Medication Assisted Treatment for Addiction: How Medical Care Improves Recovery Outcomes
Can medication, combined with therapy and psychosocial support, improve safety and long term recovery outcomes for people with substance use disorder?
Medication-assisted treatment (MAT) for addiction is the use of FDA and SAHPRA-approved medications, alongside counselling and behavioural therapy, to treat substance use disorders. The medications manage withdrawal, reduce cravings, and stabilise co-occurring mental health conditions. Medication on its own does not treat addiction. Medication combined with proper clinical therapy and a structured rehab programme is what produces durable recovery.
For South African families looking at private rehab, the question is usually clinical and practical: is the rehab properly staffed to deliver this safely, and does medication management actually happen on-site or is it outsourced? At Changes Addiction Rehab in Johannesburg, every client undergoing detox is assessed and managed by an addiction psychiatrist, medical doctors, registered nurses on 24-hour duty, and addiction counsellors working as one multidisciplinary team. Medication is prescribed and monitored throughout, not handed off.
The criteria below draw on the evidence base compiled by the European Association for the Treatment of Addiction (EATA) and align with NIDA and SAMHSA guidance on the role of medication in substance use disorder treatment. The article walks through what medications do at each stage of treatment, with links to the Changes pages that evidence how each is delivered.
What Medication Assisted Treatment for Addiction Actually Does
Medication assisted treatment for addiction has four jobs, and a quality rehab programme uses medication for any combination of them depending on the substance and the patient.
| Stage | What Medication Does | Common Examples |
|---|---|---|
| Detox and withdrawal | Manages physical withdrawal safely, prevents fatal complications | Benzodiazepines (alcohol/GHB), clonidine (opiates), baclofen, NAC |
| Alcohol craving control | Blocks pleasure response, reduces urges, deters drinking | Naltrexone, acamprosate, disulfiram |
| Opioid substitution and craving control | Replaces illicit opioids with monitored doses, blocks euphoria | Methadone, buprenorphine (Suboxone), naltrexone |
| Co-occurring mental health | Stabilises depression, anxiety, psychosis, sleep, mood | Antidepressants, mood stabilisers, antipsychotics, sleep aids |
Each row is covered in detail below. The important point is that medication is matched to clinical need, not prescribed to anyone walking through the door. At Changes, medication decisions are made by an addiction psychiatrist and medical doctors who assess each patient on admission and adjust the regimen as withdrawal progresses.
Medications for Detox and Withdrawal
Detox is the first phase of any inpatient treatment programme and it is also the most medically risky. Withdrawal symptoms range from uncomfortable to fatal depending on the substance, the duration of use, and the patient’s underlying health. Around 50% of alcoholics experience withdrawal, 4% develop severe symptoms, and up to 15% of those die without proper supervision. This is why detox is medically managed, not handed to the patient to handle alone.
Medication during detox does three things: it manages the worst withdrawal symptoms, prevents life-threatening complications such as seizures and delirium tremens, and reduces cravings during the highest-risk window. The peak danger period for alcohol withdrawal is the 24 to 72-hour window after the last drink. Read more on the Changes medical detox process, which describes how withdrawal is clinically managed from admission through to stabilisation.
Common withdrawal symptoms include anxiety, depression, nausea, insomnia, muscle aches, shaking and sweating. The medications below are the ones most commonly prescribed at South African inpatient facilities including Changes.
Benzodiazepines
Benzodiazepines reduce anxiety and irritability during withdrawal. They are themselves addictive and require careful clinical supervision, but short-term use is genuinely life-saving in cases of severe alcohol and GHB withdrawal where the alternative is seizures or death. Patients who enter treatment with an existing benzodiazepine addiction are tapered: smaller and smaller doses over time to avoid the potential life-threatening symptoms of severe benzodiazepine withdrawal.
Antidepressants
Patients in early recovery often experience profound depression because their brain chemistry has adapted to the substance and now has to recalibrate without it. Antidepressants are prescribed to manage this period and to support clients who have an underlying depressive disorder that the addiction was masking.
For some patients antidepressants are short-term, used during the brain’s adjustment phase. For others, particularly those whose depression preceded the addiction, longer-term medication is appropriate. The decision is clinical, not formulaic, and at Changes it is made by the addiction psychiatrist on the multidisciplinary team.
Sleep aids
Insomnia is one of the most common withdrawal symptoms and a major reason patients leave treatment early when it is not managed. Sleep aids prescribed during detox typically include atypical antipsychotics, older sedating antidepressants, and antihistamines. Popular Z-drugs like zolpidem are deliberately avoided because they carry their own dependence risk.
Clonidine
Clonidine is a blood pressure medication used off-label for alcohol and opiate withdrawal. It reduces sweating, cramps, muscle aches and anxiety, and helps prevent tremors and seizures. It is particularly useful for opioid withdrawal because it manages the autonomic symptoms (raised heart rate, sweating, agitation) that make opioid detox feel intolerable.
Baclofen
Baclofen is a muscle relaxant used in alcohol and GHB withdrawal. It reduces symptoms and helps prevent life-threatening events such as seizures, particularly in patients who cannot tolerate benzodiazepines or whose history makes benzodiazepine prescribing risky.
NAC (N-acetylcysteine)
N-acetylcysteine (NAC) is an over-the-counter antioxidant with growing evidence as an add-on treatment for withdrawal and craving control across multiple drug classes. It has not been formally approved for addiction treatment by regulatory bodies, which means it is used adjunctively rather than as a primary therapy. NAC is increasingly used both during detox and as longer-term relapse-prevention support, partly because it is inexpensive and has minimal side effects.
