Substance Use Disorder Treatment

Key Takeaways

• Substance use disorder (SUD) is a progressive psychiatric condition that varies in its presentation, beginning with mild symptoms and often leading to moderate or severe cases (which are classified as addiction).

• Effective treatment for SUD varies from individual to individual. It typically involves a combination of withdrawal management, medical detox, inpatient or outpatient services, psychotherapy, medication, and support groups such as Narcotics Anonymous (NA).

• Research has revealed that recovery outcomes are significantly improved when individuals remain in treatment for at least 90 days, set clear goals, and attend self-help groups.

What is Substance Use Disorder?

Substance use disorder (SUD) is a complex psychiatric disorder characterized in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as “a problematic pattern of substance use.” SUD is a progressive condition that ranges from mild to severe.^[1]

This means that in the majority of cases, individuals with mild SUD ultimately go on to develop moderate or severe symptoms, widely referred to as addiction. When the disorder reaches this stage, individuals struggle with dependence on various drugs (including alcohol) and compulsively use their substance of choice despite destructive outcomes and a desire to quit.^[1]

At this level of severity, substance use disorder disrupts a person's ability to function within society or even manage minor responsibilities. According to the DSM-5, SUD is diagnosed based on a set of 11 clinical criteria, with the seriousness of the condition determined by how many of these are met within 12 months as follows:^[2]

• Mild: 2 to 3 criteria

• Moderate: 4 to 5 criteria

• Severe: 6 or more criteria

The DSM-5 criteria for substance use disorder include:^[2]

• Using more of the substance or for longer periods than initially intended.

• Unsuccessful attempts to cut down or quit.

• Spending excessive time obtaining, using, or recovering.

• Experiencing strong, uncontrollable cravings.

• Neglecting responsibilities at work, school, or home.

• Continuing substance use despite social or relationship problems.

• Abandoning important activities to prioritize substance use.

• Using substances in unsafe situations (e.g., driving under the influence).

• Ignoring worsening physical or mental health issues.

• Developing tolerance (needing more for the same effect).

• Experiencing withdrawal symptoms when not using.

How SUD Affects the Brain

When substance use disorder is left untreated (and with the repeated use of substances that flood the brain with dopamine), the condition worsens over time, eventually causing permanent changes to brain structure and function. These changes can cause individuals with moderate to severe SUD to physically crave a substance simply to feel stable.^[1][2]

In fact, brain scans of these individuals reveal that several different regions are involved in varying phases of the addiction cycle, due to disruptions in the networks that regulate:^[1][2]

• Reward and motivation: motivates humans to seek out pleasurable experiences, including sex and food.

• Executive function: supports impulse control, decision making, learning, and planning.

• Salience and emotion networks: noticing and prioritizing important stimuli, emotional regulation, memory, and stress response.

• Interoceptive and default mode networks: connected to self-awareness of the body, emotions, thoughts, and behaviors.

Unfortunately, after a person’s brain has been altered in this way, mental cravings can persist long after substance use has ceased, with over 60% of individuals treated for SUD experiencing recurrence of use relapsing within 12 months of treatment, and can remain at high risk for years. That said, although treatment for SUD cannot rewire the brain or cure addiction, it can teach individuals to maintain recovery successfully and live a fulfilling life.^[3]

Understanding SUD Treatment

While even two problematic substance-related episodes within the period of a year are recognized as mild SUD, unfortunately, most people with the disorder only seek treatment once their use has progressed to addictionit has progressed into full-blown addiction. With this in mind, it is important to note that support is available at all stages of substance use disorder, and the sooner treatment is sought, the better the prognosis.^[2]

In fact, research has revealed that both psychosocial (the combination of psychiatric and social support) and medication-based interventions are effective regardless of the intensity of the disorder. However, those with moderate or severe SUD, where the brain has been rewired, tend to require more intensive, long-term support, such as inpatient or outpatient care.^[4]

For certain substances, medications can help to manage physical cravings, ease withdrawal symptoms, and reduce the risk of recurrence of use. In addition to pharmaceutical treatments for SUD, therapy is administered to assist individuals in addressing underlying issues, such as building self-worth, developing healthy coping skills, and addressing co-occurring psychiatric issues.^[4]

