DPA's Principles of Substance Use Disorder Treatment

Treatment must be immediately available to all who seek it. Barriers to SUD treatment need to be removed or minimized. People should have easy access to treatment when they are most motivated for change.

Insurance coverage for treatment should be comprehensive. Ability to pay should never be a barrier to care.

Treatment should meet people where they are at. It should be designed to encourage engagement and retention, including low thresholds for enrollment. For example, programs should not require abstinence as a condition for starting, continuing, or completing care

Treatment must be grounded in respect for the human rights and dignity of all clients. Treatment should be provided in a voluntary, ethical, and client-centered manner in the least restrictive setting possible.

All SUD treatment providers must recognize and support the inherent dignity of the clients they serve. Clients have the right to autonomy. Providers should exercise all measures in order to protect the health, welfare, and confidentiality of clients.

The expertise provided by treatment professionals is important and helpful. However, it should not supersede a client’s right to bodily autonomy. Providers must respect that clients are the authorities and experts of their own minds, bodies, and narratives.

Clients should have final authority over any treatment decisions. Treatment should never be forced or against the will of the client. When treatment is available, attractive, and wanted, people will access the services on their own without coercion.

Treatment should be based on the best available current evidence to improve client engagement, retention, and outcomes. Providers should track outcomes beyond abstinence, including client satisfaction, quality of life and other indicators of well-being.

If a strong evidence base does not exist for specific aspects of treatment, new models should incorporate best practices. They should also include rigorous evaluation to monitor implementation and outcomes.

Treatment providers and clients should participate in program evaluations. Evaluation results should be readily available to oversight bodies, researchers, clients, and the public. Funding should be driven by what has proven to be effective or promising.

Treatment providers should work closely with other providers to address health or social service needs beyond substance use. In some cases, these needs may be more urgent than SUD treatment. Clients should be able to decide whether these needs take precedence over SUD treatment.

Treatment must be culturally sensitive and attuned to the needs of special populations. This will help ensure individuals receive the best possible care. Providers should understand that cultural sensitivity is essential and not optional in SUD treatment settings.

Program administrators, supervisors, and providers must make ongoing efforts to understand how stigma, discrimination, criminalization, and marginalization impacts certain groups and their treatment needs.

SUD treatment settings may need to change so they are more accessible. This may include changes to language and translation services, materials, approach, hours, and modalities.

While all treatment should be individualized, different client populations have unique strengths, vulnerabilities, and needs. Populations requiring special consideration and treatment can include:

• Adolescents
• Aging populations
• Women
• Pregnant and parenting people
• Sex workers
• LGBTQ people
• People with disabilities
• Communities of color
• Ethnic and religious minorities
• Criminal legal system-involved individuals
• People experiencing homelessness
• Individuals who are socially marginalized for other reasons

They should engage in transparent governance practices and be adequately monitored by licensing bodies. SUD treatment should be delivered by trained professionals and peers in approved treatment settings. Federal and state agencies should establish standards for training, credentialing, and/or licensing for SUD treatment providers.

Providers should also receive adequate supervision, professional development, and continuing education. This will ensure they are providing appropriate care informed by best practices.

Clients should also be able to seek recourse through licensing bodies, when needed.

People involved in the criminal legal system should have access to the full range of treatment service options available in the community. Clients should determine the course of treatment with their credentialed provider(s) and without influence from the criminal legal system.

Community-based SUD treatment should never be viewed as an “alternative to incarceration.” This creates a false and dangerous narrative that some people with SUD deserve punishment and others deserve treatment. Treatment should always be available to those who want and need it, whether they are involved in the criminal legal system or not.

Judges and other legal professionals should not decide the level or type of care clients receive in court-mandated SUD treatment. This is a decision that clients should make with their SUD treatment provider.

People with SUDs in court-ordered treatment or in correctional settings should have access to the full range of treatment services that are available in the community. This includes all forms of Medications for Addiction Treatment (MAT) and harm reduction services. This treatment should be held to the same quality and ethical standards as treatment in the community.