Medication-Assisted Treatment, commonly called MAT, is the use of FDA-approved medications in combination with behavioral therapy and counseling to treat substance use disorders. MAT is endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Society of Addiction Medicine (clinical), the American Medical Association, and the World Health Organization as a first-line, evidence-based treatment for opioid use disorder and alcohol use disorder.
Despite that overwhelming clinical consensus, MAT remains dramatically underutilized in the United States, and the stigma surrounding it continues to cost lives across the Roanoke Valley and the broader Southwest Virginia region. If your family has felt that stigma, we hear it often. The science has settled.
Roanoke Refuge prescribes FDA-approved MAT medications on-site as part of PHP, IOP, and Telehealth IOP. The medication and the therapy are one integrated plan, not two parallel tracks. Our treatment approach describes the broader clinical model.
What MAT Is, and What MAT Is Not
The most common misconception about MAT is that it simply trades one addiction for another. We hear it on the first call all the time, often from family members who have been told this by people they trust. That belief reflects a fundamental misunderstanding of what addiction is.
Addiction is defined by compulsive use despite harmful consequences, not by physical dependence. A person taking buprenorphine as prescribed, engaging in therapy, maintaining employment, caring for family, and not experiencing harmful consequences is not addicted to buprenorphine. They are managing a chronic brain disease with a medication, in the same way a person with diabetes manages their condition with insulin.
The clinical evidence on this point is unambiguous. MAT for opioid use disorder reduces overdose mortality by 50 percent or more, reduces illicit opioid use, reduces criminal activity, reduces infectious disease transmission, and improves treatment retention (NIDA, 2024). Withholding MAT from people with opioid use disorder because of stigma is a clinical and ethical failure. We will not participate in that failure, which is why MAT is prescribed by our medical team directly inside the program rather than treated as an outside referral.
What MAT in the program looks like, week to week
MAT at Roanoke Refuge is prescribed, dispensed, and monitored on-site by our medical team. There is no separate prescriber to coordinate with for the medications we offer — the prescriber is part of your treatment team and meets with you inside the program. The medical visit cadence is set by which medication you are on: weekly during induction and stabilization, then monthly once the regimen is stable.
For buprenorphine (Suboxone, Subutex, Sublocade, Brixadi) and naltrexone (oral and Vivitrol monthly injection), prescriptions are written by our medical team and either filled at a partner pharmacy or administered on-site (in the case of long-acting injectables). For acamprosate and disulfiram for alcohol use disorder, the same applies.
The exception is methadone, which under federal law can only be dispensed through certified Opioid Treatment Programs. Clients on methadone continue with their existing OTP — most commonly the Roanoke Valley Comprehensive Treatment Center — and our clinical team coordinates clinical care around that medication.
If you arrive already on MAT from an outside prescriber, you can either continue that relationship while we provide the clinical work, or transition the prescription to our medical team. Either path is normal; what fits depends on your situation. You will never be forced to switch prescribers as a condition of admission.
FDA-Approved MAT Medications for Opioid Use Disorder
Buprenorphine (Suboxone, Subutex, Sublocade, Brixadi)
Buprenorphine is a partial opioid agonist that binds to opioid receptors, reducing cravings and withdrawal symptoms without producing the full euphoric effect of full opioid agonists at standard doses. It is available in sublingual film or tablet formulations taken daily at home, and as an extended-release injectable formulation administered monthly.
Buprenorphine can be prescribed from a physician’s office or clinic rather than requiring daily observed dosing at a specialized clinic. It is one of the most life-saving medications in addiction medicine, and it is significantly underprescribed relative to the regional need. If you have heard buprenorphine is “not real recovery,” that is stigma talking, not science. Our medical team prescribes buprenorphine on-site as part of treatment.
Naltrexone (Vivitrol, Oral Naltrexone)
Naltrexone is a full opioid antagonist that completely blocks opioid receptors, preventing any opioid from producing its effects. It is available as a daily oral tablet or as a monthly extended-release injectable (Vivitrol).
Naltrexone requires full opioid detoxification before initiation. Attempting to start naltrexone without full detox will precipitate immediate, severe withdrawal. The medication is well-suited for highly motivated clients who have completed medical detox and want a pharmacological barrier to relapse. Naltrexone is also FDA-approved for alcohol use disorder. Our medical team prescribes naltrexone on-site for both indications.
