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About this program

What medication-assisted treatment is, and what it is not

Medication-assisted treatment, or MAT, pairs an FDA-approved medication with counseling and behavioral therapy to treat opioid use disorder and alcohol use disorder. The medication steadies the body: it relieves withdrawal, quiets cravings and, for opioids, blocks the high, so a person can think clearly enough to do the work of recovery. The counseling addresses the reasons behind the use, the triggers, the relationships and the habits. Neither half works as well alone. Federal health agencies, including SAMHSA and the National Institute on Drug Abuse, describe medication combined with counseling as the standard of care for opioid use disorder, not a last resort and not a shortcut.
At Clear Steps Recovery in New Hampshire, MAT is delivered inside our outpatient programs at 1D Commons Dr, Units 21 & 22 in Londonderry. You keep living at home, you keep working if you can, and you attend Day Treatment, an intensive outpatient schedule or weekly outpatient sessions while the medication does its part. The medications we prescribe are buprenorphine, including the buprenorphine and naloxone combination sold as Suboxone, for opioid use disorder, and naltrexone, as a daily tablet or the monthly extended-release injection Vivitrol, for opioid and alcohol use disorder. For alcohol use disorder, acamprosate and disulfiram are also FDA-approved options our medical team may discuss with you. Every prescription is written and overseen by our Medical Director, Dr. Richard Marasa, MD, who is board certified in Addiction Medicine, Emergency Medicine and Internal Medicine, and who reviewed this page.
MAT is not medical detox. We do not run detox on site. When withdrawal needs to be managed in a medical setting first, which is common with heavy daily drinking or a history of withdrawal seizures, we arrange it with a partner facility and plan your medication start with us for the day it is complete. And MAT is not trading one addiction for another. Taken as prescribed, these medications stabilize brain chemistry rather than produce a high, which is why people on them can hold jobs, drive, parent and rebuild.

The medications

Suboxone, buprenorphine, naltrexone and Vivitrol: what each one does

The right medication depends on the substance, your medical history, what you have tried before and what fits your life. These are the options our medical team prescribes.
  1. 01

    Buprenorphine (Suboxone): A partial opioid agonist for opioid use disorder. It relieves withdrawal and cravings without producing a full opioid high, and its effect plateaus at higher doses, which makes it safer than the opioids it replaces. Suboxone is buprenorphine combined with naloxone, a formulation designed to discourage misuse. Taken daily as a film or tablet under the tongue, prescribed in our outpatient program and filled at your pharmacy.

  2. 02

    Naltrexone (daily tablet): An opioid blocker with no abuse potential and no controlled-substance status. For opioid use disorder it prevents opioids from producing a high. For alcohol use disorder it blunts the reward from drinking, so the craving-and-reward loop weakens over weeks of consistent use. It is not a treatment for withdrawal and, for opioids, it can only be started after a drug-free window.

  3. 03

    Vivitrol (monthly naltrexone injection): The same medication as the tablet, given once a month by our medical team as an extended-release injection. It removes the daily decision to take a pill and blocks opioids for roughly 28 days per dose, which matters most for people whose relapses have come from missed doses. FDA-approved for both opioid and alcohol use disorder.

  4. 04

    Acamprosate and disulfiram (alcohol use disorder): Two further FDA-approved options for alcohol. Acamprosate helps maintain abstinence by easing the brain imbalance left after long-term drinking. Disulfiram causes an unpleasant reaction if alcohol is consumed, which some people find helps them stay stopped. Our medical team decides with you whether either one fits.

Whatever the medication, it sits inside a care plan rather than replacing one. Prescriptions are paired with counseling in Day Treatment, an intensive outpatient schedule by day or in the evening, or our Outpatient Program, and every plan ends in aftercare rather than at the door.

