Substance abuse treatment plans, or SUD treatment plans, are structured and comprehensive strategies designed to help individuals overcome their struggles with substance use or addiction. These plans outline a series of steps, interventions, and goals that are tailored to the individual’s specific needs, circumstances, and the severity of their substance use. The primary objective of a substance abuse treatment plan is to support the individual in achieving and maintaining recovery, leading to a healthier and more fulfilling life.
A typical substance abuse treatment plan may include the following components:
Substance abuse treatment plans are typically developed by a team of professionals, including addiction counselors, therapists, medical professionals, and other specialists, who work closely with the individual to provide a comprehensive and individualized approach to recovery. An individual with SUD may be aware that their substance use is causing harm to themselves and others, even to the point that it impairs their relationships and day-to-day functioning.
Indeed, the effects of SUD go beyond the individual. For one’s family and social circle, there is often an immense emotional burden that may include worry, anger, and shame, as well as a sense of guilt for being unable to help the individual overcome their disease. There are societal effects, too — the likely neurological, cognitive, and psychiatric effects of SUD, along with issues such as housing instability, job instability, and potential incarceration. SUD can be difficult to overcome, however, because it can alter brain structure and cause the body to become dependent on the substance.
Today, we understand that SUD is a disease that requires a science-based treatment approach that addresses the root of the disease. But we have arrived at that understanding only after centuries of studying and overcoming biases against those who live with the disease. Looking back at the evolution of substance abuse treatment plans allows us not only to appreciate how far we’ve come in our comprehension of SUD as a disease but also to recognize how to optimize care for those who need it and envision how to improve treatments in the future.
Before we discuss the therapeutic strategies underpinning modern substance abuse treatment plans, it’s worth examining the role of psychotherapy in early substance abuse treatment and how it sought to address the psychological factors influencing addiction.
Psychotherapy, also called talk therapy, refers to the treatment of mental health concerns through verbal communication. A psychotherapy session involves an individual interacting with a mental health provider such as a psychologist or psychiatrist. Through this interaction, both parties explore the individual’s thoughts and emotions to identify the root cause of their primary complaints.
There are several methodologies within psychotherapy, including:
The early psychotherapeutic approaches were limited in their efficacy and pertinence because they assumed a one-size-fits-all approach. Another limitation is that these approaches didn’t address the stigma surrounding SUD and that people only seek help when they’ve hit rock bottom.
Medication-assisted treatment (MAT), as the name suggests, is the use of medications to treat SUD. The medications help not only to reduce cravings for target substances but also to mitigate withdrawal systems. Typically, it is used in conjunction with counseling and therapy to initiate a holistic substance abuse treatment plan and optimize outcomes. The FDA has approved numerous MATs to help people with SUD to recover from a variety of dependencies, including:
The advent of MAT represented a turning point in SUD remedies, as it offered an alternative to pure abstinence and filled gaps that abstinence leaves open. MATs highlight the reality of SUD as a disease. Also, they allow substance abuse treatment plans to align with the precepts of modern medicine, to be holistic and compassionate.
Despite the greater efficacy and sensibility of MATs, as they drastically reduce the risk of death among people with SUD by more than 50%, there has been a great deal of societal resistance to them, particularly when it comes to treating opioid use disorder. Many people believe that providing MATs is just swapping one substance for another. Other common misunderstandings are that MATs are only suitable for severe cases of SUD and that abstinence-only programs are more effective.
Aside from medication-assisted treatments, there are many other applications and options available to those wanting to overcome their substance use disorder. This enables individuals and their care team to create a treatment plan that aligns with their individual disorder and behavior, which drastically increases the likelihood of them discontinuing their substance use. Some options might involve temporary inpatient care that evolves into an outpatient care model, allowing a natural progression of recovery for the individual.
Different therapy treatment options include:
This type of behavioral therapy focuses on using positive reinforcement strategies to promote positive behavioral change and can be effective for many substance use disorders. While positive reinforcement can vary between individuals, the principle remains the same across CM treatment plans. The individual receives a material reward for maintaining or exhibiting desired behaviors. This can be as simple as earning a piece of candy for each day a person remains sober to getting monetary incentives for remaining sober over a specific period of time. This helps to provide consistent motivation to veer from substance use, even when faced with certain triggers.
Studies have shown that using CM strategies has helped improve substance use disorder program retention and completion. Using these strategies as a part of a whole mental health and wellness approach has also helped to reduce drug use relapse, which is a common treatment-related issue.
