Every year, millions of people are diagnosed with a substance use disorder, and many lives are improved dramatically through treatment and recovery. It is important to understand that, like other chronic disorders, substance use disorders are medical conditions that can be treated.1 A substance use disorder involves the dependence on, or abuse of, alcohol and/or drugs, including the nonmedical use of prescription drugs.
My drug addiction began at age 13. I wanted to be in with the crowd. Being in meant trouble with the law. I experienced loneliness and alienated the people I loved. Treatment gave me a foundation for recovery. However, returning to school provided no environment for recovery. I researched and found Sobriety High in Minnesota. I am now a Sobriety High graduate, and am involved in the planning for recovery high schools in Massachusetts. Now I am 21 years old with 3 years of recovery, and want other young people to have the same experience.
Laura Goode
Recovery Advocate
To improve the effectiveness of addiction treatment, it is essential that people with substance use disorders and their providers identify the most appropriate course of treatment to meet their specific needs. Just as substance use disorders can affect people regardless of their age, race, ethnicity, class, employment status, or community, treatment services also should respect these unique characteristics.2, 3, 4, 5 Effective treatment depends on the substances misused, as well as a person’s cultural background, family responsibilities, other health considerations, and even their faith or religion.6
Treatment is offered in both residential and outpatient programs, and can include counseling or other behavioral therapy, family therapy, medication, or a combination of services.7, 8 The following sections provide an introduction to the various avenues of treatment and recovery.
Different populations often have distinct methods of treatment that may work better for them. Carefully assessing a person’s needs and preferences and providing individualized treatment has been shown to increase treatment retention and outcomes.9 Treatment should be tailored to the individual’s needs, substances of misuse, demographics, and available options. For example, family-oriented treatment approaches can be effective among adolescents with substance use disorders.10 However, older adults have been shown to respond well to age-specific, supportive, and non-confrontational group treatment that aims to build or rebuild self-esteem.11 Also, treatment can be adapted to address a person’s dependence on a specific substance, and may take place over a long period of time. It can incorporate a cohesive group of services, particularly if the person is dependent on more than one substance.12
Some people who need to safely stop drinking or using multiple substances may require medical detoxification, a process administered under the care of a physician that helps manage physical withdrawal symptoms. Detoxification is a set of interventions aimed at managing a person’s safe withdrawal from a particular substance. Detoxification also should be catered to the individual’s specific needs, just as all other elements of treatment are personalized. It can take place in a wide variety of settings and at a variety of intensity levels.13
It is also important for the setting where detoxification occurs to be appropriate for the specific medical and psychological conditions that are present, and to provide the degree of monitoring necessary to ensure safety. Personnel at medical facilities should be aware of the signs of withdrawal and how it affects the treatment of known medical conditions. Detoxification staff who are monitoring a patient should also be familiar with the signs and symptoms of co-occurring medical disorders.14
Use of medications, such as buprenorphine and methadone, can be a component of treatment for addiction to opioids.15 Additionally, treatment for alcohol dependence can include medication-assisted therapies, such as naltrexone, which reduces an individual’s desire for alcohol. Naltrexone, sometimes marketed as Vivitrol® in an extended-release version, when used in conjunction with counseling or other components of alcohol treatment, has been found to improve treatment outcomes and reduce relapse.16
For more information about medication-assisted therapy, visit www.dpt.samhsa.gov. This Web site, through the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment (CSAT), provides information on the therapies listed above.
Remaining in treatment for an appropriate period of time is critical for treatment to be effective. Yet in 2004, only 40 percent of people discharged from treatment programs had actually completed treatment, according to a SAMHSA study.17 In addition, counseling—individually and/or in groups—and other behavioral therapies are essential components of effective long-term treatment for substance use disorders. In therapy, people address issues of motivation, build skills to resist substance use, replace substance-using activities with constructive behavior, and improve problem-solving abilities. Therapy also facilitates the development of interpersonal relationships and the ability to function in the family and community.18
In terms of smoking cessation, tobacco treatment is extremely cost-effective when compared with commonly provided clinical preventive services, including mammography, colon cancer screening, PAP tests, and others. Further, tobacco use screening and brief intervention by clinicians has been found to be cost-saving.19 The Centers for Disease Control and Prevention (CDC) offers smoking cessation help through the National Network of Tobacco Cessation Quitlines, which can be reached by calling the toll-free number 1-800-QUIT-NOW (1-800-784-8669, TTY 1-800-332-8615). Callers are automatically routed to their state-run quitlines, which offer a variety of services such as counseling and referral to local cessation resources. Some states offer counseling services in multiple languages and provide over-the-counter nicotine replacement therapy for eligible callers.
Other resources exist to enhance and complement professional treatment programs available to those seeking a path of recovery from substance use disorders. Peer-to-peer services and mutual support groups help prevent relapse and promote long-term recovery, thereby reducing strain on the treatment system.20 For example, the Recovery Community Services Program (RCSP), a SAMHSA grant program, provides support for peer-to-peer recovery support services that help people initiate and/or sustain recovery from substance use disorders. Some RCSP grant projects also offer support to family members of people needing or seeking treatment, or in recovery. For more information about the RCSP projects, visit www.rcsp.samhsa.gov.
