Treatment

Treatment services for individuals with a substance use disorder diagnosis include assessment, the development of a treatment plan, implementation of the treatment plan, evaluation, case management, extended care, and monitoring. Programs vary in length and intensity, and they may include approaches like medical stabilization/detox, counseling and behavioral healthcare, and rehabilitation services. In treatment, the ASAM Criteria (American Society Of Addiction Medicine) is the most widely used and comprehensive set of standards for placement, continuation of services, and determining levels of care for individuals seeking treatment for substance use disorder. Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s medical, psychological, and social needs to help determine what services are a best fit to meet individual and/or patient needs. Additionally, when utilizing ASAM criteria, these guideline assessments take into account an individual's strengths, needs, resources, and recovery capital. Levels of care/continuum of care include:

(Figure 1 ASAM American Society Of Addiction Medicine, 2024)

In SAFE Solutions, treatment themes, which are addressed below, are tightly linked to issues addressed across the full spectrum of the Institute of Medicine's (IOM) Continuum of Care, and the reader is strongly encouraged to read each of the other five overview articles. Three clusters of treatment articles are provided.

The first menu, "Focus on Effective Treatment," addresses general treatment themes. The second menu details considerations on Medicated Assisted Treatment (MAT)/Medicated Assisted Recovery (MAR), and the last menu addresses treatment concerns linked to the criminal justice system.

• "Support and Advance Effective Treatment" addresses the major types of treatment options and provides an introduction to the framework within which new treatment services are developing.
• "Improve Links to Treatment for People who Experience Non-Lethal Overdoses or Naloxone Revivals" covers a specific harm reduction strategy which treatment providers should prioritize.
• "The Role of Treatment Providers in Promoting Early Intervention, Harm Reduction, And Recovery" addresses the unique opportunity that treatment providers have in advancing efforts across the continuum of care.

Articles which focus on MAT/MAR include:

• "Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)" provides a detailed coverage of the MAT/MAR process, medication choices involved, and the community context within which MAT/MAR must be promoted.
• "Accelerate the Development of New MAT/MAR Approaches" covers the need for innovation in the MAT/MAR field and an FDA program designed to foster treatment approaches.
• "Expand DNA Testing to Improve Precision MAT/MAR Therapies" highlights the benefits of Precision/Personalized Medicine and its emergent status.
• "Expand the Use of MAT/MAR in Correctional Facilities" bridges to the focus of the next cluster of articles.

More than half of those in U.S. prisons and jails meet the criteria for substance use disorders, so correctional institutions are looking for best practices which they can use to help handle the increased demand for substance use treatment, including diversion and drug courts, treatment while incarcerated, and reentry services. Articles which focus on criminal justice involvement include:

• "Shift from Punishment to Treatment Approach" advocates for the need to address the correlation between recidivism and substance use disorder by amplifying treatment options available to the judicial system.
• "Expand Law Enforcement Assisted Diversion and Deflection Programs" defines the difference between diversion and deflection approaches and provides examples of the benefits of both types of programs.
• "Expand First Response and Crisis Intervention Teams" supplements the previous article, which has a focus on law enforcement, with a focus on the role of other first responders, such as EMS, fire departments, and behavioral health outreach workers.
• "Expand and Enhance Speciality Courts" describes the variety of specialty courts which are often referred to as drug courts. It provides the historical context within which the implementation of these courts has increased, and it documents their individual and social benefits.
• "Expand Community Service Alternatives to Incarceration" delineates four major types of incarceration alternatives and outlines five benefits of these alternatives.
• "Improve Recovery Support for People in the Criminal Justice System" focuses on many of the themes covered in the set of SAFE Solutions articles on recovery, which are of particular relevance to the criminal justice system.
• "Improve Reentry After Incarceration" documents the challenges of returning to community and delineates a variety of resources aiming to support the recovery process.