How it works

How starting MAT and follow-up work in an outpatient program

People often picture MAT as something that happens in a hospital. In our program it happens in an office visit, on a schedule built around the rest of your treatment. Here is the sequence.
  1. 01

    Assessment and medical evaluation: Your first visit is a confidential clinical assessment with a licensed clinician plus a medical evaluation with our medical team: substance use history, what you have tried before, other medications you take, medical conditions, pregnancy, and for alcohol use disorder, liver function. Together they decide whether MAT fits, which medication, and which level of care you start in. In many cases this happens the same day you call.

  2. 02

    Starting buprenorphine (Suboxone): Buprenorphine works best when the first dose is taken once early withdrawal has begun, so our medical team times it with you rather than sending you home with a prescription and no plan. You are told exactly when to take the first dose and what to expect, the team checks in with you that day and the next, and the dose is adjusted over the first days until withdrawal and cravings are controlled. Most people are stable within the first week.

  3. 03

    Starting naltrexone or Vivitrol: For opioid use disorder, naltrexone cannot be started while opioids are still in your system. You need to be opioid-free for roughly 7 to 10 days first, and longer when coming off buprenorphine, or the first dose can trigger sudden severe withdrawal. That window is why naltrexone is usually started after a medically managed detox we arrange with a partner facility, or after a supervised transition. For alcohol use disorder there is no waiting period, only a liver function check. Vivitrol is given as a monthly injection in our office.

  4. 04

    Follow-up and dose adjustment: Early on, medical visits are frequent, often weekly, while the dose settles and side effects are watched. As you stabilize, visits space out. Every visit reviews cravings, sleep, mood, other medications and any use, and the plan changes when it needs to. Drug and alcohol screening is part of the program because it is part of keeping you safe, not because anyone is looking for a reason to discharge you.

  5. 05

    Counseling alongside the medication: Group and individual therapy run in parallel from day one, in whichever level of care your assessment recommends: Day Treatment on weekdays, an intensive outpatient schedule during the day or Monday through Thursday evenings, or a weekly outpatient program. Family sessions are available for the people close to you.

  6. 06

    Overdose safety and how long MAT lasts: Anyone treated for opioid use disorder is counseled on overdose prevention, because tolerance drops after a period without opioids and a return to a former dose can be fatal. Naloxone is discussed with every opioid client. How long you stay on medication is a decision you make with your prescriber based on your progress, not a fixed timeline. Many people benefit from a year or longer. Stopping early is the most common reason a medication seems not to work.

If you are not sure whether MAT is right for you, that is exactly what the assessment is for. A clinician will tell you plainly whether medication would help, which one, and what the alternative looks like if it would not.

Who it helps

When medication-assisted treatment is worth considering

MAT tends to make the biggest difference when substance use has created a level of dependence that willpower alone has not overcome. If cravings feel bigger than you, that is not a character flaw. It is brain chemistry asking for support. Consider MAT if:
  • Withdrawal has been too intense to push through, or fear of withdrawal has kept you stuck.
  • Cravings keep interrupting recovery and you have relapsed more than once because of them.
  • You have tried to stop on your own, or with therapy alone, and it has not lasted.
  • Substance use is already harming your health, your work or your family.
  • Anxiety, depression or trauma sit underneath the use and the two feed each other.
  • You are balancing work, parenting or school and need a treatment you can keep up.
Research supports it. A 2022 systematic review pooling 20 studies and more than 30,000 people found that justice-involved adults receiving MAT had roughly 60 percent lower odds of a non-fatal overdose than those who did not. After Rhode Island's corrections system began offering all FDA-approved opioid medications, researchers at Brown University documented a 61 percent drop in post-incarceration overdose deaths. For alcohol, a large analysis published in JAMA found that oral naltrexone meaningfully reduced return to drinking. The most durable results in every study come from medication combined with counseling, which is how our program is built.

