Treatment

Substance use disorders are complex, treatable chronic medical conditions from which people can recover. A person is diagnosed with a substance use disorder if they have two or more of the symptoms and behaviors related to their substance use listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.¹ 

For example, they may use the drug more or for longer than intended, experience a strong desire to use the drug (craving), continue to use the drug even when knowing that it causes problems, or experience withdrawal symptoms when stopping drug use.²

A person who has a severe substance use disorder, also known as addiction, finds it very hard or even impossible to control their drug use. Read more about substance use disorders and addiction on the NIDA web site.

Yes. Treatments for substance use disorders can help a person stop or reduce their drug use, help prevent a return to use (relapse), alleviate the negative consequences associated with their drug use, and help them regain the ability to function successfully at work, in their family, and in their community.
 

There are multiple settings in which a person can receive treatment for substance use disorders. These include:

• Outpatient care may include regular office or telehealth visits for counseling, medication support, or both and can be delivered by primary care providers or providers that specialize in treating substance use disorders. Outpatient counseling can take the form of one-on-one appointments or group sessions.
• Intensive outpatient care refers to more intensive, coordinated outpatient care and may involve hours of outpatient treatment services per week, including individual and group sessions and medications support.
• Inpatient care means staying in a hospital or clinic overnight for a few days or weeks. Inpatient care is usually for people who need 24-hour care for health problems related to substance use, or to manage withdrawal symptoms.
• Residential care programs are inpatient programs that provide extended care, usually for a few weeks to a few months, although longer-term care in residential settings is also available. Residential care programs may provide individual and group counseling, medications for substance use disorders and other health conditions, access to mutual support groups, and referrals to continuing care upon discharge.
• Opioid treatment programs provide evidence-based care for opioid use disorder. They may be residential or outpatient facilities. They usually include treatment with medications like methadone, buprenorphine, or naltrexone, combined with behavioral therapies. Only certified opioid treatment programs can dispense methadone for treating opioid use disorder.

Addiction treatment can also be initiated in other settings including emergency departments (for instance, after a drug overdose) and in criminal justice settings. 

Yes. Various types of individual, group, and family counseling or psychotherapy (sometimes called behavioral therapies), are the most common treatments for substance use disorders. Behavioral therapies are delivered by a licensed mental health professional. 

Depending on the type of psychotherapy or counseling, it may:

• Alter negative or unhealthy thought processes that lead to substance use. Behavioral therapies like cognitive behavioral therapy (CBT) can help a person gain control of stressful emotions and thoughts that lead them to want to take drugs and strengthen their resolve when encountering cues (such as people, places, things, and moods associated with their past drug use) that might otherwise trigger a return to use.
• Replace drugs with healthy, non-drug rewards. A therapy called contingency management uses small incentives (e.g. prizes, gift cards) to help patients stop using drugs and restore their ability to enjoy and engage with other activities. This type of treatment has been shown to be especially effective in treating addiction to stimulants like cocaine and methamphetamine.
• Bolster motivation to change drug-use behavior. A short-term treatment approach called motivational enhancement therapy (also called motivational interviewing) helps people build their resolve to quit using drugs or alcohol and assists them in setting and sticking with their goals.
• Encourage and facilitate participation in mutual-aid groups like 12-step programs. A behavioral therapy called 12-Step Facilitation is designed to encourage participation in and systematically link people to 12-Step mutual support organizations—groups that enlist the support of peers who are in recovery. 12-Step Facilitation includes extended counseling that adopts some of the same techniques and principles used in 12-Step mutual support groups.³ 

Mutual help groups are peer-led recovery organizations that provide fellowship and support to people with substance use disorders by connecting them to peers who are in recovery. These include 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous and others such as SMART Recovery, Women in Sobriety, and Life Ring. 

Mutual help groups are not led by healthcare professionals, so they are not the same as treatment. But unlike most forms of treatment, they are free, not time-limited, and many people find them to be useful on their own or in addition to professional care. Most of the research conducted on mutual help groups has been conducted on 12-step programs and particularly Alcoholics Anonymous.⁴ Studies show that these programs can be very effective at supporting people’s long-term recovery.⁵

There are FDA approved medications to treat some, but not all, substance use disorders. For example, treatment with methadone, buprenorphine, or naltrexone is standard of care for opioid use disorder. The medication lofexidine is approved for treatment of opioid withdrawal symptoms. Medications are also available for the treatment of alcohol use disorder and to help people quit smoking. Depending on the type of medication, it may:

• Reduce withdrawal symptoms and cravings. When patients first stop using drugs, they can experience various physical and emotional symptoms, including restlessness or sleeplessness, as well as depression, anxiety, and other mental health conditions. They also can experience strong cravings for the drug. Some medications available for opioid, alcohol, and tobacco use disorders can help reduce these symptoms, which makes it easier to stop or reduce use of those substances.
• Make substance use less appealing. A few medications available for opioid and alcohol use disorders block the rewarding effects of the substance or even make taking it unpleasant, helping the individual remain abstinent.

