Treatment for substance use disorder can be inpatient or outpatient and is unique to each individual.
Every person with substance use disorder (SUD) has walked a unique path. For many people, substance or alcohol use was a way to self-medicate for depression, anxiety, or another mental health condition. For others, perhaps it began as a way to stay motivated during long hours of working or studying.
Regardless of the reason, substance use becomes less of a choice over time. Long-term exposure leads to changes in brain function, and the person is no longer in control. SUD affects the parts of the brain involved in reward and motivation, learning and memory, and control over behavior.
This is where evidence-based treatments come in. They can help rewire the brain in a variety of ways to put the person back in the driver’s seat.
SUD treatment is administered in two basic settings: inpatient and outpatient. The primary goal is for the person with SUD to be in the most effective — but least restrictive — environment to get them started, and then move them along a continuum of care depending on their needs.
From least to most intensive, this continuum of care includes:
- outpatient treatment
- intensive outpatient treatment
- residential treatment
- inpatient hospitalization
Different SUD treatment programs are usually based on three basic models:
- Psychological model. This may include behavioral or talk therapy and looks at emotional dysfunction or potentially harmful motivations as the main cause of SUD.
- Medical model. This requires medication to relieve symptoms and treatment by a physician. It emphasizes the physiological, biological, or genetic causes of SUD.
- Sociocultural model. This aims to alter the physical and social environment of a person with SUD to address possible deficiencies in that environment. It may include self-help or spiritual activities. Oftentimes, people who have personal experience with addiction and are in recovery themselves facilitate treatment.
When you have SUD, it’s important to match your needs to the right treatment. In general, the right choice will depend on several factors, including:
- whether the SUD has been diagnosed as mild, moderate, or severe
- how motivated the person is
- what their sociocultural environment is like
- their cognitive functioning and level of impulse control
- whether the person has any other mental health conditions
For most people, the main goal of treatment is maintaining abstinence, as it is significantly linked to a positive long-term prognosis. But being completely substance-free is only the beginning.
Many people receiving treatment for SUD may have complex problems in different areas, including:
- physical and mental health issues
- relationship problems
- poor social and work skills
- legal or financial difficulties
This means the ideal treatment needs to:
- address mental and physical well-being
- help resolve relationship issues
- help improve educational and vocational skills
Outpatient behavioral treatment involves a variety of programs, including individual or group substance use counseling or both. This may include:
- cognitive behavioral therapy (CBT)
- family therapy
- motivational interviewing
- contingency management (incentives)
Psychosocial treatments target aspects of a person’s social and cultural environment, as well as any psychological and behavioral patterns that may cause difficulties in their life.
Residential or inpatient treatments can be very effective, particularly for individuals with severe SUD and those with co-existing conditions. Licensed residential treatment facilities offer 24-hour structured care with medical attention.
Once a person has completed medically managed intensive inpatient treatment, sometimes known as detoxification, or “detox,” it’s often very helpful to temporarily relocate to a monitored sober community within the first year. This period is considered the early remission phase.
Living in this monitored community may be beneficial because the person’s old familiar environment may have influenced their substance use.
In general, residential facilities to help people taper off or remain sober may include:
- Shorter-term residential treatment. This approach focuses on therapy for cessation (“detox”) and provides initial intensive counseling and preparation for treatment in a community-based setting.
- Therapeutic communities. These are highly structured programs where people remain at a residence, usually for 6–12 months. The whole community works together to impact the person’s attitudes, understanding, and behaviors associated with substance use.
- Recovery housing. This setting provides supervised, short-term housing for people, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life. This may involve helping them learn to manage their finances or look for a job and connect them to support services in the community.
You also learn stress-coping skills and how to work through relationship problems.
Several psychological treatments are supported by research and have been deemed appropriate by the American Psychological Association (Division 12) for treating SUD.
Motivational interviewing (MI)
Motivational interviewing (MI) is client-centered counseling developed to help you find the internal motivation to quit. Many people with SUD have a low or moderate desire to quit, despite the health, financial, social, and legal consequences the SUD may be causing.
MI helps you figure out what you want for yourself — not what the counselor thinks is good for you.
The role of the MI therapist is to ask open questions to get you to explore your ideas, experiences, and perspectives, and encourage you to recognize and resolve your own ambivalence or fear of change.
The goal is to get people to realize they are not being forced to give up something they love but rather be motivated to pursue a life they’ve chosen for themselves.
Motivational enhancement therapy (MET)
Motivational enhancement therapy (MET) is a good choice for people not quite ready to make significant changes in their lives.
It combines the style of MI with psychological counseling. While the former targets your internal motivation, the latter guides you to a new way of thinking if you’re fearful or unsure about treatment.
Research suggests the success of MET may depend on the type of substance used. It appears to be more effective for people with alcohol or cannabis addictions. Results are mixed for those using heroin, nicotine, or cocaine or those using multiple substances.
