Substance use disorders are chronic disorders in which a person continues to use a specific substance in a nonmedicinal manner, even though they continually experience negative problems associated with their drug use. Even though many individuals will initially believe that they can control their substance use and can stop on their own, the vast majority find that they need to become involved in some professional and formalized treatment program in order to regain their lives.
This article will outline the major types of treatments that are used for substance use disorders. A full discussion of all available options for treatment is well beyond the scope of this article. In addition, this article will refer to empirically validated models of treatment, meaning that these general forms of treatment have been supported by numerous research studies regarding their effectiveness.
Using Pharmacotherapy to Treat Substance Use Disorders
The term pharmacotherapy refers to treatment using medications. Pharmacotherapy has a solid foundation for the treatment of substance use disorders, and the specific type of medication being used will depend on the issue being addressed. There are certain medications that are administered to reduce cravings for drugs (e.g., baclofen, ReVia, etc.); there are medications that are used to help individuals get through the withdrawal process (e.g., Suboxone, methadone, benzodiazepines, etc.); there are medications that can be used to discourage an individual from taking drugs or alcohol (e.g., Antabuse); and there are specific medications that can be used to treat other types of symptoms that occur during withdrawal or that co-occur with individuals who have substance use disorders (e.g., antidepressant medications, antipsychotic medications, Clonidine, etc.).
While the use of medications in the treatment of substance use disorders is very common, it is also not designed to be a standalone treatment. Simply using medications to go through the withdrawal process or to control cravings for drugs or alcohol does not address the core issues that individuals with substance use disorders often have. While pharmacological approaches to assisting the treatment of substance use disorders are extremely useful and sometimes absolutely necessary, they do not represent a total approach to the treatment of substance use disorders.
The administration of medications in the treatment of substance use disorders can only be accomplished under the supervision of a licensed physician in most states. There are some exceptions to this rule; however, addiction medicine is typically the domain of physicians trained in addiction medicine or psychiatrists (who are MDs).
Therapeutic Communities, Residential Treatment, and Inpatient Programs
Residential treatment or inpatient treatment provides around-the-clock care in a clinic, hospital, or residential setting. Inpatient treatment programs are often used for withdrawal management or for individuals who have serious substance use disorders and need to be isolated from potentially toxic environmental conditions. The focus of these programs is typically designed to get the person through the withdrawal process, develop a solid foundation in recovery, and/or re-acclimate the person to living without the need for drugs or alcohol. These types of treatment programs are typically:
- Very structured with specific schedules for the clients in them
- Multidisciplinary in nature, meaning that a number of different treatment providers from different backgrounds participate in the treatment of the individual, including physicians, therapists, counselors, social workers, nurses, volunteers, etc.
- Designed to deal with any co-occurring psychological disorders or medical conditions
- Aimed at imparting a sense of accountability in clients
- Focused on developing a strong foundation for long-term recovery
Most residential programs are time-limited, such that individuals will eventually need to transition to outpatient treatment. For the most part, these programs are designed to last from two weeks to 12 months or longer, depending on the needs of the individual and on the particular situation. Shorter programs are typically designed toward withdrawal management or preparing the individual for treatment outside of the facility. Longer programs typically deal with more complicated issues.
The bulk of most treatment interventions are done on an outpatient basis. Research indicates that, in general, inpatient and outpatient treatment programs are equivalent in terms of their effectiveness, except in very specific instances. The choice between outpatient and inpatient treatment should be based on individual circumstances and be made in conjunction with one’s treatment team.
Behavioral therapy refers to a number of different interventions that include counseling and the assistance of a professional therapist in helping someone modify or change their behaviors or attitudes, or deal with specific situations. There are hundreds of forms of behavioral therapy. A few types of therapy relevant to the treatment of substance use disorders are listed below.
- Cognitive Behavioral Therapy: Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that combines two major schools of thought in psychology: the cognitive school and the behavioral school of psychology. Cognitive Behavioral Therapy is a family of different types of therapy that all attempt to help the person to recognize and understand how certain types of irrational beliefs and expectations often lead to dysfunctional behaviors, including substance use disorders. The therapist works with the individual to understand these irrational beliefs and expectations, identify and challenge them, and help the person alter or replace them with more functional behaviors that are in line with the real world.
Cognitive Behavioral Therapy is often considered to be the most appropriate choice of therapy in the treatment of substance use disorders, although there are other forms of therapy that can also be used. In addition, CBT is an umbrella term that covers a number of different recognized forms of therapy, including Dialectic Behavior Therapy, Rational Emotive Behavioral Therapy, Motivational Interviewing, and many others.
- Psychodynamic Therapy: Psychodynamic therapy is an extension of Freudian psychoanalysis that can be applied to problems individuals face today. Psychodynamic therapy for substance use disorders concentrates on identifying the internal motivations that individuals have for using substances and helping the individual recognize these motivations (e.g., to relieve anxiety, to forget past trauma, to counter the effects of one’s upbringing, etc.). As individuals begin to discover more about themselves, they begin to develop more realistic coping methods. Although psychodynamic therapy traditionally is designed to be delivered over period of years, the current conceptualizations of psychodynamic therapy are much shorter in duration and may be attractive to individuals who wish to understand more about their deeper motivations.
- Contingency Management Interventions: Contingency Management is a form of behavioral intervention that motivates individuals by offering them tangible reinforcers (rewards) when they engage in behaviors that promote recovery from the abuse of drugs or alcohol. These reinforcers can be anything depending on what the individual values, including not being incarcerated, a type of Contingency Management program often forced on individuals with substance use disorders who are caught up in the legal system. Contingency Management programs may have their best effectiveness in the maintenance of recovery compared to fostering compliance in the initial stages of recovery.
- Group Therapy: Group therapy occurs when one or more therapists treats one or more clients at the same time. Individual therapy is typically a one-on-one situation with one therapist and one client. Group therapy can be delivered from any of the different perspectives of psychotherapy. In general, group therapy and individual therapy are equivalent in their effectiveness but group therapy does offer the chance for group members to learn from one another, share and help one another, develop a sense that they are not alone in their issues, and develop a support system. Group therapy includes all forms of family therapy and couples therapy (e.g., marital therapy).
Support groups do not qualify as formal therapy groups because they are not typically run by licensed therapists. These include 12-Step groups, such as Alcoholics Anonymous, certain community support groups, and others. While the research supporting their effectiveness as standalone treatments is mixed, these groups do offer individuals long-term and ongoing opportunities to remain focused on recovery. In addition, they are excellent sources of social support, essentially free to attend (individuals can donate money if they wish), and held nearly every day at different times so they are extremely accessible. For many individuals, support group participation is an important part of the long-term recovery process.
Formal types of therapy and counseling can only be delivered by trained and licensed therapists. Support groups are typically run by other individuals in recovery, and there are no statewide regulations regarding qualifications to run these.
The major available interventions for substance use disorders include pharmacotherapy, behavioral therapy, and support group participation. The use of behavioral therapies is the most common form of intervention that is delivered individuals with substance use disorders followed by the use of medicines. In addition, social support groups offer long-term opportunities for individuals in recovery to remain focused on their commitment to living a sober life.