Treatment plans for substance use disorder vary based on individual circumstances and may involve:^[4]

• Withdrawal management (medical detoxification)

• Residential treatment (inpatient rehabilitation facilities)

• Partial hospitalization programs (PHP)

• Intensive outpatient programs (IOP)

• Standard outpatient programs (SOP)

• Medication management and therapy (within an inpatient or outpatient setting, and in some cases, on an ongoing basis)

• Structured, drug-free living settings such as sober living communities

• Peer support groups such as Narcotics Anonymous, Alcoholics Anonymous, or SMART Recovery

Common Types of Substance Use Disorder

The United Nations Office on Drugs and Crime (UNODC) World Drug Report 2025 highlights a new period of global instability that is strengthening criminal networks and driving drug use, along with substance use disorder, to record-high levels. According to the DSM-5, there are 11 different types of SUD, the most common of which are listed below in order of prevalence.^[5]

Cannabis Use Disorder (CUD)

As noted by the World Drug Report, cannabis is the most commonly abused substance on the planet, with 244 million users. Despite the widespread myth that cannabis is not addictive, around three in ten cannabis users go on to develop CUD. Contrary to popular belief, this natural substance can cause serious health consequences, including psychosis and cancer.^[5][6]

Alcohol Use Disorder (AUD)

Between 1990 and 2021, the number of people aged 15 and older with alcohol use disorder more than doubled worldwide, rising to around 80 million. However, although the drug is still legal in most parts of the world, alcohol’s mainstream appeal is declining globally, with the rise of health-conscious lifestyle trends and recent studies revealing that it is a carcinogen.^[7]

Stimulant Use Disorder (StUD)

The most commonly abused stimulants are amphetamines, including speed, ecstasy, MDMA, prescription amphetamines, methamphetamine (crystal meth), and cocaine. While cocaine use disorder is classified as a standalone condition in the DSM-5, StUD as a whole affects approximately 57 million people around the globe.^[8]

Opioid Use Disorder (OUD)

The most recognized opioid is heroin, yet in recent years, fentanyl (which is 50 times stronger) has become increasingly prevalent, as have over-the-counter opioids like codeine and prescription opioids such as tramadol. It is estimated that 61 million people use opioids worldwide, with over 40 million of whom struggle with OUD.^[5][9]

Cocaine Use Disorder (CoUD)

Cocaine is a highly addictive substance that is found in two primary varieties: powdered cocaine (which is snorted through the nose) and crack cocaine (which is smoked through a pipe in the form of crystals and comes with an even higher risk for addiction). Overall, CoUD is thought to affect over 32 million people worldwide.^[8]

Benzodiazepine Use Disorder (BZDUD)

Benzodiazepines are scheduled medications (such as valium and xanax) that are prescribed with caution due to their risk of dependence to trigger addiction, particularly when used long-term. While global statistics on the prevalence of what are colloquially known as “benzos” are limited, it is estimated that nearly 5 million U.S. citizens misuse the substance.^[10]

Less Common Types of Substance Use Disorder

Less well-known substance use disorders are also recognized in the DSM-5, although some are socially accepted, mistakenly considered non-addictive, or widely misunderstood. However, despite being less widely acknowledged, these disorders affect millions globally and can result in serious psychological, physical, and social harm.

Caffeine Use Disorder (CfUD)

While it is common for people to casually joke about having a caffeine addiction, when reduced intake leads to an inability to function, this SUD becomes a clinical concern. Although studies have not systematically investigated the prevalence of CfUD, caffeine is the most commonly consumed psychoactive substance globally.

Tobacco Use Disorder (TUD)

Much like the carcinogenic effects of alcohol, smoking tobacco was previously considered harmless, yet it is now widely known that cigarettes can cause lung cancer and a host of other serious health issues. Although many consider tobacco to be non-mind and mood- altering, the substance is technically a stimulant and the second most widely abused substance in the world, with 1.3 billion users.^[11]

Hallucinogen Use Disorder (HUD)

Hallucinogens like LSD (acid), psilocybin (magic mushrooms), ayahuasca, DMT, and mescaline have become increasingly popular around the world and are commonly believed to be non-addictive and serve as a catalyst for spiritual experiences. However, studies suggest that just under 1 million people in the United States live with HUD, and numbers continue to rise.^[12]

