CBT): addresses maladaptive thought patterns, reducing the likelihood of relapse triggers.
• Motivational Interviewing (MI): enhances intrinsic motivation for behavioural change, particularly in ambivalent patients.
• Contingency Management (CM): employs positive reinforcement strategies19 to promote abstinence.

Ultimately, an integrative approach – combining MAT with psychotherapy – yields superior outcomes compared to either modality alone, reinforcing the necessity for whole-person treatment models.

Seek help for alcohol use or make a referral today

For healthcare practitioners, identifying candidates for MAT and ensuring timely referrals are critical in addressing the health burden of alcohol use disorder20. 

At Harbor London, we offer comprehensive addiction treatment services, incorporating state-of-the-art pharmacological interventions, psychological therapies, and individualised recovery planning. Whether you are a clinician seeking guidance on MAT implementation or an individual in need of specialised support, our team is here to help.

To learn more about Medication-Assisted Treatment for alcohol, or to refer a patient, contact Harbor London today.

References 

1. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder 
2. https://www.who.int/news-room/fact-sheets/detail/alcohol
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC7006178/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC8476113/
5. https://medschool.cuanschutz.edu/docs/librariesprovider294/default-document-library/mat-overview-10-28-2020.pdf?sfvrsn=5b388db9_0
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC6007012/#:~:text=Misinformation%20and%20stigma%20about%20MAT,and%20contribute%20to%20its%20underuse.&text=The%20discourse%20surrounding%20%E2%80%9Copioid%20substitution,than%20treating%20the%20underlying%20disorder.
7. https://publichealthscotland.scot/population-health/improving-scotlands-health/substance-use/treatment/medication-assisted-treatment-mat-standards/overview/
8. https://americanaddictioncenters.org/addiction-medications
9. https://ukhsa.blog.gov.uk/2020/11/17/alcohol-dependence-and-mental-health/
10. https://www.matclinics.com/matclinics-blog/mat-a-neurobiological-approach-to-addiction-recovery#:~:text=Medication%20Assisted%20Treatment%20(MAT)%20harnesses,underlying%20neurobiological%20mechanisms%20of%20addiction.
11. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.965142/full#:~:text=The%20disruption%20of%20neurochemical%20homeostasis,synaptic%20signaling%20in%20the%20brain.
12. https://www.sciencedirect.com/science/article/pii/S1043661824003992
13. https://pubmed.ncbi.nlm.nih.gov/31125801/
14. https://www.alcoholhelp.com/treatment/naltrexone/
15. https://pmc.ncbi.nlm.nih.gov/articles/PMC3277871/
16. https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-024-00522-1
17. https://journals.lww.com/inpj/fulltext/2019/28010/comparison_between_baclofen_and_topiramate_in.8.aspx#:~:text=Baclofen%20and%20topiramate%20are%20GABAergic,but%20none%20has%20compared%20them.
18. https://americanaddictioncenters.org/addiction-medications
19. https://pubmed.ncbi.nlm.nih.gov/40064640/

https://www.theguardian.com/society/article/2024/may/17/27bn-a-year-spent-in-england-on-harm-done-by-alcohol-study-finds