Substance Abuse Treatment Options
Substance abuse treatment focuses on reducing your drug use, helping you stay in recovery, and improving other areas of your life.
There is no “right treatment” that applies to everyone. Instead, treatment should be tailored to you and your specific needs.1,2
This article intends to increase your understanding about addiction treatment options, what each option consists of, and ways to find the best fit for you.
Inpatient or Residential Treatment
Inpatient or residential options help people that have acute substance abuse symptoms and psychiatric issues or people that have struggled with less intensive levels of care. Inpatient or residential treatment implies that you live, sleep, and attend treatment in the same facility. The terms are often used interchangeably, though there are a few conceptual distinctions.
Inpatient treatment programs tend to be shorter and more intensive than residential settings. They are often located in standalone psychiatric centers or specialized units within a general hospital.3,4
- Inpatient psychiatric. This setting is a good option for individuals that require strict 24-hour medical and psychiatric observation and clinical management to stabilize substance abuse and mental health symptoms.3 Staff provide a structured environment that helps ensure safety. Inpatient lengths of stay vary from just a few days to several weeks.
- Inpatient detoxification. Detoxification permits the body to process and remove toxins such as drugs and alcohol.1 People that need inpatient detox are often detoxing from more harmful substances, have a prior history of dangerous withdrawal, have additional medical/psychiatric issues, or lack outside supports.4
Residential programs tend to be set in home-like environments and have longer stays.
Though they share many treatment aspects, residential treatments are often set in more home-like environments than inpatient programs. Residents have fewer restrictions and more privileges. Lengths of treatment may be, on average, longer as well, with some programs lasting 12 months.5
- Residential treatment. Residential treatment focuses on intensive therapy and detoxification.5 These programs may last for a few weeks to months. They also connect individuals to additional recovery services to follow once they complete the program.2
- Recovery housing or sober living. This type of treatment is a form of supervised, drug-free housing that allows the person to transition back to the community after a period of inpatient or residential treatment.
Depending on the style of the program, inpatient and residential addiction treatment may include:
- Detox and withdrawal treatment.
- Individual therapy.
- Group therapy.
- Family therapy.
- Medication management from a medical team.
- A range of support services to build educational, vocational, or financial skills.
Executive and Luxury Programs
Luxury addiction treatment programs are residential centers that offer additional amenities during recovery such as spa treatments, swimming, horseback riding, and tennis.
Some luxury treatment programs also have executive accommodations. The person in treatment remains connected to work responsibilities while receiving treatment.
Outpatient treatment is a less intense type of addiction treatment. Rather than 24-hour care, supervision, and treatment where the individual lives at the center, people attending outpatient treatment live at home and come to the center as needed. Some outpatient programs provide participants with detox schedules and withdrawal treatment to people with mild symptoms.
Outpatient treatments include:
- Partial hospitalization programs (PHP). People with severe substance abuse issues that can maintain their symptoms at home might be appropriate for PHP (sometimes called day treatment). These programs consist of treatment lasting 4-6 hours daily, 5 days per week. 7
- Intensive outpatient programs (IOP). IOP consists of 3-hour sessions for two or more times weekly. IOP may use a combination of group and individual sessions to maintain recovery and improve well-being.7
- Standard outpatient. Typical outpatient treatment consists of hour-long sessions that occur weekly, biweekly, or monthly depending on the client’s needs. This therapy can be individual only, group only, or a combination.7 This type of therapy is the least intense, but it can last for months or years if needed.
Outpatient programs are not appropriate for everyone – particularly people with more severe addictions. However, they can provide a certain amount of additional flexibility. They allow the person to work, care for their family, and maintain other aspects of their life while receiving treatment.
Dual Diagnosis Treatment
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly half (45%) of all people seeking addiction treatment have a mental health disorder. When someone has both types of disorders, they have a dual diagnosis or co-occurring condition.8
Effective substance use treatment targets the entire person.1,2 If treatment focuses only on mental illness, symptoms of addiction could worsen. If treatment only focuses on substance abuse, the underlying mental disorder could make long-term recovery unlikely. Fortunately, many inpatient/residential and outpatient treatment options address mental illness and substance use.
The program should frequently review your symptoms and status and modify your treatment plan as needed.1
12-Step Programs and Support Groups
Support groups can complement and extend the benefits of professional treatment.2 Additionally, support groups can be used as long-term aftercare after treatment. They offer peer support, but no formal treatment.
