Most 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. Some people may find themselves moving along this continuum at various points in their lives. The majority of people will manage their substance use without seeking professional help. Some people simply need harm reduction support and tools to be safer. Others who develop issues with their use will choose to pursue professional substance use disorder 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, Relapse Prevention, and Contingency Management.
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 therapies have proven to be the most effective forms of treatment for opioid use disorder. There are 3 medications approved by the Food and Drug Administration (FDA) to treat opioid use disorder. These are methadone, buprenorphine (e.g., Suboxone), and naltrexone (e.g., Vivitrol).
The 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.
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. 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.
The majority of people with substance use disorders do not seek treatment, and many can overcome any negative consequences of drug use 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:
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.