Methadone
Methadone is a full opioid agonist that has been used in opioid use disorder treatment for more than 50 years. By federal regulation it must be administered through a federally licensed Opioid Treatment Program (OTP) under direct observation, at least during the initial phase of treatment. Methadone is highly effective for severe opioid use disorder, particularly for clients who have not responded well to buprenorphine.
Methadone is dispensed only through federally licensed Opioid Treatment Programs. Clients who are candidates for methadone are referred to local OTPs including the Roanoke Valley Comprehensive Treatment Center, and our clinical team coordinates with the OTP so the methadone treatment and the outpatient therapy work as one plan.
FDA-Approved MAT Medications for Alcohol Use Disorder
Naltrexone for Alcohol Use Disorder
Naltrexone blocks the euphoric and reinforcing effects of alcohol, reducing cravings and the rewarding aspects of drinking. The extended-release injectable formulation (Vivitrol) is particularly effective because adherence is guaranteed for the full 30-day dosing interval. Naltrexone is one of the most well-supported pharmacological treatments for alcohol use disorder and is prescribed by our medical team on-site as part of treatment.
Acamprosate (Campral)
Acamprosate reduces the prolonged post-acute withdrawal symptoms, including anxiety, insomnia, dysphoria, and restlessness, that persist for weeks to months after acute alcohol withdrawal and are a major driver of recurrence. It is most effective in clients who have already achieved abstinence and is taken three times daily. Our medical team prescribes acamprosate on-site as part of treatment.
Disulfiram (Antabuse)
Disulfiram creates a severe aversive reaction if alcohol is consumed, including flushing, nausea, vomiting, and palpitations, which serves as a behavioral deterrent. The medication requires strong motivation and medical monitoring and is used less commonly than naltrexone or acamprosate because of adherence challenges. For the right client, it is an effective tool. Our medical team prescribes disulfiram on-site as part of treatment.
How MAT Works Inside PHP and IOP
When you enter PHP or IOP, the medication is part of your treatment plan from the assessment forward, not bolted on later. Here is what that looks like in practice:
- Intake conversation covers your substance use history, prior medication trials, current medications, and clinical picture.
- The medical team meets with you to discuss whether MAT fits, which medication, and at what dose.
- Subsequent appointments handle ongoing prescribing, dose adjustments, side-effect management, and integration with your therapy work.
Group and individual therapy address MAT-related stigma directly in psychoeducation so the clients in the room who are not on MAT understand what the medication is doing for the clients who are. That conversation matters. It is part of why people on MAT often feel safer disclosing it here than they did in previous programs.
Starting MAT at Roanoke Refuge
If you are not yet on MAT but may be a candidate, our medical team initiates MAT directly as part of your treatment plan. The intake conversation determines candidacy, the medical team meets with you to discuss the options and the medication, and the prescription is written and managed through the program.
The historical X-waiver requirement for prescribing buprenorphine was eliminated in 2023, which has expanded the regulatory environment in which we operate. The clinical bar remains the same: appropriate prescribing, appropriate monitoring, appropriate integration with the therapy.
If you are already on MAT from another provider, you have two options. The medical team can either continue your existing prescription through our program (the simpler path in most cases), or we can coordinate with your existing prescriber so the medication treatment and the outpatient program stay aligned. The admissions conversation walks through which approach fits your situation.
Dual Diagnosis and MAT
Many clients who benefit from MAT are also living with co-occurring mental health conditions such as depression, anxiety, post-traumatic stress disorder, or bipolar disorder. If that describes you, the medication for the substance use disorder and the medication or therapy for the mental health condition need to work together rather than at cross purposes.
Untreated mental health conditions are among the most consistent biological drivers of recurrence of symptoms (what some still call relapse). Treating the substance use without treating the underlying mental health condition is like treating the smoke while leaving the fire burning. Our dual diagnosis program treats both at the same time, in the same setting, with MAT prescribed by our medical team and psychiatric medication coordinated with the appropriate prescriber.
Local, regional, and accessible.
Roanoke Refuge delivers this level of care from a facility at 1630 Braeburn Drive in Salem, Virginia — just off I-81 exit 137 and a short drive south of downtown Roanoke via I-581. The service area covers the full Roanoke Valley: Roanoke City, Salem, Vinton, and the surrounding counties of Roanoke, Botetourt, and Bedford. Most clients are within 30 minutes of the facility.
If you are weighing whether this program is the right fit, the answer is rarely obvious on your own — and it is exactly what the admissions team is built to help with. A short, free, confidential call walks through level of care, insurance benefits, and what the first week will actually look like. Free insurance verification happens during the same call. Call (540) 900-0353 when you are ready.