Behavioral approaches: These treatments help engage people in drug use treatment, provide incentives for them to remain abstinent, help them to modify attitudes and behaviors related to drug use and increase coping skills to handle stressful circumstances and environmental cues that may trigger intense cravings to use drugs.
Cognitive Behavioral Therapy: Shown to be effective for treating problems with alcohol, marijuana, methamphetamine, and nicotine, this treatment involves learning to identify triggers for use and correct problematic behavior by developing coping strategies, exploring positive and negative consequences of drug use, self-monitoring to recognize cravings early and identify situations that may lead to drug use, and avoiding high-risk situations and relapse.
Contingency Management: Found to be effective for treating problems with alcohol, stimulants, opioids, marijuana, and nicotine, this treatment involves giving people tangible rewards (e.g., vouchers, prizes) to reinforce positive behaviors such as abstinence (as verified by urine screening, for example).
Community Reinforcement Approach Plus Vouchers: This intensive outpatient therapy for treating people with alcohol, cocaine or opioid problems. It uses a range of recreational, familial, social, and vocational reinforcers, along with material incentives, to make a non-drug-using lifestyle more rewarding than using drugs. This treatment aims to help maintain abstinence long enough for patients to learn new life skills to help sustain it.
Motivational Enhancement Therapy: Effective for treating problems with alcohol, marijuana, and nicotine, this treatment helps individuals resolve ambivalence about engaging in treatment and stopping drug use. This approach aims to evoke rapid and internally motivated change.
The Matrix Model: Effective for treating stimulant addiction, this therapy involves positive, collaborative therapy, use of self-help programs, relapse prevention, psychoeducation, family and group therapies, urine testing, and relapse analysis.
If a patient is experiencing severe problems resulting from use, risky compulsive use and/or toxicity may require additional medical monitoring. Intensive outpatient, inpatient, or residential treatment may be necessary before considering lower-level interventions.
Higher Level of Care Programs for SUD:
Intensive Outpatient Programs: These programs may combine individual and group therapy components using approaches mentioned above, peer support, and may include other monitoring services such as breathalyzer and/or urine toxin screenings. Intensive outpatient programs typically involve attending several sessions or classes per day for most of the day, for up to several weeks. The structure of these programs can help people avoid using alcohol or other drugs, in addition to helping to build coping skills to avoid further use.
Inpatient and Residential Substance Use Treatment: These programs typically involve a stay at a hospital or other treatment facility, utilizing several of the treatment modalities mentioned above. Like intensive outpatient programs, the structure of residential treatment programs help individuals to avoid using alcohol by removing them from tempting environmental cues and stressors that may lead them to drink while new skills and behaviors are learned and developed. Residential treatment is considered a higher level of care than regular outpatient or intensive outpatient treatment.
Aftercare: After completing residential substance use treatment, involvement in aftercare programs involving monitoring, skill bolstering, and relapse prevention, can lead to better outcome.
Pharmacological treatments: For some substances, pharmacotherapy is available as a standalone or (ideally) an adjunct to behavioral treatment. These treatments work by reducing cravings by stimulating the same receptors drugs act on, without the negative effects, and/or by causing negative effects when the substance is injected.
Opioids
- Methadone – Synthetic opioid agonist medication that can prevent opioid withdrawal symptoms and craving
- Buprenorphine – Semisynthetic opioid that can also be used to prevent opioid withdrawal symptoms and craving
Tobacco
- First-line medications
- Bupropion SR – an antidepressant medication shown to reduce cravings for smoking and withdrawal symptoms
- Varenicline – a nicotinic receptor partial agonist, this medication reduces cravings for nicotine and decreases pleasurable effects of tobacco products
- Nicotine replacement – blocks craving and withdrawal by providing nicotine with a safer route of administration
- Nicotine gum
- Nicotine inhaler
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine patch
- Second-line medications
- Clonidine
- Nortriptyline
Alcohol
- Naltrexone can help people reduce heavy drinking.
- Acamprosate makes it easier to maintain abstinence.
- Disulfiram blocks the breakdown (metabolism) of alcohol by the body, causing unpleasant symptoms such as nausea and flushing of the skin. Those unpleasant effects can help some people avoid drinking while taking disulfiram.
Other strategies that may prove effective include:
12-Step Facilitation Therapy: Twelve-step facilitation therapy is an active engagement strategy designed to increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence.
Family Behavior Therapy: This treatment shows promise for adults struggling with SUD and co-occurring disorders and involves the patient along with at least one significant other such as a cohabiting partner. Therapists seek to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment.
