Addiction (Substance Use Disorder) Treatment

CBT focuses on changing thought and behavioral patterns around substance use. With their CBT therapist, clients identify thought patterns and triggers that lead to substance use, set achievable goals, make plans to achieve them, and develop accountability strategies.

Once triggers for use are identified, therapists work with patients to develop strategies to cope with them. This can involve learning new skills, such as practicing mindfulness techniques, to handle triggers without using substances.

CBT then emphasizes the importance of setting and working towards achievable goals. These goals can be both short- and long-term and focus on a number of issues regarding substance use, including:

• Maintaining abstinence

• Improving relationships

• Managing stress or triggers for use

• Developing new habits

• Changing negative thought patterns

Through regular sessions, therapists provide support and accountability, helping clients stay on track with their recovery journey.

RP is an addiction-specific form of CBT that focuses on identifying high-risk use situations and feelings, then developing strategies to cope and prevent relapse.

First, patients work with their therapist to identify triggers that might lead to excessive use. Triggers can include specific environments or certain emotional states that increase cravings.

Then, they work to develop or expand coping skills that address these triggers in order to reduce the likelihood of relapse.

Patients are expected to practice these coping skills outside of triggering situations so when triggered, they will adapt to naturally use the coping skill.

MI focuses on using empathy and active listening, empowering patients to find their own motivation for changing their substance use habits.

For example, a patient may be unsure about their treatment goals or worry whether they are capable of changing their substance use. An MI therapist would build trust through open dialogue and ask open-ended questions to help the client to explore the pros and cons of changing to achieve their overall goal.

The therapist and patient first build a plan with small, achievable goals that can then increase motivation and confidence to achieve larger goals. The patient is held accountable to these goals by the therapist who continues to check in and monitor their progress.

Contingency management focuses on rewarding positive behavior changes to increase the likelihood that behavior is continued.

For example, some programs provide a reward (e.g., a gift card, cash, or other prize) for a positive behavior in line with treatment goals, such as a negative urine drug test result. Over time, clients become more confident in their ability to meet their goals and they become more motivated to maintain their progress.

Contingency management is one of the most effective treatments for stimulant use disorders because it significantly improves treatment engagement, retention, and outcomes. 

Methadone and buprenorphine are considered the “gold standard” for treating opioid use disorder. Patients who take these medications are less likely to experience cravings and withdrawal and are less likely to overdose than people who do not take these medications for their opioid use disorder.

Both medications are strictly regulated, though they are regulated differently.

Methadone is only available through federally approved opioid treatment programs (OTPs). Patients must complete a medical evaluation, submit to regular drug testing, and take medication under daily supervision.

Buprenorphine can be prescribed in doctors’ offices, clinics, and OTPs. Providers include doctors, physician assistants, and nurse practitioners. It’s also accessible via telehealth.

Naltrexone is the third medication for opioid use disorder. Its research is more mixed, but it can be helpful for some people who voluntarily choose this option.

Detoxification (detox), also referred to as withdrawal management, is the process of clearing the body of drugs or alcohol and managing withdrawal symptoms under medical supervision, often in a hospital-like setting. 

It can take days or weeks to get through withdrawal symptoms for most drugs. The length of withdrawal depends on a number of factors, including:

• Type of substance

• Length of use

• Physical dependence

• Last amount of substance taken

• Family history
• Underlying medical conditions

Detox may not be necessary before engaging in other treatment options, but this should be discussed with a medical provider since withdrawal from certain substances is riskier than others.

Residential addiction treatment programs provide longer-term 24/7 support for people in a non-hospital setting. Patients can be in residential programs for months to over a year. In these programs, patients may receive varying forms of treatment including:

• behavioral therapy
• peer support
• education and training
• medications for opioid use disorder*
  • While a growing number of residential treatment programs have begun to offer medications for substance use disorders, access to all three forms of medications for opioid use disorders remains relatively low.

Most residential programs require abstinence, and many do not offer harm reduction options. 

IOPs involve the same therapies as other levels of care, such as individual and group counseling, medication, behavioral therapies, case management, and more.

IOPs are a more flexible option, with an average of 3 hours of treatment per day for at least 3 days a week, and clients can commute to treatment from home or another form of supportive housing. Intensive outpatient treatment is usually provided for 12 weeks.

There is also outpatient daytime rehabilitation, also known as partial hospitalization, which involves up to 6 hours of outpatient treatment per day up to five days per week. Usually, clients stay at a supportive recovery housing program and are transported back and forth. When this is completed, clients usually transition to intensive outpatient treatment.

This treatment option is the least intensive and most flexible, with clients required to attend the program for 9 hours per week or less. Clients commute to treatment from their homes or from supportive housing programs.

Outpatient programs allow patients to have structured individual and/or group therapy sessions while also maintaining a more present outside routine, such as engagements with work or school.

Voluntary treatment means that a person is choosing to pursue substance use disorder treatment. In fact, roughly half of all treatment admissions are because the person chose to pursue treatment on their own.

Involuntary treatment means a person is being forced to attend treatment and, often times, maintain abstinence. If they do not complete it, they may be incarcerated, lose public benefits, lose child custody, or experience some other negative consequence. A person can be forced to attend treatment through the criminal justice system, the child welfare system,  social services, civil systems, or other agencies.

Some people believe that treatment should be forced in certain circumstances. Often times, this belief comes out of desperation to help someone and keep them alive.  We agree that when someone is struggling it’s urgent that they are connected to care and support. That’s why we advocate to making treatment on-demand, making it low-cost/free, and increasing funding, so there are more beds and spots. Right now, there is not enough treatment to meet the demand, and that must change.

