Addiction medications like methadone and Suboxone are incredible resources for those struggling with addiction. In fact, these medications are so effective that there’s been a movement to switch to language that recognizes the merits of medication as its own evidence-based treatment rather than a supplement to therapy. For example, major organizations such as the National Institute on Drug Abuse (NIDA) now avoid the term “medication-assisted treatment” in favor of terms such as “medications for addiction treatment,” “medications for opioid use disorder,” or “medications for substance use disorder.”
While this is a welcome change in many ways, we cannot dismiss or undervalue the role of therapy for sustainable recovery. It is a crucial adjunct to medications and the core of a person’s recovery toolbox. I almost never prescribe medication without it.
Medications: A powerful stabilizer with a bad rap
To be clear, I am in favor of addiction treatment medications whenever they are appropriate for the patient. They help patients stabilize and engage in treatment by mitigating withdrawal symptoms and alleviating overwhelming cravings. Research on methadone and buprenorphine shows that adherence to medications can lead to fewer relapses and overdose deaths.
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For far too long, these medications have been stigmatized, falsely accused of being just another addictive drug. Those seeking medications for opioid or alcohol use disorder are routinely discouraged from using them or outright denied them due to the myth that they “replace one addiction for another.” This attitude has caused needless harm for those struggling with addiction for decades. In reality, these medications are prescribed by a health care professional and can not only help the physical dependence aspect of substance use disorder (SUD) but also help patients avoid engaging in dangerous behaviors to obtain illegal substances. When a person feels physically well enough and not under the constant influence of strong cravings, they can better participate in the things that support their recovery, such as attending meetings and going to therapy, activities that support meaningful behavioral change.
Thinking beyond symptom management
Medication addresses physical symptoms, but long-term recovery is an endeavor that requires lifelong work and a multitude of emotional coping skills. There is significant value in medications for managing the physical symptoms that put someone on a crash course to relapse; however, the benefits only go so far when the underlying traumas or other issues that led to the substance use go unaddressed.
A substance use disorder is a chronic and progressive disease that is incredibly complex. It doesn’t make sense to attempt to manage it with just one tool. When I’ve seen patients struggling with SUD attempt to recover with only medication, I’ve often seen them continue to struggle with their triggers, lacking the healthy coping skills they need to deal with them as they arise.
Therapy can help patients become better at identifying their triggers and come up with effective ways to cope with their cravings. Therapy helps patients learn how to self-regulate, tolerate distress, and find healthy outlets for hurtful emotions.
The best outcomes I’ve seen are when patients are treated with a multifaceted approach that involves several types of evidence-based treatments that include not only medications but therapies like CBT, DBT, and motivational interviewing. This is especially crucial for people with co-occurring mental health disorders, as substance use is a common maladaptive coping strategy for the symptoms of mental illness. When the mental health disorder goes untreated, the chances of lasting recovery dwindle.
Thriving in recovery with integrated care
Medication without therapy can be effective to the extent that it can prevent relapse and overdose. But avoiding the threat of overdose and death is different from building a meaningful and fulfilling life in recovery. That’s my goal in working with patients. I don’t just want to see them survive; I want to see them thrive.
Thriving in recovery takes a lot of work. There’s no getting around it. That might look like years or even a lifetime of therapy, daily or weekly meetings, meditation, acts of service, and other activities that keep one’s focus on cultivating positive behaviors, community, and contributing to society in healthy ways.
Recovery advocates say to take it “one day at a time,” and there’s a good reason for that. Looking at a lifetime of inner work can be incredibly overwhelming, but doing the work of one day is achievable. That might look like waking up, taking your addiction medication, exercising, going to a meeting or therapy session, going to work, journaling, and getting a good night’s sleep. That’s doable. Even this might feel impossible on day one. But with ongoing therapy, it gets easier and easier. And eventually you find you’re living the life you could only dream about when you were in active addiction.
There’s no doubt that for many people medication lays the foundation for this work. But therapy creates the building that lies on top of that foundation. And over time, that structure becomes something solid and lasting. Integrated care isn’t about choosing one path over another; it’s about using every effective tool available to support real, sustained change. When both pieces are in place, recovery stops being just about avoiding relapse and starts becoming about creating a life worth living.
Gary Mitrevolis is an addiction medicine physician.
