Substance Abuse Treatment – What Really Works? (Part Two)

In the previous blog, I spoke about the importance of a thorough assessment to individualize a person’s treatment, the inclusion of group, individual, and family services, the use of education about the recovery process, and the utilization on an outpatient basis of consistent urine toxicology and breathalyzer screening.  In today’s blog, I will focus on the importance of medical care, psychiatric services, addiction medications, and community recovery support.

Many abusers of substances come to treatment with an array of medical issues, including malnutrition, infections, sexually transmitted disease, HIV, hypertension, or poor hygiene.  Many have not been seen by a medical professional in years.  It is a sign of good care that any patient entering substance abuse treatment be seen early in the process by a medical care professional.  This screening should determine what medical issues need to be addressed immediately and what issues need to be monitored throughout the treatment process.

Good treatment should also include a thorough screening of mental health concerns.  This may begin with completion of standardized screening tools used to pinpoint areas of concern around suicidal or homicidal thoughts, mood disorders, anxiety disorders, psychotic disorders, trauma, or personality disorders.  Any concerns identified would lead to a more specific exploration with a psychiatrist or other trained mental health professional.  This may lead further to a recommendation of medication to alleviate some of the symptoms of mental health disorders.

Another area of good practice is the inclusion of addiction medicine in the overall treatment plan.  Today, we are fortunate to have a variety of medications that can aid in reducing urges and craving for particular substances or to act as a better substitute for physical addiction to particular drugs.  For example, naltrexone seems to benefit many individuals dependent on opioids and/or alcohol.   Oral naltrexone acts as an opioid blocker in the brain, blocking the euphoric effects of opioids, and also seems to decrease the urges and cravings for alcohol.  For those who may not be compliant with taking the medication daily, there is now a monthly injectable version of naltrexone with the product name of Vivitrol.  Acamprosate, with the product name Campral, has also shown benefit in decreasing the urges and craving for alcohol in many users.  There are also medications to replace opioid dependence, such as methadone and the newer medication buprenorphine.  For nicotine dependence, there are now nicotine replacement aids, such as patches, gums, and even an electronic cigarette.  There is also an effective medication, Chantix, which appears to help decrease the cravings for nicotine.

Lastly, good treatment involves educating clients about the usefulness of participating in community recovery support services during and after leaving the treatment program.  Since substance use disorders are no longer considered to be an acute care disorder, but rather a chronic care condition needing a lifetime of monitoring, ongoing support is vital to arresting the disorder from reoccurring. This community recovery support may include participation in such programs as Alcoholics Anonymous and Narcotics Anonymous, or newer groups including SMART Recovery, Women for Sobriety, and Secular Organization for Sobriety (SOS).  There are now online support groups with chat rooms and videoconferenced services, such as Chat2Recovery.  Community recovery support can also include working with a particular professional specializing in helping people maintain a lifestyle free from substance use.  There are now even groups such as Moderation Management that support those who wish to attempt controlled use of substances.

High-quality substance abuse treatment can be very effective when it consists of the ingredients mentioned in the last two blogs.  Before entering any treatment program, ask specifically about the services offered and make certain that the program that you are considering includes many if not all of the services mentioned.


Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.  He can be reached at

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