Medication Assisted Treatment (MAT) appears in the depth-psychology and addiction-medicine corpus as a site of sustained empirical advocacy and institutional tension alike. The dominant voices — Avery, Timko, McPheeters, and Sugden — converge on MAT’s evidence-based efficacy in reducing opioid-related mortality, infectious disease transmission, criminal recidivism, and relapse rates, yet they also register a persistent implementation gap: only a small fraction of eligible patients receives these interventions. The pharmacological armature of MAT — methadone, buprenorphine, and naltrexone for opioid use disorder; acamprosate, naltrexone, and disulfiram for alcohol use disorder — is treated empirically rather than ideologically, though methadone’s superior retention rates over buprenorphine generate ongoing debate. A crucial tension runs throughout: MAT is positioned as the gold standard of first-line care and simultaneously acknowledged as insufficient for treatment-resistant populations, necessitating complementary modalities such as therapeutic communities, contingency management, and psychosocial counseling. The corrections-system literature (Avery) highlights structural barriers — security imperatives overriding treatment goals, hiring policies restricting staff diversity — that curtail MAT access in carceral settings. McPheeters documents the staggering underutilization of MAT for alcohol use disorder, where under one percent of those with past-year AUD received pharmacotherapy. Retention, not mere initiation, emerges as the organizing clinical and research challenge.