Medication-Assisted Treatment vs. Abstinence-Only Rehab: What the Research Shows, Drug by Drug

Families often hear two camps argue. One says medicine is the only thing that works. The other says real recovery means no drugs at all, not even medicine. The research is clearer than either camp, and the answer depends on the drug. This page sets out what the largest research reviews found for opioids, alcohol and stimulants, why the choice is usually not either-or, and what to ask before you choose a program.

Yes, on the outcomes that matter most. The National Institute on Drug Abuse says medication should be the first-line treatment for opioid addiction, usually combined with counseling.

A Cochrane review of 11 trials, with 1,969 people, found methadone kept people in treatment and cut heroin use better than care without medicine. A second review of 31 trials found buprenorphine kept people in treatment better than a dummy pill at every dose tested.

The biggest difference is staying alive. A 2017 review in the BMJ pooled studies of more than 138,000 people. Deaths were about three times as common off methadone as on it, and about twice as common off buprenorphine as on it. The weeks just after stopping were the most risky.

Source: Methadone maintenance therapy versus no opioid replacement therapy, Mattick et al., Cochrane, 2009; Buprenorphine maintenance versus placebo or methadone maintenance, Mattick et al., Cochrane, 2014; Mortality risk during and after opioid substitution treatment, Sordo et al., BMJ, 2017.

Both have good evidence, and they work well together. Three medicines are approved for alcohol use disorder, and 12-step groups such as Alcoholics Anonymous also hold up in trials.

The National Institute on Alcohol Abuse and Alcoholism says the three medicines help people stop or reduce drinking and can be used with counseling. On the other side, a 2020 Cochrane review of 27 studies, with more than 10,000 people, found that structured 12-step programs helped more people stay sober for a full year than other proven therapies did.

Because the two approaches work in different ways, many people use both: a medicine to reduce cravings, and meetings for support.

Source: Alcoholics Anonymous and other 12-step programs for alcohol use disorder, Kelly, Humphreys and Ferri, Cochrane, 2020.

No. Addiction means compulsive use despite harm. A prescribed medicine taken as directed, under a doctor’s care, is far less likely to produce that pattern, and it lets people work, parent and stay in treatment.

The National Institute on Drug Abuse says these medicines act on the same parts of the brain as opioids, but more safely, and with far less of the harm that marks addiction. Whether and when to stop later is a choice for the person and their doctor.

Detox treats withdrawal, but it is not treatment for the addiction. The National Institute on Drug Abuse says detox without further treatment generally leads back to drug use.

Briarwood’s inpatient centers in Austin and Houston have a nurse on site 24 hours a day and a physician on call, and most stays last five to seven days. Before discharge, the next step is arranged with real dates. That can include medication for opioid use disorder continued with an outpatient prescriber, an intensive outpatient program, residential treatment or sober living.