Prize-based contingency management (CM)
Prize-based contingency management (CM) rewards drug abstinence. For instance, a client might have the opportunity to win $100 after having a drug-negative urine sample. In some programs, people have a better chance of winning the longer they remain drug-free.
With CM, the incentive acts as positive reinforcement. It competes with the reinforcing effects of the addictive substance, therefore increasing the chances abstinence will be maintained.
CM is among the most empirically supported strategies for helping clients stay drug-free. It’s particularly encouraged for those with cocaine use disorder.
The treatment may last from 8 to 24 weeks and is often used as an adjunct therapy alongside other treatments, such as cognitive behavioral therapy (CBT) or 12-step programs.
Seeking Safety is a therapeutic approach designed for people with both an SUD and post-traumatic stress disorder (PTSD). It’s a commonly used group treatment among veterans.
The fundamental principle of the program is the belief that combining treatment for co-occurring PTSD and SUDs is more effective and yields better results than treating each disorder separately.
Seeking Safety educates clients about the link between trauma, substance use, and coping skills and acknowledges how people often use substances to cope with anxiety.
The program is designed to be used with other treatments and can be administered in an individual or group setting. The treatment teaches drug-alternative coping skills and helps people find other ways to “feel safe.”
Guided Self-Change (GSC)
Guided Self-Change (GSC) is a brief cognitive-behavioral and motivational approach first developed for people with alcohol use disorder and then expanded to treat other types of substance use.
GSC combines CBT with motivational counseling similar to what is used in MI.
The CBT aspect of the program helps people increase their awareness of substance-using habits and recognize situations that may not be safe.
Medications may be used during SUD treatment to:
- help manage withdrawal symptoms
- prevent recurrence of the condition
- treat co-occurring conditions
When tapering off of the substance, you can experience painful withdrawal symptoms. It’s best to be monitored closely in a treatment center while tapering off.
When appropriate, your doctor will prescribe medications to address the physical withdrawal symptoms and help you feel more comfortable throughout this process.
One study of treatment facilities found that almost 80% of people undergoing therapy for cessation received medications.
Withdrawal can involve physical symptoms such as:
- body aches
Many people also experience psychological symptoms such as:
- thoughts of suicide
Medication can also be used to help re-normalize brain function and decrease cravings.
Currently, pharmaceutical drugs are available to treat SUDs involving:
- opioids, including prescription pain relievers and heroin
Medications to help with opioid use disorder
- Methadone and buprenorphine. These two medications help diminish withdrawal symptoms and relieve cravings.
- Naltrexone. This medication blocks the effects of opioids at the receptor sites and should be given only to people who have already completed therapy for cessation.
Medications to help with tobacco/nicotine use disorder
- Over-the-counter nicotine replacement therapies. These include patches, sprays, lozenges, and gums.
- Bupropion and varenicline. These prescription medications have been approved by the Food and Drug Administration (FDA) for nicotine addiction. They’re deemed more effective when combined with behavioral therapies.
Medications to help with alcohol use disorder
Three medications have been approved by the FDA for alcohol use disorder:
- Naltrexone. This medication helps block the rewarding effects of drinking and reduces cravings.
- Acamprosate. This medication may reduce symptoms of withdrawal such as restlessness, anxiety, insomnia, and dysphoria.
- Disulfiram. This medication causes unpleasant effects after drinking alcohol, such as nausea, flushing, and irregular heartbeat.
Once you’re on the road to recovery, it’s important to engage in self-care, which may include attending a recovery support group and finding activities you enjoy.
Recovery support groups
Research has shown that peer-delivered recovery support services, including 12-step programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can be beneficial for people recovering from SUD.
However, 12-step programs may not work for everyone.
While AA and NA may be best known, an internet search for “recovery support groups near me” may give you additional choices.
Before going through treatment for cessation, the drug may have been a top priority in your life. Much of your time may have been spent thinking about the drug, seeking it out, using, and recovering.
Now you’ll need to fill that space with healthy and enjoyable pursuits. Consider participating in positive activities, such as exercise, meditation, and other recreational pastimes.
Not only does exercise offer all of the obvious health benefits, but it also shows promise for those in recovery from SUD.
Treatment for SUD generally happens either in an inpatient or outpatient setting. It involves a form of talk or behavioral therapy and sometimes medication.
Regardless of how you got here, if you’re not happy with the path you’re on now, you can change your direction. Many people have been where you are now, and just as many are wanting to help you.
If you think you have a SUD, consider reaching out to a trusted healthcare professional for an evaluation and to discuss your treatment options.
If you want to learn more or are unsure where to begin, these resources may be worth checking out:
- SAMHSA. You can call the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-4357. This is a free, confidential, 24/7 treatment referral and information service available in English and Spanish.
- Drugs and Me. Created by a group of educators, scientists, and analysts, Drugs and Me provides a detailed list of educational materials for different types of substance use.
- National Harm Reduction Coalition. If you’re looking for advocacy, the National Harm Reduction Coalition is an action-oriented group for people with SUD.