Substance Use Disorder Treatment

While many Americans have used alcohol or an illicit drug in their lifetime, most will never develop a substance use disorder. Substance use occurs along a continuum from abstinence to addiction, and some people may find themselves moving along this continuum at various points in their lives. 

The treatment continuum: non-use/abstinence, experimental use, recreational use, regular use, misuse, problematic use, addiction

The majority of people will manage their substance use without seeking professional help. Many alter their patterns of use according to their health, and others simply need harm reduction support and materials to stay safe. Others who develop issues with their use will choose to pursue professional substance use disorder treatment. 

What is Substance Use Disorder Treatment?

Substance use disorder (SUD) treatment involves professionally delivered psychosocial treatment and/or medications to reduce harmful substance use and improve health and quality of life. These services are provided in a variety of settings, including specialized treatment facilities like outpatient, inpatient, or residential centers, and in medical settings such as hospitals and clinics. 

Unfortunately, there are currently no standard federal licensing or credentialing requirements for substance use treatment facilities, and there are varying levels of accountability for facilities in individual states. As a result, treatment quality in the U.S. varies widely.  

Psychosocial Treatment (also known as behavioral treatment) 
This is the primary form of treatment available in most substance use treatment facilities in the U.S. It can involve any combination of individual, couples, family, or group therapy. The most commonly available types of psychosocial treatments include Cognitive Behavioral Therapy, Motivational Interviewing, Contingency Management, Relapse Prevention, and Twelve-Step Facilitation. 

Each of these forms of psychosocial treatment have varying degrees of efficacy and evidence supporting their use. Unfortunately, the consistent use of evidence-based treatments remains a challenge in the U.S., and few facilities provide multiple therapy options for clients to choose from.

Medication-Assisted Treatment (MAT)
There are currently three FDA-approved medications for opioid use disorder: methadone, buprenorphine, and naltrexone. Methadone is known as the gold-standard treatment for opioid use disorders because it has the most research supporting its efficacy, and it has proven to cut overdose risk by 50% among patients who take the medication. Buprenorphine shares many of these same benefits, whereas the evidence on naltrexone and reduced overdose risk is still mixed. Drug Policy Alliance (DPA) is committed to allowing client choice for any of the three forms of MAT for opioid use disorder in all treatment settings. Research suggests that these medications remain underutilized in the U.S.

Self-help Groups
These groups are free, available in the community or online, and are facilitated by fellow peers and people in recovery instead of trained or credentialed professionals. 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. 

Research suggests that self-help groups can be helpful for some individuals with substance use disorder, but more research is needed to understand what aspects of self-help are most beneficial and for whom. Self-help groups should not be mistaken for treatment.

DPA believes that people should be able to choose the self-help groups that align with their own personal recovery goals and personal preferences. We do not endorse any single self-help group over others, and we do not believe that attendance at any self-help group should be mandated or coerced by a treatment facility, the justice system, employers, or other entities.

Substance Use Disorder Treatment and COVID-19 

States have instituted a number of policy changes in response to the COVID-19 pandemic that have proven to reduce exposure to the virus in many parts of the country. But they have also had the unintended consequence of restricting access to substance use disorder treatment. Stay-at-home orders and social distancing requirements have reduced in-person outpatient, inpatient, and residential treatment availability, including access to Medication-Assisted Treatment (MAT) for opioid use disorder. While many programs have embraced telehealth services and have loosened restrictions for MAT treatment, far too many still struggle to get the services they need.

DPA is fighting to expand and make permanent some loosened restrictions for MAT in light of COVID-19 and to continue to remove barriers that were hindering treatment access prior to the pandemic. 

See our COVID-19 policy recommendations.

Why Don’t Most People Receive Treatment for Substance Use Disorders?

90% of people with a substance use disorder did not receive treatment in the past year.

The majority of people with substance use disorders do not seek treatment and many can overcome their problems without treatment. However, far too many people who desire treatment often face challenges that stop them from accessing the services they want. The more barriers people face, the less likely they are to access services. 

Some of the most common obstacles are:

  • Cost: Treatment is not affordable or fully covered by health insurance, or what is covered is inaccessible due to insurance requirements and limitations.
  • Few providers: In many parts of the country, especially rural communities, there are too few providers nearby and long waitlists at existing providers. This can also include long distances to travel for treatment, which can be challenging for those without reliable transportation and busy schedules. 
  • Programmatic issues: Many treatment providers have strict attendance requirements or limited treatment hours, which may be challenging for people who work or have family/caretaking responsibilities. Treatment may not be attractive to potential clients due to imposing restrictions on drug use like abstinence-only programs, visitation, and limited access to other services or MAT.
  • One-Size-Fits-All Approach: Treatment may not be tailored to the specific needs or preferences of individuals, including their personal treatment and recovery goals, as well as the needs of special populations including those with co-occurring mental health diagnoses, racial or ethnic minorities, or gender or sexual minorities.
  • Stigma: The taboo associated with substance use often makes it difficult for people to seek help.

Even when treatment is accessible, it is often not evidence-based, provided by highly-trained professionals, or subject to adequate oversight. Client engagement is correspondingly low and drop-out rates are high.

Key SUD Treatment Issues

Principles of Treatment 
DPA has established seven principles to ensure substance use treatment is provided at and held to the highest quality standards. We’re working to instill these principles into policies, providers, and payers across the country.

Medication-Assisted Treatment
Medication-Assisted Treatment (MAT) is the use of FDA-approved medications for the treatment of substance use disorders. DPA works to ensure all forms of MAT are available and accessible for all who could benefit.

Heroin-Assisted Treatment
Heroin-Assisted Treatment (HAT) refers to the medically supervised administration of pharmaceutical-grade heroin to people with heroin use disorders who have not responded well to more traditional forms of treatment. We advocate for the adoption of HAT models in the U.S.

Contingency Management
Contingency management is a behavioral therapy that uses tangible (usually monetary) rewards to reinforce positive behavior change. DPA is pushing for the widespread dissemination of contingency management into mainstream substance use treatment.

Involuntary Treatment
Every person has the right of bodily autonomy, which includes the right to refuse unwanted treatment. Unfortunately, policymakers and providers often ignore this right and force people into services they do not want. DPA challenges mandated treatment and coercion in treatment settings and advocates for more attractive treatment designed to increase voluntary access, as well as lower threshold and harm reduction options along the continuum of care.

Treatment in the Criminal Justice System
People involved in the criminal legal system should be able to determine the goals and strategies for substance use treatment with the consultation of their chosen treatment provider. They should have access to the full range of treatment services available in the community, including MAT and harm reduction services. DPA fights for improved access, quality, and choice of substance use treatment in criminal legal settings.

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