Inhalant Use Disorder (IUD)

Inhalant use disorder is an SUD characterized by the problematic use of inhaled substances, such as solvents like glue, aerosols including deodorant, nitrates such as “poppers”, or gases like laughing gas. IUD are most common among adolescents or those from marginalized backgrounds, with approximately 600,000 teenagers in the United States affected.^[13]

Phencyclidine Use Disorder (PCPUD)

Phencyclidine, also known as PCP, angel dust, rocket fuel, and animal tranquilizer, is a globally rare hallucinogen most prevalent in the United States of America. The drug is notorious for causing severe psychosis and, according to the National Drug Intelligence Center, is found in 24% of cannabis samples, with more than 6 million people above the age of 12 having tried it.^[14]

Treatment Programs and Rehab

If you suspect that you may have a problem with substances (no matter how mild you believe the issue to be), it is best to seek treatment as soon as possible to prevent the SUD from worsening into a cycle of addiction. For those with moderate to severe SUD, empirical evidence has revealed that 90 days or more of treatment substantially improves outcomes.^[15]

This framework is supported by the world-renowned SUD support group, Narcotics Anonymous (NA), which advocates for newcomers to attend 90 meetings in 90 days. While commonly criticized for lacking scientific validity, in reality, there is strong evidence to suggest that the link between NA meeting attendance and duration of abstinence is noteworthy.^[16]

In fact, the latest NA survey revealed that the average length of time not drinking or clean time, among members attending two to four meetings a week, equates to just over 11 years. This means that individuals who participate in This means that Narcotics Anonymous have likely found the 12-step structure beneficial. It has been found highly effective in supporting recovery maintenance, and for this reason, it is of benefit to look into treatment programs that offer the 12-step structure.^[17]

Inpatient Treatment

In moderate to severe cases of SUD, admission to a live-in inpatient facility (or residential treatment center) is often the most effective means of addressing the disorder. Rehabilitation facilities offer individuals a safe space to begin the recovery journey alongside others who are struggling with similar challenges, while preventing access to substances. around the clock.

Inpatient care allows people in recovery to focus on learning healthy coping tools and managing the freedom from the mental preoccupation and physical urge to use substances that can persist during withdrawal and early recovery. Inpatient treatment facilities are also a good option for those who need medical support, are medically unstable, or have been suffering from dual diagnoses, as 24/7 supervision is provided.

Additionally, residential treatment centers typically provide both group and individual therapy, aftercare planning, holistic support, and classes that teach healthy coping skills. Inpatient treatment centers also offer withdrawal management or medical detox facilities, which are essential for individuals who have become physically dependent on highly addictive substances.

Withdrawal Management

Once an individual has developed substance use disorder, upon ceasing the use of substances, cravings and withdrawal begin. Withdrawal management, previously referred to as “detoxification” or commonly referred to as “detox,” is the medically supervised process of safely managing substance withdrawal symptoms while someone is reducing or stopping use, during the initial period of abstinence, when, in some cases, individuals are in a state of extreme discomfort.

While withdrawal management detoxification cannot cure substance addiction, it can ease the process of recovery by stabilizing the mind and body in preparation for the therapeutic journey. Withdrawal management. Detox may involve the use of medications to alleviate emotional and psychiatric turmoil, along with preventing potentially life-threatening symptoms.

The Dangers of Withdrawal Symptoms

Different substances produce different withdrawal effects, with some more dangerous than others (where attempting to cease use without medical supervision can be fatal). Here is an overview of common withdrawal symptoms in the most prevalent substance addictions:

Cannabis Use Disorder (CUD)

• Loss of appetite.

• Irritability or aggression.

• Restlessness or anxiety.

• Vivid dreams or sleep disturbances.

• Mild physical discomfort (including sweating, shivers, and headaches).

Alcohol Use Disorder (AUD)

• Shaking and tremors.

• Nausea, vomiting, and sweating.

• Seizures (within 6 to 48 hours of abstinence).

• Hallucinations (seeing, hearing, or feeling things that are not real).

• Delirium tremens (disorientation, distress, rapid heartbeat, fever, hallucinations, and seizures typically within 3 to 5 days of abstinence).

• Risk of coma or death.