What MAT can do

The benefits people notice first

Because each person's substance use disorder and response to treatment differ, the benefits vary. The ones our clients describe most often:
  • Fewer cravings and less use
  • Lower risk of overdose and withdrawal complications
  • Staying in treatment long enough for it to work
  • Sleeping, eating and thinking clearly again
  • Repairing relationships with family
  • Better physical health
  • More energy for the work of recovery
  • Handling stress without using

New Hampshire

Medication-Assisted Treatment in New Hampshire: our Londonderry center

Our New Hampshire MAT program runs from 1D Commons Dr, Units 21 & 22, Londonderry, NH 03053, just off Route 102 at I-93 Exit 4, with free on-site parking. Adults come to us from Manchester (about 15 minutes), Nashua (20), Salem (20), Derry (10), Windham (12), Hudson (20) and Concord (35). Suboxone, buprenorphine, naltrexone and Vivitrol are prescribed here and paired with counseling in Day Treatment (PHP) on weekdays, IOP during the day or Evening IOP on Monday through Thursday evenings from 6 to 9 pm, or our Outpatient Program. Medication visits are scheduled around your program hours, and the evening track means a person who works days can see the medical team and attend group without missing shifts.
Dr. Richard Marasa, MD, our Medical Director, holds a New Hampshire medical license and personally oversees MAT at the Londonderry center. He brings 46 years of clinical practice and 23 years of personal recovery to the work. Our Londonderry program works with Ambetter Health, AmeriHealth, Blue Cross Blue Shield, Harvard Pilgrim, NH Healthy Families, Point32Health, TRICARE, Tufts Health Plan, VA Community Care and WellSense Health Plan, and with New Hampshire Medicaid through Granite Advantage plans. Learn more about our Londonderry center or New Hampshire insurance.

In Massachusetts

Closer to Boston? MAT in Needham, MA

This page describes our New Hampshire program. Massachusetts clients get the same medications, the same counseling and the same medical oversight at our Needham center, 392 Chestnut Street, Suite 200, off Route 128/I-95 and about 30 minutes from downtown Boston. Read about medication-assisted treatment in Massachusetts for the Needham schedule, MassHealth and Massachusetts insurance, and how to start.

Paying for treatment

Insurance for MAT

Most health plans cover medication-assisted treatment. The counseling and medical visits are usually covered under your plan's behavioral health or medical benefit, and the medication itself is usually covered under the pharmacy benefit, with the monthly Vivitrol injection often billed under the medical benefit instead. Prior authorization is sometimes required for the injection. None of that is yours to sort out. Admissions checks your plan with the carrier at no cost, tells you what it covers, and explains any deductible or copay before you start. See how cost and payment work for a plain-language walk-through.

Check my coverage

Your name and a number is all we need to start. Admissions calls you back with what your plan covers, usually within minutes during the day.

Check my coverage

Same-day admissions

In many cases you can be assessed the same day you call and see the medical team within days.

How same-day works

In their own words

Why patients choose our medication-assisted treatment program

  • Amazing place all around. The staff are awesome, loving, caring, and very respectful. Very well prepared and suited for anyone who is looking to build a structure in their recovery! Thank you for your hospitality and care.

  • Compassionate and diligent staff. I unfortunately have been to many rehabilitation centers. This facility was by far my favorite for many reasons. I felt shame about my relapses. But the staff here went above and beyond to encourage and support me. They treated everyone with so much respect and maintained a positive attitude. I felt like I was heard for the first time in a long time. I'm so blessed to have had the opportunity to come and really dig deep, not only into my physical sobriety but also my emotional sobriety. I would recommend coming here. It saved my life.

  • Clear Steps Recovery offers an incredible program. The clinicians and all the staff at Clear Steps Recovery are knowledgeable and are invested in the well-being of everyone there. I would highly recommend Clear Steps to anyone who is looking for support and compassion in their recovery journey.

  • Educated and seasoned professionals from top to bottom, Clear Steps Recovery brings the Three Principles to an outpatient setting in the state of New Hampshire, expanding on the philosophy brought to the state last decade. The knowledgeable, kind, caring, and engaging staff look to improve each client's whole health picture, not just the substance abuse disorder, and teaches that that is something that comes from within each individual with a shift of thought. I would highly recommend Clear Steps Recovery to anyone looking to break free of the thought patterns that lead to behaviors that lend to being stuck in the cycle of addiction.