Support and Advance Effective Treatment

Introductory Paragraph

According to a 2022 national survey, about 29.5 million people ages 12 and over in the United States had an alcohol use disorder and 48.7 million people had a substance use disorder within the past year. Alcohol and substance use impacts not just the user but the entire family.

There are several evidence-based therapies for alcohol and drug misuse, with most common being talk therapy, medications, and support groups. Evidence-based therapies include cognitive behavioral therapy and 12 step-programs. Medication-assisted treatment has also proven effective in treatment of opioid use disorder. Medication in combination with talk therapy can reduce withdrawal symptoms and promote long-term recovery.

Key Information

There are multiple effective pathways leading to long-term recovery and improvements in work, family, relationships, and overall mental health and well-being. Substance use disorders treatments which meet the needs of the individual may include the following:

• Therapy (individual, group, couples & families)
• Medications
• A combination of therapy and medications
• Peer support programs
• 12-step or recovery programs
• Family support and family recovery programs

Specific evidence-based treatments that have been researched and scientifically proven include:

• Cognitive behavioral therapy (CBT) provides one-to-one attention by a a therapist. CBT has been proven to reduce substance use and to have a positive impact for life improvements. CBT has also been proven to be effective with trauma which often coincides with substance use disorders.

• 12-step therapy programs, such as Alcoholics Anonymous and Narcotics Anonymous are self-help group programs which are evidence-based in assisting with maintaining sobriety.

• Medication-assisted treatment (MAT) is a combination of medications and talk therapy. Depending on the substance, MAT is an evidence-based option for recovery from alcohol and opioid use.

There are inpatient treatment options, such as residential treatment, and outpatient choices, depending on what is best suited for the level of care for an individual. Treatment may require detox on either an outpatient or inpatient basis, depending upon professional medical advice.

Relevant Research

HHS has a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." This study addresses the models of care, quality improvement interventions, and best practices used by higher-performing health plans to improve initiation and engagement in SUD treatment. It also describes the provider, beneficiary, and market factors that affect their ability to successfully initiate and engage beneficiaries in substance use treatment services.

This NIDA article provides a literature review of treatment communities, such as community lodges and sober houses that have seen themselves as a mutual self-help alternative to medically oriented strategies to address addiction.

This book is in its third edition and is titled "Principles of Drug Addiction Treatment: A Research-Based Guide." It offers health professionals and other stakeholders information on principles of effective drug addiction treatment, answers to frequently asked questions, an overview of the drug addiction treatment landscape in the United States, and an outline of evidence-based treatment approaches.

This book provides a set of analyses focused on the evaluation of alcohol and drug treatment programs.

This article provides a comprehensive review of empirical studies that have addressed differences in patient outcomes and retention rates and their correlation to the effectiveness of the therapists. It notes that the differences appear to be independent of both the therapists' professional background and the patient factors at the start of therapy and that the primary therapist characteristic associated with higher effectiveness is the possession of strong interpersonal skills.

Impactful Federal, State, and Local Policies

The STOP Act. The Sober Truth on Preventing (STOP) Underage Drinking Act of 2006 which was reauthorized in 2016 as part of the 21st Century Cures Act. It mandates community coalition enhancement grants, epidemiological research on excessive and underage drinking, and the annual report to Congress on state underage drinking and enforcement activities. It also launched a national adult-oriented media campaign managed by the Interagency Coordinating Committee to Prevent Underage Drinking (ICCPUD).

Facing Addiction in America: The Surgeon General's Report provides a review of prevention, treatment, and recovery policies and programs and discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment.

California. The Safe Neighborhoods and Schools Act (Proposition 47) reclassified certain theft and drug charges from felonies to misdemeanors enabling focus on more violent crimes and serious offenses. This resulted in monetary savings being directed to school programs, victim services, and mental health. The creation of new drug treatment programs offered a way to decrease recidivism and to support those with newly classified misdemeanor drug possession charges to have more options for recovery.

Available Tools and Resources

SAMHSA has numerous resources including:

• Behavioral Health Treatment Services Locator -- a confidential and anonymous source of information for persons seeking treatment facilities for substance use/addiction and/or mental health problems.
• The Evidence-Based Practices Resource Center which provides communities, clinicians, policy-makers, and others with information and tools to incorporate evidence-based practices into their communities or clinical settings.
• "Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." This resource places the selection of programs and practices within the broader context of evidence-based prevention and covers the value of embedding program and practice selection in a strategic planning process. It provides information on programs and practices, how to choose among them, and tips for their adoption, adaptation, and implementation, and continual improvement.

SAFE Project offers a Treatment and Family Support Locator to "find critical resources and options best matched to your needs or the needs of a loved one."

BJA has published "Promising Practices Guidelines for Residential Substance Abuse Treatment." This aims to assist correctional administrators and practitioners at the state and county levels in establishing and maintaining programs that adhere to the promising practices suggested by current research and standards for substance-use disorder treatment and criminal justice programming.

The National Association of Addiction Treatment Providers has a web page titled "Navigate Treatment Options" which provides addiction and treatment FAQs. It evaluates new methods based on developments in neurobiology and behavioral health. It integrates best practices within the bio-psycho-social-spiritual treatment model.

American Addiction Centers provides "Treatment Solutions," an online resource dedicated to helping people find solutions to meet their specific treatment needs. It also provides a succinct overview of SAMHSA programs, grants, and treatment services.

Promising Practices

Kentucky. In Kenton County, the prison has become an important treatment facility. Instead of focusing on punishing people with substance use issues, the Kenton County Detention Center envisions turning a time of incarceration into a time for much-needed treatment. Leaders in Kenton County believe that jail may be the best place to initiate recovery. People often end up in jail for minor crimes, long before they commit more serious crimes which warrant a prison sentence. Kenton County is one of over 20 Kentucky county jails that have started full-time therapeutic communities that focus on rehabilitation within their walls, providing inmates the type of services that private treatment centers offer on the outside.

Maryland. The Baltimore County Health Department provides treatment through community providers for substance users and their families. It develops, coordinates, and monitors a countywide network of substance use prevention and disorder treatment services. The Health Department also operates a dedicated phone line staffed with clinical social workers with specialized training in helping people with substance use issues move toward recovery.

Massachusetts. Boston Medical Center opened its Faster Paths to Treatment Opioid Urgent Care Center in 2016. This center, which is specifically for treating patients addicted to prescription painkillers, is located next to the hospital emergency room, giving patients immediate access to comprehensive care including counseling, case management, home visits, and transportation to detox.