The chairs were arranged in a loose circle for my weekly nursing group.
We were discussing buprenorphine and how it works.
Then one client said, “I’m still taking Suboxone…and I still want to use.”
The room went quiet.
In that silence, it felt as if I could read their thoughts in slow motion. I knew what they were feeling and what everyone in the room was thinking: if the medication is working, why is the urge still there?
Outside of treatment centers, people tend to talk about medication-assisted-treatment (MAT) in extremes, and a lot of it misses what actually happens in real life. It is often framed as either a miracle solution or as simply replacing one addiction for another. But inside treatment programs, the reality looks very different.
From a nursing perspective, medication-assisted treatment is not a miracle and is not a failure. It is stabilization. It reduces withdrawal. It lowers overdose risk. It gives the brain and body a chance to settle.
Stabilization is not the same thing as transformation. Medication can help soothe the nervous system and quiet the mind. However, years of trauma, conditioning, and learned behavior do not disappear overnight. Recovery involves rebuilding patterns, relationships, and ways of coping that developed over years.
In practice, the early weeks of recovery often involve learning how to sit with discomfort that medication alone cannot eliminate. Clients may still feel anxiety, sadness, restlessness, or frustration as their bodies and minds adjust. For many, this is unfamiliar territory. During active addiction, uncomfortable emotions were often managed quickly with substances. In recovery, those feelings have to be faced and worked through in new ways.
This is where the broader recovery process becomes essential. Counseling, peer support, structure, and time all play important roles alongside medication. Medication-assisted treatment can create the stability needed to begin this work, but it cannot replace it. Recovery is built gradually through new habits, relationships, and ways of responding to stress.
On the unit, this reality becomes clear very quickly. Clients often stabilize physically within a relatively short period of time, but the deeper work of real recovery is only in its early stages. Many are surprised to discover that cravings can still appear, even when they are taking their medication exactly as prescribed.
In the early weeks of recovery, this can be confusing for many clients. Their bodies may feel more stable than they have in a long time, yet emotionally they may still feel unsettled. Anxiety, restlessness, or sadness can surface as the brain begins adjusting to life without constant substance use. For someone who has relied on substances to quickly change how they feel, this adjustment can be uncomfortable and unfamiliar. Medication can help reduce the intensity of withdrawal and cravings, but it cannot instantly teach someone how to manage stress, disappointment, or difficult emotions. Those skills take time to develop and often require support through counseling, peer groups, and daily practice.
This is where the broader recovery process becomes essential. Medication-assisted treatment can provide a critical foundation, but recovery is built through many different pieces working together. Structure, therapy, community support, and time all play important roles in helping people create a more stable life in recovery. From a nursing perspective, these changes are often gradual. Clients begin to recognize triggers, learn healthier coping strategies, and slowly rebuild trust in themselves and others. Medication can create the stability needed for this work to begin, but it cannot replace the process itself.
In the early stages of recovery, this adjustment period often becomes very apparent. Even as the body begins to stabilize, emotions can feel unpredictable and intense. Feelings that were once quickly numbed with substances may now surface without warning. Clients may experience frustration, discomfort, or doubt as they begin learning how to manage these emotions without returning to substance use. This does not necessarily mean the medication has failed. Instead, it often reflects the natural process of the body and brain recalibrating after prolonged substance use.
Moments like the one in that group are not unusual. When clients say the medication isn’t working, what they often mean is that the urge has not disappeared completely. The expectation is that medication should remove the desire to use altogether. But many people entering early recovery are still thinking through the lens of addiction itself, where relief often comes quickly and externally. It can be easy to believe that another medication should provide the same kind of immediate quick fix. In reality, medication-assisted treatment was never designed to erase every urge. Its purpose is to stabilize the body and reduce risk so that the deeper work of recovery can begin.
Outside of treatment settings, another common criticism is that medications like buprenorphine (often known by the brand name Suboxone) are simply replacing one addiction for another. This assumption overlooks an important distinction between active addiction and treatment aimed at stabilizing the brain and body. Addiction is marked by loss of control and escalating harm, while medication-assisted treatment is designed to reduce risk and restore stability. Unfortunately, this misunderstanding is not limited to the general public. Some individuals in recovery communities still question whether someone using medication-assisted treatment is truly “clean,” which can create additional shame for people trying to rebuild their lives.
Part of the misunderstanding surrounding medications like buprenorphine comes from a lack of awareness about how opioid use affects the brain over time. Prolonged opioid use alters the brain’s reward systems, making it extremely difficult for individuals to simply stop using substances through willpower alone. Medication-assisted treatment works by partially activating those same receptors while preventing the intense highs and dangerous cycles associated with full opioid use. By stabilizing these systems, medications like buprenorphine can significantly reduce withdrawal symptoms and cravings, allowing individuals to focus on the psychological and behavioral aspects of recovery. Rather than replacing one addiction with another, the medication creates a safer and more stable foundation from which recovery can begin.
In these conversations, education becomes incredibly important. Clients are often relieved to learn that medication is not meant to eliminate every urge or emotion they experience. Instead, it is meant to create enough stability for people to begin learning how to cope with those urges in healthier ways. These everyday clinical realities rarely make their way into public conversations about addiction treatment.
In the United States, addiction treatment policy has increasingly focused on the role of medications like buprenorphine in addressing the opioid crisis. Policymakers, regulators, and treatment systems continue to debate whether recovery should be defined by complete abstinence from all substances or whether medications like buprenorphine should be considered a legitimate part of long-term recovery. While some treatment models still frame sobriety as the absence of any medication, many clinicians and public health experts argue that medications can play a critical role in preventing relapse and overdose.
Other policy discussions focus on how long patients should remain on medications like buprenorphine and concerns about diversion. Some policies encourage short tapers or strict limits on treatment duration, while clinicians working directly with patients often see that recovery timelines vary widely from person to person. What may appear straightforward in policy conversations is often far more complex in the day-to-day treatment realities.
Experiences like this inside treatment programs rarely appear in policy debates about medication-assisted treatment, yet they reveal something essential about how recovery actually unfolds.
Part of the challenge may also lie in how treatment expectations are communicated. When medication-assisted treatment is discussed publicly, the focus is often on its ability to reduce cravings and prevent relapse. While those benefits are important, they can sometimes create the impression that medication should eliminate the desire for use altogether. For people early in recovery, this expectation can lead to confusion or discouragement when urges or emotional discomfort still appear. In practice, clinicians spend a great deal of time helping clients understand that medication stabilizes the body and reduces risk, but the deeper work of recovery unfolds gradually through therapy, support, and daily effort.
When I explained this to the group that day, the tension in the room seemed to ease. What had initially sounded like failure began to look more like the recovery process. Understanding what medication can and cannot do allows people to approach recovery with more realistic expectations and, perhaps more importantly, less shame. In many ways, that shift in understanding is where recovery truly begins.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.