Navigating the seemingly intricate world of substance use treatment might seem a complex endeavor. With the multiple types of care, treatment locations, levels of care, medication, and behavioral therapies, being familiar with commonly used terms will help you more easily find the care you need.
Types of Treatment
Treatment Types—Refers to the broad therapeutic categories used to treat substance use disorders.
These treatments typically have the goals of modifying the thoughts, feelings, behaviors, and perspectives of the recovering individual regarding their current situation and are delivered by trained professionals like therapists, counselors, social workers, psychologists, and psychiatrists. All of these therapeutic approaches are utilized in a number of different treatment settings and levels of program intensities. Treatment types include:
- Individual/One-on-One Therapy. This refers to any therapy that involves the professional treating the recovering individual during a one-on-one session. Individual therapy sessions will focus on ending substance use, building needed skills for sustained recovery, and creating a plan for relapse prevention 1,2.
- Family/Collaborative Therapy. This therapeutic format includes not only the person in recovery, but one or more family members or other supports like friends and romantic partners. Here, the goals will focus on strengthening relationships, building communication, and learning how the relationship encourages or deters substance use 3,4.
- Group/Multi-Person Therapy. This involves at least one professional in a room with two or more individuals in recovery. It can be utilized independently or combined with one-on-one therapy to gain social reinforcement to continue recovery 2. Group therapy can be extremely valuable but may introduce some potential challenges, such as group members reinforcing drug use (common among highly delinquent adolescent members) 4.
Levels of Care
Levels of Care—Refers to the intensity of treatment, who will be providing the care, and where those in recovery will reside while engaged with that specific level of treatment.
The appropriate level of care will be based on the individual’s current substance use, coping skills, outside supports, employment, and other factors 3,4. Levels include:
- Detoxification Process. Though it should not be regarded as a standalone treatment, detoxification is a key first step in the route away from substance abuse and towards recovery. It allows the body to process and remove the unwanted substance from the system. Detoxification can occur across a range of settings and may be performed with or without medical supervision and varying intensities of medical/pharmaceutical intervention.
- Inpatient Care. The highest level of care for people that need the most support. Inpatient treatment will be short-term, highly structured, and most appropriate for people that have significant medical or psychiatric issues that present with their substance abuse 2,4,5. Many inpatient programs will take place in specific units in a hospital and will not resemble a residence 2.
Residential Care. While technically also a form of inpatient care, this is the name given to a range of care levels that more resemble a typical residence than a hospital. Recovering individuals will live at the facility for a specific duration of time with the goal of establishing the foundation for a drug-free life. Residential options include:
- Therapeutic Communities (TC). With lengths of stay that range from 6 to 12 months, TCs focus on using professional staff, other residents, and social opportunities to elicit change and “resocialize” the individual. This type of structured treatment works to confront the individual’s views and behaviors that lead to use. TCs hope to encompass all aspects of recovery and can be modified to be effective with a number of special populations like young adults or teenagers, people with mental health disorders (co-occurring situations), and people with disabilities 4.
- Short-Term Residential Rehabilitation. Using treatment lengths of 3 to 6 weeks, this level of care is shorter in duration but remains intense. Short-term residential programs are frequently based on 12-step models. They include a detoxification period and, later, emphasis on a diligently established aftercare regimen for follow-up substance abuse treatment at the end of this initial 3-6 week duration 3,4.
- Recovery Housing. Typically, recovery houses offer a “step-down” level of residential care that is started after first completing a period of more intensive treatment. Recovery housing focuses on transitioning the individual back into the community and may provide assistance with employment and financial matters 3.
- Social Model. Sometimes referred to as “sober living,” social model homes will offer peer counseling, support, and appropriate role models for recovery, but there will be no formalized, professional treatment provided for residents. These services will be sought outside of the home 6.