Some of the benefits of support groups are:
- They are free and widely available.
- They offer an opportunity to build a drug-free social support system.
- They can help treat a number of addictions.
Examples of support groups include:
Alcoholics Anonymous (AA). AA was the first 12-step support group. It is led by group members and encourages:2
- Acceptance of the addiction.
- Surrender to one’s higher power (does not have to be God).
- Active involvement in meetings and related events.
Other 12-step groups. Due to AA’s success, other 12-step groups have been developed. These groups typically hold the same core values of AA while specifically focusing on a drug of abuse. Options include:
- Narcotics Anonymous (NA).
- Cocaine Anonymous (CA).
- Dual Recovery Anonymous.
- SMART Recovery. SMART stands for “self-management and recovery training.” The program offers online and in-person meetings for those in recovery and their support network.10
Behavioral counseling helps people find the motivation to begin and maintain recovery. Psychotherapy refers to behavioral counseling used to treat substance abuse and mental health concerns. Behavioral therapies help people find motivation to begin and maintain recovery, and they can be used in all treatment settings.1,2
Types of psychotherapy include:2,5,8
- Individual therapy – only includes therapist and client during sessions.
- Group therapy – applies to any treatment with one or more clinicians and two or more group members in the session.
- Family therapy – when the client and one or more of their supports, even those that are not actually family members, attend the session.
The style of psychotherapy refers to the therapist’s approach or theoretical orientation. Some commonly used therapy styles for addiction treatment are:1,2,5
- Cognitive-behavioral therapy (CBT) – looks at thoughts, feelings, and behaviors to identify, avoid, and manage events that lead to substance use.
- Dialectical behavioral therapy (DBT) – uses CBT principles to treat people with significant dual diagnosis problems and long-term suicidality.11
- Contingency management (CM) – offers clients rewards for completion of healthy activities, treatment, and negative drug screens.
- Motivational interviewing (MI) – works to decrease ambivalence and build desire and need for change.
Medication for Substance Abuse
Medications are used at various stages of addiction treatment. These medications (sometimes called pharmacotherapies) can be used independently, but they are most effective when paired with psychotherapy.8
Medications are commonly used:
- During detoxification. According to the National Institute on Drug Abuse (NIDA), medications are used during about 80% of detoxifications to reduce withdrawal symptoms.1
- For mental illness. Antidepressant, anti-anxiety, mood stabilizing, and anti-psychotic medications are used to treat co-occurring mental health conditions that are common with substance abuse.8
- To prevent relapse. Medication-assisted treatments (MAT) combine the use of specific medications and behavioral therapy to reduce cravings or block the effects of substances. 8
Examples of medications used in MAT include:1,2
- Opioid treatments.
- Methadone – a drug that reduces withdrawal symptoms and cravings by activating the same brain areas as heroin and morphine.
- Buprenorphine – a medication that produces less intense effects than other opioids due to its status as a partial opioid agonist (a drug that triggers opioid receptors to a lesser extent). Buprenorphine commonly comes in a formulation with naloxone (Suboxone). Naloxone is an opioid blocker that reduces the effects of abuse and is included to deter attempts at misusing the treatment drug itself.
- Naltrexone – an opioid antagonist that blocks the effects of opioids.
- Alcohol treatments.
- Antabuse – produces unpleasant effects when the person consumes alcohol after using the medication.
- Campral – can reduce the uncomfortable effects of extended withdrawal.
- Naltrexone – the same medication used in opioid addiction – reduces the rewarding effects of alcohol and can help minimize cravings.
. 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.
. Commonwealth of Massachusetts. (2010). Psychiatric Inpatient Hospital Manual.
. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
. Substance Abuse and Mental Health Services Administration. (2016). Treatments for Substance Use Disorders.
. Massachusetts Executive Office of Health and Human Services. (2016). Substance Abuse Services Descriptions.
. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
. Substance Abuse and Mental Health Services Administration. (2015). Behavioral Health Treatment and Services.
. Substance Abuse and Mental Health Services Administration. (2014). Recovery Services Provided by Substance Abuse Treatment Facilities in the United States.
. Substance Abuse and Mental Health Services Administration. (20145). SMART Recovery.
. Dimeff, L. A., & Linehan, M. M. (2008). Dialectical Behavior Therapy for Substance Abusers. Addiction Science & Clinical Practice, 4(2), 39–47.