Treatment for Substance Use Disorders

Article | March 2018

Treatment for Substance Use Disorders

Getting treatment for substance use disorder is difficult. It's tough if it’s by personal choice. And it's hard if it’s being recommended or required by the court system, family, or employer. The first step toward getting the right treatment is a full evaluation. This evaluation includes:

  • A full assessment of the person's current use
  • A review of past substance use and treatment history
  • A physical history
  • A look at the person's social situation
  • Identification of treatment goals

After this evaluation, you'll get a treatment recommendation. The recommended treatment will happen on either an inpatient or outpatient basis. This is called level of care (LOC).

Outpatient care

Outpatient care can include 12-step programs, therapy, support groups, and partial hospitalization.

12-step programs:

  • Are usually community-based and free.
  • Include programs such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, or Ala-Teen.
  • Can be very useful for patients trying to achieve recovery. They can also help family members affected by substance use.
  • Allow you to connect with other people in recovery.
  • Offers support and strategies for a successful recovery.
  • Can make the different in long-term sobriety if you commit to them.

Routine outpatient care (ROC):

  • Includes individual counseling with a trained therapist.
  • May also include a psychiatrist or addictionologist. They can help decide whether medication would be helpful.
  • Does not include medical treatment for complicated withdrawal symptoms.

Substance use disorder intensive outpatient program (IOP):*

  • Is a structured treatment that teaches about addiction and recovery.
  • Usually encourages participation with 12-step programs.
  • Involves frequent visits (usually three to five days per week). Takes about three to four hours of treatment per day.
  • Is structured so patients can continue to work and live their usual routine.

Substance use disorder partial hospitalization:*

  • Is a structured treatment.
  • Can help patients who are still struggling after completing lower levels of care.
  • Involves treatment five to seven days per week for six to eight hours each day.
  • May offer an arrangement for sober housing while attending the program.

Ambulatory detox:*

  • Is provided on an outpatient basis. It's meant for people who are highly motivated to recover, but need medical treatment for withdrawal symptoms.
  • Can work when the patient can be monitored by medical professionals.

Inpatient care

Inpatient detox:*

  • Is right for people who need 24-hour intensive medical care.
  • May be needed for people who are dependent on certain drugs. These include alcohol, sedatives, and some opiates such as painkillers or heroin.
  • Is meant for people whose situations are medically complicated.

Inpatient acute care:*

  • May be needed after inpatient detox once withdrawal symptoms have decreased. If the patient is having medical or psychiatric symptoms, 24-hour care and daily doctor visits may be needed.
  • Is usually a short-term treatment.

Inpatient residential:*

  • Is tried after multiple attempts at other levels of care have failed.
  • Is meant for people who don't need medical supervision.
  • May last 28 days or more.
  • Is not right for people who aren't motivated to change and recover.
  • Is no more effective than any other type of care in achieving long-term sobriety.
  • Should include weekly family therapy.

Expectations of treatment

People often ask, “What's the success rate of each level of care?” There's no simple answer to this question. Addiction is a chronic and progressive disease, much like diabetes. If a diabetic takes his medication without diet or exercise, the medication won't work well.

People with substance use disorder are most likely to recover if they:

  • Learn about their addiction
  • Manage conflict in a healthy way
  • Take care of their physical and emotional health
  • Follow the direction of their health care providers
  • Develop a sober support group
  • Make changes to the parts of their life that support drinking or using.

Recovery takes heroic effort every day. Most people who achieve recovery feel that the work is worth it. Relapse is common during the recovery process. Relapse doesn’t mean that the person or treatment program has failed. It’s often a sign that the treatment may need to be re-examined or changed.

Extra support is needed during a relapse. If the person feels shamed for having a relapse, they may be less likely to return to recovery or treatment.

Family dynamics

Having a loved one with an addiction problem is tough on family members. They may have to take on a caretaking role and advocate for their loved one. They may not fully understand the substance use problem. They may try to cope with their feelings in unhealthy ways.

It’s a common myth that certain types of treatment will "fix" a person. Loved ones often hope there's a "cause" for the behavior. They assume that once the cause is found, the addictive behavior will stop.

Loved ones may also resent the time and energy the person must spend on recovery. They might pressure them to turn their focus away from recovery. They may resent the lifestyle changes necessary for long-term change. All family members must work on their own “recovery.” It's important to learn new ways of operating within the new family.

When to consider a higher level of care

A higher level of care should be considered when the patient:

  • Has been sticking to treatment but is still drinking or using.
  • Is struggling with medical complications.
  • Shows a decreased level of functioning.

What do I need to know, and how can I help?

Your first step is to get a clear understanding of the situation. Then you can look at the available treatment options. It’s important to remember that substance use disorder is an illness. It doesn't just go away. Like other serious illnesses, it may require medical attention. And a caring, sober support system can make all the difference.

Each substance user is different, and will have different needs and responses. They'll also have different reasons for drinking or using. Knowing the person’s unique qualities puts you in a good position to help them. And knowing the signs and effects of substance abuse helps even more.

Be active and get involved

Don't be afraid to talk about the issue honestly and openly. You may need to be persistent. Let your loved one know how much courage it takes to ask for or accept help. Most people with substance use disorder really want to talk. It helps to have people who are truly concerned about them.

Early identification and treatment of substance use is crucial. Approach the person in a way that isn’t judgmental or confrontational. Gentle encouragement at the right time may be helpful. Many people with substance use disorder have been helped by outside pressure.

You may not be able to cure the illness. But you can provide support and guide the person to competent help.

Treatment for Substance Use Disorders

*Authorization requires a face-to-face assessment by facility staff who will contact their plan with clinical information and a request for authorization. The plan will then make a determination regarding the appropriate level of care to authorize based on medical necessity guidelines.

This material is provided by Cigna for informational/educational purposes only. It is not medical/clinical advice. Only a health care provider can make a diagnosis or recommend a treatment plan. For more information about your behavioral health benefits, you can call the member services or behavioral health telephone number listed on your health care ID card.