Evolving from efforts to create a treatment plan for multi-problematic, suicidal women, dialectal behavioral therapy aims to help individuals regulate their intense emotions. Regulating emotions helps prevent people from turning to self-destructive behaviors, like substance use, to cope with their intense feelings. Instead, it teaches ways to first recognize that they are feeling these intense emotions, and then use research-based techniques to help them return to a state of equilibrium.
This method revolves around four different skill sets that all work together to help extreme emotions from overwhelming a person to the point where they feel the need for self-destructive measures to intervene. These skills include distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness. The benefits of incorporating this type of behavioral therapy in a substance use disorder setting are that patients reduce cravings to avoid relapse situations, give up self-destructive habits that lead to substance use, and learn healthier coping mechanisms when faced with intense emotions.
Substance use is often the result of past experiences that keep a person in a state of distress. Substances are used to temporarily overcome this distress, but when those substances wear off, the distress returns, making for a vicious cycle of substance use. Eye movement desensitization and reprocessing works to help people talk about and overcome these past traumas that are at the root of their substance use.
This American Psychological Association-approved treatment for post-traumatic stress disorder (PTSD) and other trauma conditions uses an eight-step approach to process and resolve trauma, which ultimately helps a patient put substance use in their past as well. These eight steps or phases involve taking a patient’s history, preparing the patient for the treatment approach, assessing the target memory or memories, processing those memories to adaptive resolutions, and evaluating treatment results.
If the treatment didn’t help the patient fully process the memory to the point where they feel as though their emotions associated with those memories are resolved, then the treatment will continue in the next session. Continual psychological evaluation can help the therapist evaluate the patient’s progress in the treatment plan and will likely see an eventual decrease with ideally a complete elimination of substance use.
This type of treatment places more control in the patient’s hands as they are guided in the journey of identifying, challenging, and replacing their destructive thoughts and convictions that often lead to substance use. Individuals work to replace these thoughts with healthier, adaptive thoughts that can help them improve their emotional wellness and achieve their goals. Taking a logical and rational approach to process thoughts and feelings can prevent them from being all-consuming and overwhelming, which can lead to substance use.
A key foundation of this therapy is that external situations are not what bring true happiness or unhappiness, but rather that these feelings come from within. Therapists work with patients to help them identify the beliefs that lead to emotional distress and find ways to challenge these beliefs. They’ll also work together to discover the goals the patient wants to work toward, such as overcoming substance use or enhancing their personal well-being, and develop actions that can help them work toward these goals.
Substance use can result from consistent exposure to trauma conditions. This type of therapy approach aims to help clients gain safety from trauma and substance misuse. It accomplishes this by teaching patients about coping skills and grounding techniques to help them find a sense of safety with their own thoughts, emotions, and relationships. This approach also strives to reestablish the patient’s ideals they may have lost due to trauma or substance use.
Another goal of this therapy is to educate patients about how humans experience trauma to help them recognize what traumas are rooted in their past that might be contributing to their substance use. Upon recognition, therapists impart the fact that it is possible to heal from these traumas and move forward while leaving substance use and self-destructive behaviors behind. Some studies have shown that this type of therapy has helped 41 to 95% of people overcome their PTSD and around 20% of patients no longer qualified for their substance use disorder after 30 days of these types of therapies.
As mentioned, early SUD treatments were one-size-fits-all, but today we understand that addiction is as complex and multifaceted as the people who struggle with it. Indeed, those with SUD have roots in unique historical and biological circumstances, they experience degrees of disease severity, and they have needs that are specific to themselves as individuals. That is why, to really promote recovery, substance abuse treatment plans must be personalized.
To start, personalizing a treatment plan entails at least the following:
Based on the above, you can present a range of evidence-based modalities and strategies that are conducive to achieving the goals. In addition to MAT, an individual’s substance abuse treatment plan may involve individual or group therapy (or a combination thereof), family counseling, and complementary therapies such as mindfulness and yoga. From there, it’s about consistent monitoring of the individual’s progress and situational changes and adjusting their plan of care accordingly. For example, an individual who experiences a challenging life event can benefit from grief counseling to keep triggers at bay and promote their recovery.