Forced treatment is harmful and ineffective.

It can lead to undesirable health outcomes, including:

• increased risk of overdose death

• dangerous withdrawals from forced detoxification

Forced treatment is not catered to what an individual may need most. Most will likely receive treatment in outpatient programs, attending individual or group therapy a few times a week. Some residential centers are sterile, prison-like spaces—they can be punitive and isolating, making recovery even harder. Effective services should be available when and where people are ready for them, without hurdles like preconditions to get help or unaffordable costs.

Learn more about the benefits of voluntary treatment in our report: The Drug Treatment Debate: Why Accessible and Voluntary Treatment Wins out over Forced.

For people whose goal is abstinence, treatment should support that goal. However, relapse is common and can be a part of someone’s recovery journey, so treatment should be flexible and accommodate setbacks.

Some people may want to change their relationship with drugs without fully committing to abstinence. Regardless of a person’s goals, they should have access to treatment that meets their needs.

Programs that require strict abstinence can unintentionally set people up for failure. Individuals may be removed from treatment for using substances, or they may lose tolerance during forced abstinence. If they return to use, their risk of overdose increases.

Treatment is most effective when people choose to participate willingly. Motivation cannot be manufactured by force. Instead, treatment programs should be made more appealing and supportive to draw people in.

Many people who desire treatment often face challenges that stop them from accessing the services they want. The more obstacles people face, the less likely they are to access services.

Some of the most common barriers are:

• Cost and lack of/insufficient insurance: Not all treatment is affordable or fully covered by health insurance. Other times, which services or providers are covered may be  inaccessible because they are not located nearby or they have a waitlist. Sometimes clients have to pay out-of-pocket for certain services or have high co-pays and deductibles that make treatment unaffordable.

• Few providers and long waitlists: In many parts of the country, there are few providers nearby, and long waitlists at existing providers. Having such limited options can be challenging for those without reliable transportation and/or busy schedules with family and work commitments. 

• Limited treatment hours and other programmatic issues: Many treatment providers have strict attendance requirements and limited treatment hours. It can be difficult to find treatment programs that are open on evenings and weekends. This can be challenging for people who work, go to school, or have family/caretaking responsibilities.

• One-Size-Fits-All Approach: Treatment may not be tailored to personal recovery goals, often enforcing abstinence-only treatment goals. Recovery should be about reducing negative consequences, improved wellbeing, and putting people’s health first. It’s important to remember that relapse is a common occurrence in recovery and clients should not be punished for going through ups and downs during treatment.
• Stigma: The taboo associated with substance use often makes it difficult for people to seek help for fear of getting in trouble or being judged.

Learn more about barriers to treatment and the supports necessary to address addiction on our issue page: Increase Addiction Services.

If you are looking for treatment or support, please visit SAMSHA’s  “Find Help and Support” page for more information.

Self-help groups are free, available in the community or online, and are facilitated by fellow peers and people in recovery. The oldest and most well-known self-help groups are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), with chapters across the U.S. and around the world.

Self-help groups should not be mistaken for treatment.

Self-help groups can be helpful for some individuals with substance use disorder. However, these groups are just one tool—others may not find them helpful and/or need another form of support.  Advice given in a self-help group should not be mistaken for medical advice or advice from a professional. For example, someone struggling with severe, painful withdrawal symptoms may need medications or an inpatient setting.

Harm reduction is a set of ideas and interventions that seek to reduce the harms associated with both drug use and punitive drug policies. Harm reduction tools and strategies keep people alive if they choose to use drugs and can help stop the spread of infectious diseases. Harm reduction includes:

• access to the life-saving medication naloxone that can reverse an opioid overdose,

• tools for drug checking (like fentanyl or xylazine test strips) that can detect adulteration in the drug supply.

• syringe service programs that provide people with education and equipment to keep people from contracting and spreading infectious diseases.

• overdose prevention centers where trained professionals can reverse fatal overdoses and connect people to treatment and care.

• accurate, fact-based drug education that helps people understand the risk of drug use and take steps to be safer.

Harm reduction, like safer sex practices that help prevent sexually transmitted infections, acknowledges that people engage in behaviors that carry risks and seeks to keep them alive while they do. For those who are struggling, harm reduction services can be a lifeline—keeping people connected to services and a community that will provide the support they need. These services often serve as an entry point to addiction treatment, healthcare, and broader social support. It’s important to understand that providing harm reduction tools is different from treatment. Instead, providing harm reduction services should be part of a comprehensive set of interventions that support people who use drugs.

Learn more about harm reduction on our Harm Reduction Resource Page.

For some, treatment alone is enough.

For others, it’s just one part of a longer journey. When someone is also facing unmet basic needs—like unstable housing, food insecurity, or lack of income—those challenges must be addressed alongside treatment to support real, lasting recovery.

Think about it: if someone goes to treatment but returns to homelessness, they’re still living with the same stressors that may have led them to use in the first place—like unsafe sleeping conditions, abuse, violence, constant uncertainty, and no access to a bathroom or place to rest. These pressures make recovery much harder.

When people are suffering, some turn to drugs to cope or survive. On the street, some may use stimulants to stay awake for safety or opioids to numb physical or emotional pain.

That’s why pairing treatment with support like housing, food, and income is critical. Addressing these needs doesn’t just improve someone’s quality of life—it makes recovery possible.