Stimulant Use Disorder (StUD)

• Intense depression and suicidal thoughts, colloquially referred to as a “comedown.”

• Anxiety, paranoia, or panic attacks.

• Extreme fatigue and trouble sleeping.

• Moving or speaking slowly.

• Difficulty with focus and experiencing pleasure.

Opioid Use Disorder (OUD)

• Joint pain or full-body muscle aches.

• Severe nausea, vomiting, or diarrhea.

• Cold flashes, shivering, and goosebumps.

• Restlessness, distress, and anxiety.

• Insomnia or sleep-related difficulties.

• Rapid heart rate and high blood pressure.

Cocaine Use Disorder (CoUD)

• Severe fatigue or hypersomnia.

• Extreme depression and suicidal ideation.

• Anxiety, paranoia, panic attacks, or irritability.

• Delayed thinking and physical lethargy.

Benzodiazepine Use Disorder (BZDUD)

• Severe anxiety, panic attacks, and irritability.

• Tremors and muscle cramps.

• Hallucinations or sensory distortions.

• Insomnia and mood swings.

• Risk of psychosis or delirium.

• Risk of life-threatening seizures.

Outpatient Treatment

Outpatient treatment is generally best suited to individuals with mild or moderate substance use disorder, although outcomes vary from individual to individual. There are various levels of outpatient care, with some designed to act as a step-down from inpatient facilities, while others support at-risk individuals who are not yet fully addicted to substances.

Partial Hospitalization Program (PHP)

Partial hospitalization programs (also known as day treatment) are the midway point between inpatient care and intensive outpatient programs. While enrolled in PHP, individuals with SUD can live at home and attend structured sessions during the day, typically for more than 4 hours a day and at least 20 hours a week.

It is important to note that PCP can pose risks for those with severe SUD, as access to substances is not monitored or limited outside of hospital hours. However, individuals recovering from SUD may enter a partial hospitalization program after being in an inpatient facility, to receive additional support after completing a rehabilitation program.

Alternatively, a person may be admitted to a PHP due to recurrence of use or a relapse when more intensive services are needed to stabilize the person, yet they are already aware of the tools taught in inpatient treatment centers. One of the key benefits of PHPs is that they are more affordable than inpatient programs, and still offer many of the same therapeutic services, including:

• Individual, group, and family therapy.

• Medication management.

• Educational groups.

• Recreational and occupational therapy.

Intensive Outpatient Program (IOP)

Intensive outpatient programs are a step down from partial hospitalization programs or inpatient treatment, yet are more intensive than standard outpatient treatment. These programs typically involve nine or more hours of group therapy per week, with a strong focus on relapse prevention and stress management techniques.

IOP provides individual and group therapy and is often recommended for those with moderate substance use disorder. Alternatively, many people enter an intensive outpatient program after residential treatment or PHP and attend sessions for weeks to months before transitioning to standard outpatient care.

Standard Outpatient Program (SOP)

Standard outpatient programs offer a less intensive level of care than intensive outpatient programs, with even fewer weekly sessions. SOP is typically best suited to individuals with milder substance use disorder or those who have completed more intensive treatment phases, and provides extended, ongoing support.

These programs emphasize relapse prevention and aim to teach healthy coping skills, develop resilience, and guide individuals to identify potential relapse triggers. As SOP is not as time-consuming as other outpatient treatments, individuals can attend sessions without having to forgo work, school, or family obligations.

Physical Health Complications with SUD Treatment

It is common for individuals recovering from substance use disorder to have ignored health conditions for years, due to the cognitive fog caused by intoxication, along with the denial of consequences that tends to go hand in hand with addiction, or the lack of financial, housing, and transportation resources to get the care they need and recover.

While abstaining from substance use can only serve to improve holistic well-being, as recovering addicts embark on the journey to mental wellness, so too must many begin to address various physical health complications.

