Substance Abuse Treatment: What Are the Options?

If you or someone you love is struggling with a substance abuse disorder, there is hope.

While the latest data from the National Survey on Drug Use and Health shows that 16.5% of Americans over the age of 12 met the criteria for having a substance use disorder (SUD), there are several different ways to tackle the problem. These include therapy, medications, inpatient and outpatient programs and therapeutic communities. Here, experts discuss these different substance abuse treatment options, plus what to expect with each treatment.

What is substance abuse?

SUD is sometimes called substance abuse or substance dependence. The Partnership to End Addiction says that several signs could indicate you or a loved one are experiencing a substance use disorder. This includes experiencing any two or three of these American Psychiatric Association (APA) criteria within a 12-month time frame:

• Spending a lot of time trying to get, use or recover from the substance
• Using greater and greater amounts
• Using over a longer timeframe than intended
• Using in ways that interfere with work, home, recreational or relationship responsibilities and activities
• Experiencing strong cravings to use
• Trying unsuccessfully to reduce or stop using
• Needing more and more of the substance to experience the same effects
• Experiencing withdrawal symptoms
• Using repeatedly in dangerous situations, such as driving while intoxicated
• Using the substance despite knowing it’s negatively impacting your well-being

The most severe form of SUD is sometimes called addiction, according to APA. People can develop an addiction to many types of substances such as:

• Alcohol
• Opioids
• Cocaine
• Sedatives
• Nicotine
• Hallucinogens

“The process [of addiction] would look something like this: It could begin with worsening of day-to-day human stresses, e.g., hunger, anger, loneliness and tiredness,” addiction psychiatrist Dr. Christoffel Le Roux told the American Journal of Psychiatry recently. “When these then fatefully collide or coincide with additional trauma, an individual’s coping skills are overwhelmed and stay overwhelmed.”

What types of treatment may be available for substance use disorder?

Because substance abuse is complex, your treatment should address both the drug abuse and your social, psychological, medical, employment and legal needs, according to the National Institute on Drug Abuse (NIDA). You may be treated with one or more of the following treatments.

Medications

NIDA and the National Alliance on Mental illness (NAMI) say that medications are used in SUD treatment:

• To help with withdrawal symptoms (detoxification)
• To help reduce the use of the abused substance
• To address a co-occurring disorder, such as antidepressants for major depressive disorder

Outpatient therapy

NIDA notes that outpatient therapy offers more flexibility and is often less costly than inpatient therapy, but some programs may be more education-focused than therapy-focused. It can include:

• Programs that you attend in your off hours (after work, school or parenting responsibilities)
• Individualized counseling
• Intensive daytime therapy programs that you leave each evening and return to in the morning

Inpatient therapy

During inpatient therapy, medical care and substance abuse treatment are available 24/7, and you live on-site for a period. According to NIDA, these programs are sometimes called long-term residential treatment programs or "rehab" for short, and they often provide the most comprehensive services for SUD.

Kaiser Permanente says there are several reasons a person might choose inpatient therapy:

• You’re having difficulty staying away from the substance(s) you use
• You have other mental or physical health conditions
• There is no outpatient treatment available near you

Therapeutic communities

Therapeutic communities include supportive peers and sometimes trained specialists who provide a healing community. NAMI and NIDA say they may be:

• Sober houses
• Group counseling programs
• Self-help support groups

What to expect with treatment

How long does it take?

To be effective, NIDA recommends at least three months of treatment and notes that many inpatient treatment programs last 6 to 12 months.

What are the steps?

The Hazelton Betty Ford Foundation explains that SUD treatment includes:

• Evaluation to assess your health and history
• Medically supervised detoxification (removing the drug from your body)
• Treatment, including individualized, group and special-focused therapy
• Recovery support, including follow-up care guidance

What treatments are used?

SUD therapy itself is multifaceted, says NIDA and the Cleveland Clinic. For example, addiction specialists might use cognitive behavioral therapy to help people identify their triggers and learn strategies to take control of them so they’re less likely to turn to alcohol or drugs again. Treatment for SUD could also include:

• A therapy known as "dialectical behavioral therapy," to help with emotional regulation
• Rewards-based treatments to encourage healthy choices
• Exercise
• Sober social activities

NIDA said that self-help programs are also part of many inpatient and outpatient treatments. One recent study by the Massachusetts General Recovery Research Institute found that people in treatment for SUD who self-administered “happiness” exercises experienced elevated moods.

"Recovery is hard, and for the effort to be sustainable, positive experiences need to be attainable along the way," lead study author Bettina Hoeppner said in a news release on the study.

Resources

Substance Abuse and Mental Health Services Administration: National Survey on Drug Use and Health

Partnership to End Addiction: Substance Use Disorder vs. Addiction

American Psychiatric Association: What Is a Substance Use Disorder?

American Journal of Psychiatry: An Interview with Addiction Psychiatrist Dr. Christoffel Le Roux

National Institute on Drug Abuse: Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

National Alliance on Mental Illness: Substance Use Disorders

Kaiser Permanente: Inpatient and Outpatient Treatment for Substance Use Disorder

Hazelton Betty Ford Foundation: What to Expect in Rehab

Cleveland Clinic: Substance Use Disorder (SUD)

Journal of Substance Abuse Treatment: Do self-administered positive psychology exercises work in persons in recovery from problematic substance use? An online randomized survey

The Harvard Gazette: Summoning happiness to aid recovery

Support Your Recovery: Support for overcoming substance misuse