Medically Sound takes on recovery’s most complex questions

Medication-assisted treatment (MAT)—particularly for opioid use disorder—is one of the most discussed and misunderstood tools in the treatment space. At Recovery Unplugged, we sat down with Dr. Michael Ferri, board-certified in Psychiatry and Addiction Medicine, to help demystify MAT, break down how it works, and clarify what people can really expect from it.

Here’s what he had to say.

Thank you so much for speaking with me today. To begin, could you please introduce yourself and share how you came into your current role at Recovery Unplugged?

Dr. Ferri: Sure. My name is Dr. Michael Ferri, and I’m an addiction psychiatrist and the Medical Director at Recovery Unplugged Nashville, where I’ve had the pleasure of working since 2018. I’ve been practicing medicine for over two decades, within the specialty of psychiatry and addiction medicine. Recovery Unplugged found me at a time when I had both the experience and availability to take on a medical director role. I helped launch our Nashville facility, and I can honestly say it’s one of the healthiest, most collaborative teams I’ve ever worked with.

What inspired you to focus on addiction?

Dr. Ferri: I went to medical school planning to go into psychiatry, but I also loved the hands-on side of medicine—emergency care, palliative care, even obstetrics. What drew me to addiction work is that it brings both sides together. Addiction is deeply tied to mental illness, but it also involves very physical conditions—liver issues, infections, cravings, especially in early treatment. It’s a space where you can use both your medical and psychiatric training and really see the impact of your work. People often come in at their lowest point, and as they stabilize, you see the change happen in real time. That’s incredibly meaningful to me.

Why is MAT such an important part of recovery treatment today?

Dr. Ferri: MAT is especially important in places like the U.S., where access to opioids is everywhere. The potency of street drugs is also higher now than ever before. People in early recovery are dealing with cravings that are minute-to-minute, hour-to-hour. You can have one slip and be on the phone with a dealer in minutes arranging a fix. That’s a very different environment than it was years ago.

MAT helps immediately stabilize the brain’s receptors and reduces those cravings, which lowers the risk of relapse.

What is medication-assisted treatment (MAT), and how does it work?

Dr. Ferri: The phrase “medication-assisted treatment” is a little redundant— since medication is a treatment. So really, it’s medication-assisted recovery we’re after here.

The idea is that if we believe addiction is at least partly a physical brain disorder—which most of us do—then we should also believe that a physical medication can help address that physical brain issue. MAT is about using that medication in tandem with tools such as therapy, peer support, or community involvement to help someone sustain recovery.

When we talk about using MAT for addiction, the same medications tend to come up—Suboxone, Methadone, and Vivitrol. What’s the difference between them, and how does each one work?

Dr. Ferri: For opioid use disorder, we typically talk about three medications.

First, there’s buprenorphine, which is in medications like Suboxone, Subutex, Sublocade, and Brixadi. Then there’s methadone, and finally naltrexone, which is called Vivitrol in its long-acting injectable form.

Buprenorphine and methadone are both opioids. Methadone is a full agonist—the more you take, the stronger the effect. Buprenorphine is a partial agonist—it binds strongly to receptors, but its effectmaxes out at a certain point. You can take more, but you won’t get a stronger effect, which makes it a safer option for people with opioid tolerance.

Vivitrol is different—it’s not an opioid. It’s an antagonist that blocks the opioid receptors. It can protect the opioid receptors from other opioids like fentanyl, and it can reduce cravings, but it doesn’t cause opioid effects, and if you stop taking it, you won’t go into withdrawal.

All three can significantly reduce cravings, but they work differently and come with different risks and benefits.

This is a question that comes up a lot when we talk about medication-assisted treatment: Can someone on MAT still be considered “sober”?

Dr. Ferri: That’s a very legitimate question. It’s something patients ask, families ask, and even providers debate. I think it’s important not to be dismissive of that concern.

Addiction is about loss of control—compulsive use, in spite of terrible consequences, and not being able to stop. Whether someone is on a medication that reduces cravings or not, if they’re no longer exhibiting those addictive behaviors, then yes, I’d say they’re now sober. They’re no longer in active addiction.

Now, that doesn’t necessarily mean they’re “fully in recovery.” Being in recovery is a long process that matures a person over time. But if we say that sobriety simply means the absence of addictive behaviors, then someone on MAT absolutely can be considered sober.

We talk a lot about MAT for addiction and its use in opioid recovery, but can MAT help with alcoholism?

Dr. Ferri: Yes, absolutely. When medications are used to reduce cravings for alcohol in someone with alcohol dependence, it’s still considered to be medication-assisted treatment. The two main first-line options are naltrexone (or its injectable form, Vivitrol) and acamprosate.

These medications don’t block the effects of alcohol or stop someone from getting drunk, but they do reduce cravings and dull the brain’s reward response to drinking. While we still don’t fully understand the science behind how they work, they’ve been shown to help people cut down on heavy drinking and, for many, support long-term abstinence.

What are the benefits of combining MAT with therapy and support?

Dr. Ferri: There’s good evidence that MAT alone, even without therapy, dramatically reduces relapse, overdose and even things like criminal activity. So it’s very effective on its own especially in the short term.

That said, medication alone doesn’t build recovery capital. It helps people stabilize physically and internally, which creates room for them to start doing the deeper work like therapy, support groups, and reconnecting with their community.

Studies show only a modest benefit from adding therapy, but that’s partly because it’s hard to measure long-term recovery in a research setting. Therapy and support are what help people build a life worth staying sober for, so they are certainly important to recovery.

Some people argue that MAT is just replacing one substance with another. Is MAT a crutch for true sobriety?