Regardless of whether these physical health issues were a direct result of abusing substances or arose independently, addressing medical concerns can positively impact treatment outcomes, recovery maintenance, and overall quality of life for people in recovery.^[18]

On the other hand, leaving medical concerns untreated may negatively impact SUD treatment, particularly if an inpatient or outpatient program does not offer comprehensive medical care. The following health conditions are commonly linked to the abuse of specific substances, but may also arise from other unlisted substances:^[18]

• Brain and nerve issues (including seizures): Alcohol, benzodiazepines, stimulants

• Movement or coordination difficulties: Alcohol, opioids, and benzodiazepines

• Strokes: Cocaine, meth, and alcohol

• Heart and blood pressure issues: Cocaine, meth, and alcohol

• Poor circulation: Stimulants and opioids

• Liver infections (including hepatitis): Heroin, meth, and cocaine

• Liver damage (including cirrhosis): Alcohol and inhalants

• Kidney complications: Synthetic drugs, heroin, and alcohol

• Blood sugar imbalances (diabetes): Alcohol and cocaine

• Malnutrition: Alcohol, methamphetamine, and opioids

• Weight concerns: Stimulants, alcohol, and opioids

• Joint or muscle issues: Alcohol and opioids

• Lung conditions: Tobacco, cannabis, heroin, crack cocaine, and stimulants

• Skin-related complications: Meth, heroin, and cocaine

• Tooth and gum damage: Methamphetamine and crack cocaine

• Bacterial infections: Heroin, meth, and cocaine

• HIV and AIDS: Heroin, meth, and cocaine

• Ongoing physical pain: Opioids

• Sexual health problems: Alcohol, methamphetamine, and cocaine

• Reproductive health complications (eg, fertility problems and menstrual irregularities): Alcohol, opioids, and stimulants

• Injuries resulting from intoxication: Alcohol, benzodiazepines, and opioids

• Weakened immune system: Alcohol, opioids, and meth

• Digestive issues (such as pancreatitis): Alcohol and stimulants

Medications Used in SUD Treatment

As different substances affect the brain in different ways, specific medications are used to treat specific substance use disorders. However, at present, there are no known pharmaceuticals that effectively curb cravings or withdrawal symptoms for most SUDs, except for opioid, alcohol, and tobacco use disorders.^[19]

That said, although some individuals may respond well to medication, recovering from substance use disorder is a unique process that differs from person to person. Furthermore, even in cases where medication is effective, it is still necessary to address underlying psychiatric issues through therapy and support groups to sustain ongoing recovery.

According to a 2024 review by the International Union of Basic and Clinical Pharmacology (IUPHAR), the reason there are so few medications for SUD is that clinical trials are influenced by challenges such as poverty, legal trouble, or unstable housing, which impede many addicted or recovering individuals using substances from committing to scientific procedures.^[20]Clinical trials support the development of SUD medications. For trials to be productive, participation is needed from individuals with SUD. However, many people living with addiction encounter challenges such as poverty, legal trouble, lack of transportation, and housing insecurity, which may impede consistent participation and significantly impact trials.^[20]

People with SUD may also be apprehensive about participating in trials after experiencing discrimination and societal stigma in the past, which has led them to distrust the healthcare system. Additionally, proving that an individual has stopped using substances is incredibly difficult to achieve, which discourages many drug companies from developing new treatments.^[20]

Emerging Research on Medication for SUD

Several exciting new scientific tools may assist in the development of novel medications for addiction. These include faster ways to test new drugs, discovering new parts of the brain or body linked to SUD, applying artificial intelligence to find promising patterns with large medical data sets, and exploring why treatments work better for some people than others.^[20]

Emerging research on a group of medications known as GLP-1 receptor agonists (such as Ozempic) shows promising evidence in reducing addiction-related behaviors in those with food, alcohol, nicotine, or opioid addictions. However, these findings are primarily from animal studies, and more research is needed to investigate their effects on other substances.^[21][22]

However, while GLP-1 medications might work well for some individuals, there is no one-size-fits-all medication for addiction. Like other existing pharmaceuticals used to treat SUD, some people can return to substance use after stopping the medication, while others might go on to maintain their recovery.^[22]

Therapies Used in SUD Treatment

Therapy is one of the most common treatments for substance use and has been found effective in assisting individuals to decrease or cease substance use by supporting behavior change, the development of new skills, and relapse prevention. It is common for both inpatient and outpatient programs to offer a combination of individual and group therapy.

Within these formats, there are various therapeutic modalities, each with its own approach and techniques, that are widely used to support recovery from addiction. Therapists may be trained in one or several of these approaches and often use a combination tailored to each individual’s needs.