Outpatient Care. Similar to their inpatient or residential counterparts, outpatient services vary in frequency, intensity, and duration. The commonality is that these services allow the individual to leave the care location and return to their home, unlike inpatient programs 3,4.
- Partial Hospitalization Program (PHP). Offering the most intensive services of all the outpatient program varieties, PHPs are appropriate for people with relatively severe symptoms that are able to be managed at home. Sometimes called “day treatment,” PHP involves at least 5 days per week for 4 to 6 hours of individual therapy, group therapy, or a combination of both
- Intensive Outpatient Program (IOP). Available as a middle ground between standard outpatient and PHP, IOPs meet for 3 hours per session with at least two sessions per week. Like PHP, it can include group therapy, individual therapy, or both 5.
- Standard. Standard outpatient treatment approaches may involve meeting at a care location, or at a substance abuse therapist’s office once or twice per week 5.
- Case/Care Management. A case/care manager provides support and assistance to the individual in the process of coordinating and receiving other services. They can help those in recovery secure housing, employment, and medical care while building social skills in the community 6.
Recovery Support Services. Though recovery support services are not a replacement for other formalized treatments, this category of carecan help reinforce and maintain improvements made by the individual through the sharing of their experiences with others 5.
- Peer Recovery Support. These services will be similar to those provided by a case/care manager and include transportation and education. One difference is that these non-clinical services are provided by a peer, someone engaged in their own recovery 2.
- Recovery High Schools. As an alternative school program, recovery high schools offer adolescents a more supportive environment with a mixed focus of education and recovery 5.
- 12-Step Recovery Programs. An important part of recovery, 12-step programs (e.g., AA and NA) are group meetings that are led by group members in recovery rather than a professional. These self-help groups can supplement professional treatments by adding a sense of community, understanding, and fellowship to the recovery process. 12-step programs stress the importance of acceptance, surrender, and active involvement in the program 4.
Pharmacotherapies—Medications utilized to specifically manage various substance dependencies, ease symptoms of withdrawal, prevent relapse, and treat co-occurring mental health conditions that complicate substance use 3.
The use of medication in addiction treatment typically has better results when combined with behavioral therapy. When medications are used specifically for the treatment of substance use disorders, it is called Medication-Assisted Treatment (MAT) 1.
For Opioid Addiction. Several medications are used for the treatment of addiction to opioid substances like heroin and prescription painkillers. Even though some of these FDA approved substances are opioids themselves, they are viable treatment options that help to curb cravings and addictive behaviors 4.
- Buprenorphine. A medication used sublingually and in other forms (e.g., in combination with naloxone as Suboxone), buprenorphine is a partial opioid agonist that helps to curb cravings and withdrawal symptoms without producing the euphoria or sedation associated with the abused opioid drugs 4,5.
- Naltrexone. Rather than acting in a way similar to other opioids in the body, naltrexone prevents opioid drugs from binding to their respective opioid receptor sites in the brain and, in doing so, blocks their effects. This substance is available as an oral medication or an injection that lasts for a month 4.
- Methadone. This long-acting oral opioid medication helps to reduce the withdrawal and cravings associated with more potent abused opioid drugs like heroin 5. You must visit a clinic to be administered methadone.
For Alcohol Addiction. Medications for alcohol addiction will have the goal of maintaining abstinence and reducing cravings 2.
- Acamprosate (Campral). Effective in people suffering from alcohol addiction, this medication can reduce withdrawal symptoms and maintain recovery by regulating the activity of certain neurotransmitters in the brain called gamma-aminobutyric acid (GABA) and glutamate 4,5.
- Disulfiram (Antabuse). By modifying the way alcohol is processed, disulfiram produces unwanted effects like nausea when alcohol is consumed and, in this manner, is a deterrent to continued drinking 4.
- Naltrexone. The same medication used for opioid addiction, naltrexone can reduce the rewarding results of alcohol use 4.