People experiencing both mental health and substance use disorders are said to have a co-occurring disorder. Since co-occurring disorders are fairly prevalent, ensuring that treatment is available and accessible in a collaborated treatment process for both disorders is essential to providing a successful path of recovery. According to SAMHSA’s Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Health Disorders, the treatment of both mental health and substance use disorders can help prevent the exacerbation of other health problems, including cardiac and pulmonary diseases.21
Recovery from a substance use disorder can be a long-term process and may require multiple episodes of treatment. Participation in self-help support groups during and following treatment is often helpful in maintaining abstinence.22 Adhering to aftercare therapy by participating in mutual support groups and recovery networks during and after the initial course of treatment is associated with improved outcomes. Encouraging people in recovery to seek out aftercare following their initial treatment will help them sustain their path of recovery.23
For confidential information and treatment referral, please call SAMHSA’s National Helpline at 1-800-662-HELP or visit SAMHSA’s Substance Abuse Treatment Facility Locator at www.findtreatment.samhsa.gov. For more information and materials about substance use disorders, treatment, and recovery, visit SAMHSA’s Center for Substance Abuse Treatment’s Web site at www.csat.samhsa.gov. Additional information is available at www.recoverymonth.gov.
1 Pathways of Addiction: Opportunities in Drug Abuse Research. National Academy Press. Washington, D.C.: Institute of Medicine, 1996.
2 Results From the 2005 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 06-4194. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2006, pp. 69-72, 141, 146, 170.
3 Kleber, H.D., O’Brien, C.P., Lewis, D.C., McLellan, A.T. “Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation.” Journal of the American Medical Association, 284(13), Chicago, IL: American Medical Association, October 4, 2000, p. 1689.
4 Pathways of Addiction: Opportunities in Drug Abuse Research. National Academy Press. Washington, D.C.: Institute of Medicine, 1996.
5 Principles of Drug Addiction Treatment: A Research-Based Guide. NIH Publication No. 99-4180. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, October 1999, p. 3.
6 Ibid.
7 Treatment Improvement Protocol (TIP) Series 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. DHHS Publication No. (SMA) 04-3939. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2004, pp. 51, 58-59.
8 Treatment Improvement Protocol (TIP) Series 39: Substance Abuse Treatment: Group Therapy. DHHS Publication No. (SMA) 04-3957. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2004, Chapter 1.
9 “The Role and Current Status of Patient Placement Criteria in the Treatment of Substance Use Disorders.” KAP Keys For Clinicians. DHHS Publication No. (SMA) 01-3565. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2001, section entitled “Matching.”
10 Rowe, C.L., Liddle, H.A. “Substance Abuse.” Journal of Marital and Family Therapy 29(1), January 2003, pp. 97-120.
11 “Clinical Guides for Alcohol Use Disorders in Older Adults.” The American Geriatrics Society Web site: www.americangeriatrics.org/products/positionpapers/alcoholPF.shtml, section entitled “Features of preferred treatment options for abuse/dependence among older adults.” Accessed September 26, 2005.
12 Principles of Drug Addiction Treatment: A Research-Based Guide, pp. 3, 4.
13 Treatment Improvement Protocol (TIP) Series 45: Detoxification and Substance Abuse Treatment. DHHS Publication No. (SMA) 06-4131. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2006, pp. xv, 4.
14 Ibid, p. xviii.
15 Treatment Improvement Protocol (TIP) Series 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, pp. 51, 58-59.
16 Treatment Improvement Protocol (TIP) Series 28: Naltrexone and Alcoholism Treatment. DHHS Publication No. (SMA) 98-3206. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 1998, Executive Summary.
17 Treatment Episode Data Set (TEDS): Discharges from Substance Abuse Treatment Services. DHHS Publication No. (SMA) 06-4207, DASIS Series S-35. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2006, p. 2.
18 Principles of Drug Addiction Treatment: A Research-Based Guide, p. 4.
19 Cummings, S.R., Rubin, S.M., Oster G. “The Cost-Effectiveness of Counseling Smokers to Quit.” Journal of the American Medical Association, 261(1), 1989, pp. 7579.
20 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Recovery Community Services Program Web site: http://rcsp.samhsa.gov, sections entitled “The Recovery Community Services Program,” “About the RCSP Program,” and “Peer Services: Peers Helping Peers.” Accessed November 16, 2004.
21 Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Health Disorders. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2002, p. ix.
22 Principles of Drug Addiction Treatment: A Research-Based Guide, p. 5.
23 Lash, S.J., Blosser., S.L. “Increasing adherence to substance abuse aftercare group therapy.” Journal of Substance Abuse Treatment, 16(1), January 1999, pp. 55-60.