When a therapy is described as evidence-based, it means research and clinical studies have demonstrated its effectiveness for treating substance use disorders. The following types of therapy are well-supported by scientific literature and, as a result, are the most widespread therapies used to treat substance use disorders.

Cognitive-Behavioral Therapy (CBT)

Cognitive behavioral therapy stems from the concept that thoughts affect emotions, which then, in turn, influence behaviors. The therapy teaches individuals to recognize and challenge harmful thought patterns, replacing them with healthier ones and using tools such as self-monitoring to manage cravings and prevent recurrence of use.^[23]

However, while CBT is one of the most extensively researched behavioral treatments for substance use disorders, studies show it offers moderate benefits compared to minimal or no treatment. Additionally, its effects tend to be less notable when compared to other therapies, and any reduction in substance use is often short-lived.^[19]

Contingency Management (CM)

Contingency management makes use of positive reinforcements to encourage behavior change in those struggling with addiction. Individuals recovering from substance use disorder are given rewards, such as goods or vouchers, money, for meeting specific goals or milestones (such as testing negative for substances or consistently attending therapy sessions).^[23]

Studies show this approach increases abstinence rates and boosts treatment adherence. This therapy has been proven effective in treating a range of SUDs, and extended periods of treatment are typically linked to more favorable results. The consistency of longer interventions helps to reinforce a new way of life and reduces the risk of relapse over time.^[19][23]

Motivational Enhancement Therapy (MET) and Motivational Interviewing (MI)

Approximately 60% of individuals with SUD report being ready to stop using substances, yet many are ambivalent about the thought of a major lifestyle adjustment. Motivational interviewing is a non-confrontational method that aims to enhance a person’s intrinsic motivation to change and is backed by strong evidence, although its impact over time is still unclear.^[19]

MET builds on the principles of MI in an effort to encourage individuals to strengthen their internal drive to reach personal goals more quickly. The modality supports change by enhancing a person’s confidence in their ability to take control and make meaningful progress. Research shows that MET can be effective in improving treatment engagement and commitment.^[23]

12-Step Groups and 12-Step Facilitation Therapy

Twelve-step support groups such as Narcotics Anonymous(NA) or Alcoholics Anonymous(AA) can strengthen addiction recovery by offering peer encouragement, guidance from sponsors, and role modeling (through the positive example set by others). Depending on the severity of SUD, these fellowships can be used instead of, or alongside, other therapeutic modalities.^[19]

The key principles of NA and AA center around acceptance, surrender, and living a moral life, which results in a sense of purpose and fulfillment. To benefit further from this, the 12-step approach to SUD recovery has been adapted into a therapeutic modality that, along with traditional 12-step support groups, has been proven effective in assisting sobriety maintenance.^[23]

Treating Co-Occurring Disorders

In recent years, the co-occurrence of a mental health disorder and a substance use disorder in the same individual (known as dual diagnosis) has become a widely recognized and expanding area of study.^[24]

Research indicates that as many as 75% of people with a serious mental illness also struggle with substance use, while around 60% of adults with a substance use disorder have been diagnosed with at least one serious mental health condition.^[24]

This is thought to be because psychiatric disorders drive many individuals to self-medicate, while SUDs can change the brain at a chemical level. This means that mental health conditions and SUDs have the potential to trigger the emergence of one another.

In light of the link between substance use disorder and numerous psychiatric conditions, individuals with co-occurring mental health disorders need to choose a treatment facility that specializes in dual diagnosis.

This means that an inpatient or outpatient facility recognizes mental health challenges as a separate issue to SUD, and provides a team of qualified psychiatric professionals with experience in treating not only SUDs, but conditions like anxiety, depression, bipolar disorder, PTSD, and more.

Barriers to Treatment

Substance use disorder is a complex condition that typically requires treatment, yet tragically, a large percentage of people who need professional intervention never receive it. This is due to the fact that numerous barriers stand between people with SUD and the care they need, ranging from internal obstacles like denial and self-delusion to systemic challenges such as cost and access.

Economic Instability

One of the most common barriers to treatment for substance use disorder is a lack of financial resources, which has been identified as both an influencing factor for SUD and a consequence of the disorder. Unfortunately, many treatment programs (particularly private or inpatient care) are expensive even with health insurance.