For Nicotine Addiction. Available in a variety of forms, medications for nicotine addiction will often begin while use is ongoing to help wean nicotine use and decrease the temptation to start up again in those who want to be fully free of all toxic influences as part of their recovery 5.
- Bupropion (Zyban). Initially used to treat depression, it was observed to suppress cravings without leading to weight gain 4.
- Nicotine Replacement Therapy (NRT). In the forms of patches, sprays, lozenges, inhalers, and gums, NRTs provide a steady, low level of nicotine to wean the user off of other nicotine use. Treatment can be combined with other medications to enhance the results 4,5.
- Varenicline (Chantix). This medication has the ability to mildly stimulate the nicotine receptors in the user’s brain while blocking the ability of nicotine to create pleasure 4,5.
Behavioral Therapies—Refers to various treatment options that may or may not be utilized based on the style of the therapist or the therapeutic conventions of a specific treatment center.
These therapies will strive to change the perspectives and actions of the individual while promoting abstinence and increasing positive life skills 1,4. Though these therapies serve as guides, many therapists will employ a mix of therapies across orientations 1. Therapies include:
- Evidence-Based Cognitive Behavioral Therapy (CBT). A common form of therapy that is used in mental health and substance use settings, CBT works to forecast potential issues and emphasizes productive coping strategies by discussing the interconnectedness of thoughts, feelings, and behaviors 5.
- Contingency Management (CM)/Motivational Incentives. This style of treatment favors the reinforcement of desired, drug-free behaviors with rewards that are immediate and tangible to encourage additional behaviors that maintain recovery. Centered in behaviors, there is less attention paid to thoughts and feelings surrounding use 4,5.
- Community Reinforcement Approach Plus Vouchers (CRA). An integrative approach that combines aspects of other styles, CRA is a 24-week program that uses multiple sessions weekly to reduce use and reinvest in employment and social health. This approach uses tangible rewards in a way similar to contingency management treatment 4.
- Family Behavioral Therapy. This therapy involves the individual as well as at least one significant other like a parent or romantic partner to decrease use and improve the home environment 4.
- Goal-Centered Motivational Interviewing (MI). This treatment type attempts to build internalized motivation in the client to decrease ambivalence and accept recovery 4.
- The Matrix Model of Abuse Therapy. Designed specifically for stimulant users, the Matrix Model uses individual, group, and family therapies in a formalized system to build self-esteem and self-respect 4.
Behavioral Therapies Specifically for Adolescents
Though some treatment styles will work with all populations, someone specific populations, like teenagers, will require specialized types of care to produce the best results due to their unique needs 4,5.
- Adolescent Community Reinforcement Approach (A-CRA). Like the adult version of CRA, this treatment approach works to lessen negative influences while building healthy supports at home, work, or school 5.
- Brief Strategic Family Therapy (BSFT). Focused on creating short-term solutions, the therapist utilizing this style will interact with all family members to observe, understand, and modify how they interact with one another to better promote recovery 5.
- Functional Family Therapy (FFT). This approach is based on the idea that unhealthy relationships in the family end with unhealthy behaviors. Treatment will involve identifying problems within the relationships and suggesting adjustments in order produce improved behaviors 5.
- Multisystemic Therapy (MST). An effective treatment for adolescents with substance abuse issues as well as deviant or violent behaviors, MST will address issues of peers, school, parents, the community, and the teen to improve outcomes 5.
- Multidimensional Family Therapy (MDFT). This treatment will take place in the community, school, family home, or in an office setting with the family and therapist. The goal of MDFT is to empower the entire family towards competency and health 5.
- Substance Abuse and Mental Health Services Administration. (2015). Behavioral Health Treatment and Services.
- Substance Abuse and Mental Health Services Administration. (2016). Treatments for Substance Use Disorders.
- National Institute on Drug Abuse. (2016). Drug Facts: Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
- Massachusetts Executive Office of Health and Human Services. (2016). Substance Abuse Services Descriptions.