Dr. Ferri: People do sometimes say MAT is a crutch, and I say yes, that’s exactly what it is!

A crutch is a helpful tool. If you break your leg, have surgery, and your doctor tells you not to put weight on it for six weeks, you use a crutch to take the pressure off while it heals. If the leg heals fully, you eventually put weight on it again and no longer need the crutch. But for some people, the injury doesn’t fully heal, and they may need that support long-term—and there’s nothing wrong with that. Everyone’s treatment journey is different, and how long someone uses that “crutch” depends on what they need to heal and stay stable.

Is MAT a lifelong treatment, or can people taper off?

Dr. Ferri: For some people, MAT is likely to be lifelong. And I have no judgment about that. But in my experience, most patients don’t want to be on it forever. They want to reach a point where they don’t need medication to prevent relapse or cravings.

And many of them do succeed. It doesn’t happen every time, but it’s definitely possible and I’ve worked with many patients who are living out a successful recovery post MAT.

What’s important is having honest conversations about tapering from the beginning. If you don’t prepare someone for what withdrawal might feel like down the road—or what it would mean to return to MAT—it can feel like failure if they can’t stay off. But if you walk that journey with them, and they know going back on MAT is an option, then it doesn’t have to be shameful. It’s just part of the process.

How do you help clients decide which MAT option is right for them?

Dr. Ferri:
At this point, we make it standard practice to have conversations about MAT with every patient in early recovery, whether they’re in detox, residential, PHP, or IOP. Not discussing MAT simply isn’t an option anymore. We walk patients through all available options, including the choice not to use medication, and help them understand the pros and cons of each.

There are a lot of misconceptions out there, people hear things on the street or learn from others’ experiences, and part of our role is to address those in an unbiased and informative way. These medications are powerful tools for gaining stability in early recovery, and if a patient chooses not to use them, we want them to fully understand the potential risks of that decision.

Ultimately, the choice is theirs. Our job is to advise, inform, and sometimes strongly encourage a direction we believe is safest, but it’s the patient who makes the final call.

You mentioned misconceptions, what are some of the biggest myths and misconceptions you hear about MAT for addiction treatment?

Dr. Ferri: There are so many. Some patients think it’s a short-term thing—like, “I’ll be on this for just a few weeks.” But the truth is, very few people are ready to stop in a few weeks. If you’re not ready to go through withdrawal now, you probably won’t be ready a month from now when you’re looking for a job, living in sober living or back at home where there may be triggers you weren’t prepared for.

On the flip side, there’s the judgment from people who say “MAT isn’t real sobriety,” or that someone on Suboxone is still getting high. I’d say to look at their life. If they’re not showing addictive behaviors anymore, then the medication is doing what it’s supposed to do.

Is MAT safe for people with co-occurring mental health conditions?

Dr. Ferri: In general, yes—but it depends on the person.

When making a decision to start an MAT option we always have to consider factors like a person’s other medications, their liver or kidney health, their mental health, and environmental factors like whether they have a home or transportation to make it to essential doctor’s appointments. But in almost every case, there’s at least one MAT option that can be used safely. It just has to be tailored to that person’s needs and situation.

People say addiction is a family disease, in that it affects the whole family. We also say that having strong support networks are an important part of recovery. What should families know about MAT when supporting a loved one?

Dr. Ferri: I really enjoy working with our patients’ family members whenever it’s possible. Families can sometimes have really strong opinions—they can be really skeptical of MAT, or they can be pushing hard for MAT.

From the provider side, we absolutely welcome family involvement. In fact, the quality and consistency of that involvement is often a strong predictor of a patient’s success. When patients allow their families to be part of the process and take on some level of accountability, it gives us an opportunity to rebuild trust, offer education, and respond to concerns as they come up.

Families should know that their presence matters, and whenever possible, they should be involved in their loved one’s treatment.

In your experience, what outcomes can people on MAT realistically expect?

Dr. Ferri: One way to think about MAT outcomes is in stages. The first stage is stabilization. When patients start medication early in their recovery, we often see a significant reduction in physical cravings and withdrawal symptoms. That stabilization gives them the space to start engaging in the deeper work of recovery.

Now, not everyone makes it through that first stage—some drop out—but for those who stick with it, the physical stability they gain is often a turning point.

The second stage is maintenance, which can last for months or years depending on the person. During this time, patients are gradually rebuilding their lives: restoring trust, repairing relationships, returning to work, managing finances, addressing legal issues. They’re slowly creating a full, meaningful life again, and the medication supports that process.

You’ve been practicing for over two decades and have seen how MAT has evolved; where would you like to see it go in the future?

Dr. Ferri: I’d like to see more research around what comes after MAT. It’s not fair or sustainable to treat something as complex as the opioid epidemic with a simplistic approach like, “Just put everyone on buprenorphine.” What does that lead to? A “Suboxone Nation”? And then what?

We need to think bigger. I’d love to see more creative energy and funding put into exploring what sustainable recovery looks like beyond pharmaceutical solutions. What kind of long-term support and aftercare can help someone truly build a life in recovery?

I think as providers, we have a responsibility not just to the patients in front of us, but to the broader systems that shape health outcomes. That includes advocating for better care models, pushing for more research, and being honest about what’s working and what isn’t. Research is one of the clearest ways we show care for people; it’s how we keep things moving forward.

Doctor’s Note is a monthly blog series where we ask clinicians to unpack complex topics in addiction and mental health. Our thanks to Dr. Ferri for sharing his perspective and expertise—and for his ongoing commitment to evolving how we care for people. Stay tuned for next month’s Doctor’s Note, where we’ll continue the conversation with another expert voice from the field: Dr. Carlos Tirado, on the role of ketamine therapy in treatment.