Denial and Delusion

Most individuals caught in the cycle of addiction are incapable of recognizing their substance use as a problem, a state known as denial. As a result of this delusion, addicts tend to minimize serious consequences, blame others, and believe they can control their usage without intervention \- a factor that prevents many people with SUD from seeking treatment. Many individuals living with addiction struggle to recognize their substance use as a problem, despite negative consequences. As a result of denial or low insight, people with SUD may minimize serious consequences, have difficulty accepting responsibility for their actions, or believe they can stop or control their usage without intervention. The latter may keep many people with SUD from seeking treatment.

Shame and Stigma

In light of the societal stigma surrounding addiction (which tends to view SUD as a moral failing), those with the disorder may fear public humiliation or rejection should they choose to reach out. The feelings of internalized shame and stigma that can come with living with SUD can lead someone to isolate or avoid treatment, often until faced with consequences such as a court order or severe health issues. Sadly, the shame of living with SUD may instead lead an addict to isolate for years and avoid treatment until faced with a court order or severe health-related consequences.

Concerns of Legal or Professional Implications

Another barrier to treatment is the fear that seeking treatment could lead to job loss or loss of professional licensure. This is especially true in professions with zero-tolerance policies or high public accountability. Additionally, parents or caregivers with SUD often fear losing custody of their children.

Fear of Withdrawal or Treatment Process

Individuals with severe SUD are generally already aware of how unbearable withdrawal symptoms can be before seeking treatment, as these physical and emotional sensations are a major contributing factor that perpetuates the cycle of addiction. As a result, the fear of an intensely distressing withdrawal experience may lead people with SUD to avoid seeking help.

Co-Occurring Psychiatric Conditions

Many individuals with substance use disorder also suffer from comorbid mental health conditions. These psychiatric disorders can interfere with logic and motivation, and may even cause an individual to lose touch with reality completely. Unfortunately, mental health complications and SUD can have the effect of worsening each other in a vicious cycle.

Lack of Treatment Models For Less Common SUDs

Most treatment models and even psychiatric care in general are designed to address common substance use disorders. In light of this, individuals who are addicted to less widespread substances may struggle with limited information, treatment protocols, or trained professionals, which can reduce treatment efficacy and increase the risk of relapse.

Negative Experiences with Previous Treatment Facilities

Having been judged, shamed, misunderstood, or mistreated by staff at a treatment center in the past can discourage individuals with SUD from seeking help. Unfortunately, trauma from withdrawal management, detox, harsh group settings, or untrained staff can cause harm and leave lingering fear, and for some, a single negative experience may be enough to lose hope in recovery entirely.

Long-Term Management and Recovery for SUD

Recent research has revealed that the key factors linked to successful treatment outcomes are attending self-help groups (such as NA or AA) during treatment, staying in treatment for a minimum of 90 days, and setting clear treatment goals.^[25]

The benefit of attending a 12-step treatment facility is that it can teach individuals who have never attended an NA or AA meeting before how the program works and what it involves, which paves the way for a smooth transition into recovery maintenance.

Many individuals with SUD face serious life challenges after leaving treatment, such as legal or financial issues, which increase the risk of recurrence or relapse. In light of this, many 12-step treatment programs recommend attending 90 meetings in 90 days after leaving the facility.

By joining the fellowships of NA or AA, individuals with SUD have immediate, free access to a community of recovering addicts who strive to support each other, share insights, and collectively prioritize personal growth, which can help to maintain recovery long term.

Final Thoughts

Substance use disorder (SUD) is a multifaceted psychiatric condition, often worsening over time without proper treatment. Recent research has revealed that prognosis is improved with early intervention and attending a treatment program that is a good fit for your needs in either inpatient or outpatient programs for at least 90 days.

Additionally, studies have shown that attending self-help groups (such as Narcotics Anonymous) or other peer support groups during treatment enhances recovery outcomes. Therapy and medication also play a vital role in addiction recovery, particularly for those with co-occurring disorders.

Although recurrence of use is a lifelong risk, receiving care and support that improves one’s mental well-being, physical health, and overall quality of life is beneficial for recovery. 12-step support groups have been found highly beneficial for maintaining long-term sobriety, helping recovering addicts to not only abstain from substances but to thrive.