Researchers are actively working to develop compounds to treat addiction to stimulants, cannabis, and other drugs for which FDA-approved medications do not yet exist. They are also studying medications that could treat side effects of addiction, like sleep problems. 
Read more about medications for opioid use disorder, medications for alcohol use disorder, and treatments for tobacco use disorder on the NIDA website. 

Some medications like methadone and buprenorphine for opioid use disorder and nicotine replacement therapy for smoking cessation work by activating the same receptors on neurons as illicit opioids or tobacco, respectively. But they do so in a way that does not produce the euphoria associated with the drug. 

When taken as prescribed by a person with a substance use disorder, medications control withdrawal symptoms and cravings and, over time, help restore balance to brain circuits that have been affected by addiction, and they are not addictive themselves. 

Yes. Adolescents who have drug use problems need treatment programs tailored to their needs. They may benefit from some of the same behavioral treatments as adults, such as CBT and contingency management. There are also several behavioral treatment approaches designed specifically for adolescents, many of which involve family members or other caregivers in the treatment process. One medication, buprenorphine, is also approved for adolescents 16 and over who have opioid use disorder.⁶

The brain is still developing through early adulthood, including the brain areas most closely associated with behaviors like decision-making, judgement, planning, and self-control. Drug use in young people is associated with other mental disorders such as attention-deficit hyperactivity disorder (ADHD), conduct problems, depression, and anxiety. Ideally, these co-occurring conditions should be treated in tandem with the adolescent’s substance use disorder. 

NIDA supports research to develop new medications and other new treatment approaches for substance use disorders, including:

• Neuromodulation. Techniques like deep brain stimulation and non-invasive approaches like low-intensity focused ultrasound and transcranial magnetic stimulation (TMS) help reset the brain circuitry underlying brain disorders. TMS is already FDA-approved for smoking cessation and is now being studied as a treatment for other substance use disorders.
• Vaccines and monoclonal antibodies. NIDA is researching various approaches that recruit the body’s immune system to prevent drugs from entering the brain, including vaccines against cocaine and opioids.
• GLP-1 agonists. The popular diabetes and weight-loss medication semaglutide has been found in studies to reduce alcohol and other drug use and is being researched as a potential treatment for substance use disorders.
• Psychedelic drugs. NIDA supports research on therapies using psychedelic drugs like psilocybin and dissociative drugs like ketamine. There is some evidence that these drugs may support addiction recovery when used in clinical settings in combination with psychotherapy.

More information on treatments being studied by NIDA can be found on our website.

Substance use disorder treatment is aimed at helping people stop or manage their drug use. For many people, abstinence—or stopping drug use completely and preventing return to use (relapse)—may be the most appropriate goal. Others may benefit from reducing how much or how often they use a particular drug or from alleviating certain symptoms of their substance use disorder such as sleep disturbances.⁷ Individuals seeking treatment for substance use disorder should discuss their treatment goals with their healthcare provider. 

Substance use disorders are chronic illnesses, and as with many other chronic illnesses relapse or return to drug use after a period of abstinence, is often part of the treatment and recovery process. Individuals with substance use disorder may require long-term or multiple episodes of treatment to achieve long-term recovery.⁸ 

While relapse is a normal part of recovery, for some drugs such as opioids it can be very dangerous or even deadly. If a person uses as much of the drug as they did before quitting, they can more easily overdose because their bodies are no longer used to their previous level of drug exposure. An overdose happens when the person uses enough of a drug to cause life-threatening symptoms or death. Read more about opioids and overdose on the NIDA web site.

A return to drug use is an indication that a person should speak to their healthcare provider about resuming or modifying their treatment plan.

People who have substance use disorders often have other mental disorders. Common risk factors related to a person’s genes, individual characteristics, social and family environment, and other life circumstances can contribute to both substance use and other mental disorders. Other health conditions that commonly occur with substance use disorders are HIV, hepatitis C, and chronic pain. 

When someone has a substance use disorder and a co-occurring disorder or health condition, it is usually better to treat these health issues at the same time rather than separately. Research suggests that this can make all the treatments more effective and improve health outcomes. Read more about co-occurring disorders on the NIDA web site.

If you think you have a substance use disorder, speak to your healthcare provider. They have screening tools and can refer you to treatment or other services if needed.

There are several other resources available for finding treatment, including:

• The Substance Abuse and Mental Health Services Administration’s (SAMHSA) online treatment navigator, FindTreatment.gov. SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 provides referrals to local treatment facilities, support groups, and community-based organizations.
• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a Treatment Navigator to help find treatment for alcohol use disorder.
• The National Cancer Institute provides online resources to help with quitting smoking at www.smokefree.gov .
• There are also clinical trials testing the effects of different treatments and other interventions for substance use disorders. See NIDA’s web page on clinical trials information to find out about locating and becoming part of a clinical trial.