Medication-Assisted Treatment (MAT) has historically focused on the needs of people who are addicted to alcohol or heroin and other opiates. Since the 1960s, antabuse had been the primary medication used for alcoholism, and methadone had been the primary medication used for opiate addiction. In recent years, additional pharmacological interventions have been researched and utilized. Many of the medications used in addiction medicine, including medically managed detoxification, medically assisted treatment, and medically assisted recovery fall into three basic categories: full agonists, partial agonists, and antagonists. Full opioid agonists are drugs or medications that stimulate activity at opioid receptors in the brain that are normally stimulated by naturally occurring opioids and endorphins. examples of full opioid agonists include heroin, oxycodone, hydrocodone, fentanyl codeine, and methadone. Partial opioid agonists are drugs or medications that can both activate and block opioid receptors, depending on the clinical situation. Under appropriate conditions, partial agonists can produce effects similar to those of either agonists or antagonists. Buprenorphine (Suboxone) is a partial opioid agonist. Antagonists are drugs or medications that prevent molecules of other drugs/medications from binding to a receptor (e.g., an opioid receptor). Antagonists can also displace other opioids, blocking their effects or even precipitating acute withdrawal. Naltrexone is an example of an opioid antagonist. There are many pathways to addiction recovery, and one such pathway is Medication-Assisted Recovery (MAR)—the use of medication, as prescribed and overseen by a physician (ideally an addiction medicine specialist), as part of the treatment process and to support recovery from a substance-use disorder. In some circles, Medication-Assisted Recovery is very controversial. There are those, even in the addiction treatment and the recovery communities, who view people trying to recover with the aid of medications as not being abstinent and judge them critically, even questioning the legitimacy of their recovery. This is a tragically antiquated view. Even Hazelden, the legendary organization founded on the principle that abstinence is requisite for recovery from addiction, will begin providing medication-assisted treatment for people addicted to heroin or opioid painkillers, starting at its Center City, Minnesota, facility and expanding across its treatment network in five states in 2013. From its establishment in 1949, Hazelden has championed the twelve-step method, with its roots in the principles of Alcoholics Anonymous, which became known in treatment circles as the “Minnesota Model.” The momentous shift to utilize medication such as buprenorphine (Suboxone) for some people addicted to opioids like OxyContin and Vicodin, as well as heroin, was based on science that became impossible to ignore. Studies show that for people addicted to opioids who remain on maintenance medication, the risk of death due to their addiction is reduced by more than half. They also dramatically lower their risk of contracting HIV, are far less likely to commit crime, and are more likely to stay away from their drug of choice if they continue maintenance than if they become completely abstinent. Whether or not you, as an addiction therapist, agree with the concept of medication-assisted recovery, it is essential that you accept its place in the treatment and recovery process. At the end of the day, your job is to help your client in ways consistent with his or her right to self-determination. If a medication can help him or her to stay away from more harmful substances, especially in early recovery, while he or she is participating in counseling, attending twelve-step meetings, and doing all the other things that have been recommended, why not? Increasingly, MAR is recognized as a legitimate route that, for many people, makes the difference between the continuation of active addiction and entry into recovery. This blog post is an excerpt from The therapist’s Guide to Addiction Medicine – A Handbook for Addiction Counselors and Therapists – by Barry Solof, MD, FASAM; Published by Central Recovery Press (CRP).