Early Intervention, Treatment, and Management of Substance Use Disorders

Treatment for substance use disorders can take many different forms and may be delivered in a range of settings varying in intensity. In all cases, though, the goals of treatment for substance use disorders are similar to treatment for any medical condition: to reduce the major symptoms of the illness and return the patient to a state of full functioning. Ideally, services are not “one size fits all” but are tailored to the unique needs of the individual. Treatment must be provided for an adequate length of time and should address the patient’s substance use as well as related health and social consequences that could contribute to the risk of relapse, including connecting the patient to social support, housing, employment, and other wrap-around services.

Screening for substance misuse in health care settings including primary, psychiatric, urgent, and emergency care is the first step in identifying behaviors that put individuals at risk for harms, including for developing a substance use disorder, and to identify patients with existing substance use disorders. Screening and brief intervention for alcohol in adults has been shown to be effective;31 and screening for substance use and mental health problems is recommended by major health organizations for both adults and adolescents.33-36 Brief advice or therapy would follow a positive screen and be tailored to an individual’s specific needs; referral can be made to specialty treatment depending on severity.

Treatment for all substance use disorders—including alcohol, marijuana, cocaine, heroin or other opioid use disorders, among others—should include one or more types of behavioral interventions delivered in individual, group, and sometimes family settings. Evidence-based behavioral interventions may seek to increase patients’ motivation to change, increase their self-efficacy (their belief in their ability to carry out actions that can achieve their goals), or help them identify and change disrupted behavior patterns and abnormal thinking.

The intensity of substance use disorder treatment services falls along a continuum. For people with mild substance use disorders, counseling services provided through primary care or other outpatient settings with an intensity of one or two counseling sessions per week may be sufficient while residential treatment may be necessary for people with a severe substance use disorder. Residential treatment was designed to provide a highly controlled environment with a high density of daily services. Ideally, people who receive treatment in residential settings participate in step-down services following the residential stay. Step-down services may include intensive outpatient or other outpatient counseling and recovery support services (RSS) to promote and encourage patients to independently manage their condition.36,37

Medications are also available to help treat people addicted to alcohol or opioids. Research is underway to develop new medications to treat other substance use disorders, such as addiction to marijuana or cocaine, but none have yet been approved by the U.S. Food and Drug Administration (FDA). The available medications do not by themselves restore the addicted brain to health, but they can support an individual’s treatment process and recovery by preventing the substance from having pleasurable effects in the brain, by causing an unpleasant reaction when the substance is used, or by controlling symptoms of withdrawal and craving. Widening access to highly effective medications for treating opioid addiction—methadone, buprenorphine, and naltrexone—has been identified by United States public health authorities as an essential part of tackling America’s current prescription opioid and heroin crisis.

In summary: Treatment is effective. As with other chronic, relapsing medical conditions, treatment can manage the symptoms of substance use disorders and prevent relapse. Rates of relapse following treatment for substance use disorders are comparable to those of other chronic illnesses such as diabetes, asthma, and hypertension.41 More than 25 million individuals with a previous substance use disorder are in remission and living healthy, productive lives.42

However, many people seek or are referred to substance use treatment only after a crisis, such as an overdose, or through involvement with the criminal justice system. With any other health condition like heart disease, detecting problems and offering treatment only after a crisis is not considered good medicine. Integrating screening into general medical settings will make it easier to identify those in need of treatment and engage them in the appropriate level of care before a crisis occurs. Overall, the need is for a stepped care model, in which mild to moderate substance use disorders are detected and addressed in general health care settings and severe disorders are treated by specialists using a chronic care model coordinated with primary care. The good news is that the existing health care system is well poised to help address the health consequences of alcohol and drug misuse and substance use disorders.

To learn more about medication misconceptions, review the sidebar.

For More on This Topic

See “The Opioid Crisis” box in Chapter 1 - Introduction and Overview of the Report: Key Terms, Concepts, and Perspectives – 2016 (PDF | 1.5 MB).


Review the full text for Early Intervention, Treatment, and Management of Substance Use Disorders – 2016 (PDF | 629 KB)


References: 

31. Community Preventive Services Task Force. (2012). Preventing excessive alcohol consumption: Electronic screening and brief interventions (e-SBI). Accessed on June 10, 2016.

33. Zador, P. L., Lund, A. K., Fields, M., & Weinberg, K. (1989). Fatal crash involvement and laws against alcohol-impaired driving. Journal of Public Health Policy, 10(4), 467-485.

34. Canfield, S. E., & Dahm, P. (2011). Rating the quality of evidence and the strength of recommendations using GRADE. World Journal of Urology, 29(3), 311-317.

35. Committee on Health Care for Underserved Women. (2011). At-risk drinking and alcohol dependence: Obstetric and gynecologic implications. Obstetrics & Gynecology 118(2 Pt 1), 383-388.

36. Center for Health Information and Analysis. (2015). Access to substance use disorder treatment in Massachusetts. (15-112-CHIA-01). Boston, MA: Center for Health Information and Analysis, Commonwealth of Massachusetts.

37. National Institute on Drug Abuse. (2016). DrugFacts: Treatment approaches for drug addiction. Accessed on January 25, 2016.

41. McLellan, A. T., Lewis, D. C., O'Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689-1695.

42. White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868-2011. Philadelphia, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services.