Aftercare refers to ongoing treatment that a person receives after completing a plan of care. It’s essential for chronic health concerns, such as SUD, because they are ongoing throughout an individual’s life. In an aftercare program, a person in recovery from SUD may undergo interventions and have access to resources that help them manage their stress, triggers, and cravings. Like the treatment plan they have completed, their aftercare is personalized to their specific situation and needs. Some common forms of aftercare include:
The importance of aftercare cannot be understated, as the risk of relapse is often the highest soon after completion of a treatment plan, per the American Addiction Centers. Also, studies show that 40% to 60% of people recovering from SUD relapse at some point after plan completion. So, without continued monitoring, the individual may be at risk of returning to the substance on which they are dependent.
Following the trend of digital transformation in behavioral healthcare, many treatment and aftercare programs are now integrating technology to foster desirable outcomes. Often, tech-integrated SUD treatment is as simple as leveraging familiar telecommunications tools to make it easier for recovering individuals to access counseling and therapy. Telehealth, already a common tool in medicine, has expanded to include telepsychiatry, allowing individuals to speak with their mental health provider without having to schedule their days around appointments or coordinate transportation.
Another remote technology that can facilitate recovery is remote monitoring, which may be particularly useful for helping those who have relapsed. Remote monitoring uses wearable devices that can track an individual’s vital signs to transmit real-time health information to providers. In the event of an emergency, the system alerts clinicians, who can begin interventions to save the individual’s life.
Other groundbreaking technologies being used in substance abuse treatment plans include online communities to immerse the individual in therapeutic virtual environments and mobile apps for tracking sobriety, connecting individuals with support group members, and coping with triggers.
In the years to come, we may see a wealth of new tech-driven approaches to helping people with SUD access treatment and maintain their recovery. Artificial intelligence (AI) is one area of particular interest, especially with respect to predictive analytics. For instance, by evaluating large volumes of health care data, an AI tool could predict an individual’s potential response to an MAT, including the associated risks and comorbidities. Such an advance would be a tremendous complement to existing screening and assessment tools.
Outside of the tech sphere, we may also see advances in how we view SUD. With society’s growing understanding of addiction as a chronic health concern and recovery as an ongoing journey, the consensus definition of a successful recovery could expand beyond achieving total abstinence. It could mean, instead, that an individual has gained more control over their SUD, that they’ve reduced their risk of overdose or illicit behavior, or that they’ve attained a more stable, higher-quality life.
Our treatment of SUD may even evolve to become preventive. Researchers have sought for many years to develop vaccines for addiction, which would work by blocking the individual’s ability to feel the euphoric effects of a substance, and a vaccine for cocaine dependency is under development. The future may yet bring us more preventive measures that can help us put a stop to SUD.
Looking back at the history of society’s relationship to addiction, we can feel good about the progress made toward acceptance of SUD as a chronic disease and the attendant advances in treatment. There’s still a lot of progress to make, but the prognosis is promising. We can hope to see a convergence of the medical and societal consensus about substance use and a broadening of effective, personalized treatment strategies.
Historically, society has viewed SUD not as a disease but as a moral issue. Early terminology didn’t frame it as “substance use” but as “substance abuse.” This view has served primarily to stigmatize substance use and marginalize people with SUD. Perceptions are fluid, though, and society’s perspective on SUD has evolved through the ages.
In the United States, the moral attitude has historically informed the broad approach to how society has treated people with SUD. Many viewed substance use as a moral dilemma that required moral retraining. Inebriate homes began opening in the 1800s, where people with alcohol dependency could admit themselves for nonmedical detox. Shortly after, the New York State Inebriate Asylum was opened to formally treat alcohol dependency as a mental health concern.
By the 1950s, society had adopted more progressive views on substance use. Alcoholics Anonymous, which began in 1935, was helpful in raising awareness of alcohol dependency as a disease, and the American Medical Association formally defined it as such in 1952. However, in the 70s and 80s rehabilitation efforts focused on punishment rather than recovery. A secondary effect of harsher drug laws was that they reintroduced the stigma surrounding SUD that the mid- to late 20th-century advances had helped to undo.
Public opinion of SUD seemed to shift again because of changes in legislation and societal perspectives. Both directly and indirectly, legislation formally equalized SUD with other medical concerns.
Today, the medical community continues to understand SUD as a disease that requires clinical treatment, and the American public may also be taking a more compassionate view toward the matter. In fact, there’s some evidence that indicates most Americans feel negatively toward mandatory sentences for nonviolent drug offenses and positively toward a treatment-centered approach to people who use illicit substances. The more evolved view of SUD has meant that substance abuse treatment plans now focus largely on holistic approaches and therapeutic strategies.
Person-centered planning requires more tracking, coordination, and communication across providers and programs than ever before.
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