Medications for Alcohol Addiction
Three medications are approved internationally for the treatment of alcohol use disorder. They work by different mechanisms: blocking pleasure, reducing emotional distress, or making drinking physically unpleasant. The right one depends on the patient’s drinking pattern, motivation level, and medical history, and prescribing decisions at Changes are made by the addiction psychiatrist after a full clinical assessment.
Naltrexone
Naltrexone blocks the brain receptors that produce alcohol’s pleasurable effects, which means a patient who drinks while taking naltrexone gets little reward from it. It also reduces cravings, which is the main reason it works for relapse prevention. Naltrexone is available as a daily tablet or as a monthly long-acting injection.
Acamprosate
Acamprosate reduces the emotional and physical distress associated with early alcohol abstinence, including the anxiety and low mood that follow detox and drive many patients back to drinking. It is prescribed after detox is complete, usually as part of an aftercare or relapse-prevention plan rather than during the inpatient phase.
Disulfiram (Antabuse)
Disulfiram, sold as Antabuse, causes a severe and immediate adverse reaction (nausea, vomiting, flushing, rapid heart rate) if the patient drinks alcohol. The reaction makes drinking physically unpleasant enough to act as a deterrent. Disulfiram works best for highly motivated patients with strong supervision because compliance is the limiting factor: a patient who wants to drink can simply stop taking it.
Medications for Opioid Addiction
Common opioids include heroin, morphine, codeine and prescription painkillers such as oxycodone and tramadol. Three medications are internationally approved for opioid use disorder treatment, and they are the medications featured in WHO, NIDA and SAMHSA guidance on the condition. They work in different ways and the clinical choice depends on the patient’s risk profile and treatment goals.
Methadone
Methadone is a synthetic long-acting opioid used in opioid substitution therapy. It relieves cravings and withdrawal by acting on the same brain receptors as heroin and morphine, but it activates them more slowly and steadily, which means it does not produce a euphoric high in someone with established opioid tolerance. Stopping methadone abruptly produces withdrawal, so it must be tapered under supervision. Methadone programmes are tightly regulated in South Africa and require specialist prescribing.
Suboxone (buprenorphine)
Buprenorphine is a partial opioid agonist. It activates the opioid receptors less strongly than full opioids like heroin or methadone, which means it relieves cravings and withdrawal without producing the same level of high. The naloxone component is included as an abuse deterrent: it stays inactive when Suboxone is used as prescribed, but produces immediate withdrawal if injected. Like methadone, Suboxone must be tapered rather than stopped abruptly.
Naltrexone (for opioid addiction)
Naltrexone is a full opioid antagonist. It blocks the opioid receptors completely, which means a patient using opioids while on naltrexone gets no euphoric or sedative effect. It also reduces cravings.
Unlike methadone and Suboxone, naltrexone is not itself an opioid, so it is not addictive and produces no withdrawal symptoms if stopped. It works best in highly motivated patients who have already completed opioid detox, since starting naltrexone too early produces severe precipitated withdrawal.
Medications for Co-occurring Mental Health Conditions
More than 50% of patients entering Changes for addiction treatment have an underlying psychiatric condition that needs to be treated alongside the addiction. Sometimes the mental health condition predates the substance use. Sometimes it has been triggered or unmasked by it. Either way, treating only the addiction while leaving the mental health condition untreated is the most reliable way to ensure relapse.
Psychiatric medications used during addiction treatment include antidepressants for depression, mood stabilisers for bipolar disorder, antipsychotics for psychotic features or severe agitation, and anti-anxiety medication used cautiously because of its dependence potential. The specific prescription depends entirely on the diagnosis, which is why the assessment matters so much.
At Changes, every client is assessed on admission by an addiction psychiatrist and a medical doctor to identify the mental health diagnoses that need to be treated alongside the substance use disorder. The treatment plan is integrated, with both conditions managed by the same multidisciplinary team rather than referred out separately.
Medical Supervision Is the Difference Between Safe and Unsafe Detox
Medication assisted treatment for addiction works only if the medication is properly assessed and prescribed, then monitored and adjusted as the patient moves through detox and into early recovery. The medications themselves are powerful and most of them carry their own risks. Without 24-hour clinical oversight, those risks are real: misdosing, dangerous interactions, missed mental health diagnoses, untreated co-occurring conditions, or simply patients leaving treatment because the withdrawal was not managed properly.
Changes Addiction Rehab in Johannesburg runs medical detox and primary care from a 16-bed facility in Northcliff with 24-hour nursing cover, a doctor on call, and an addiction psychiatrist on the clinical team. Medication decisions are made on admission, reviewed daily during detox, and adjusted as the patient stabilises. Read about how the Changes detox process works, or move straight to the Primary Care programme for the full continuum of inpatient treatment.
If you are weighing up rehab options for yourself or a family member, the most useful next step is an obligation-free clinical assessment. A short conversation with the Changes admissions team will clarify which substances are involved, what level of medical supervision is appropriate, and how medical aid coverage works for your situation.
Contact Changes for an obligation-free assessment or call our admissions team on 081-444-7000.
Medication assisted treatment for addiction reduces withdrawal risk and supports recovery. See how Changes Rehab delivers MAT under medical supervision.. Changes team counsellors are here to help you.Medication Assisted Treatment for Addiction | Changes Rehab
