Most people with substance use disorder (SUD)recover. They recover despite our chronically underfunded treatment services for addiction and other mental health conditions, not because of them. Even more will recover once we have publicly-funded, timely, compassionate, evidence-based treatment for all. There is great reason for hope as there is new awareness that our system requires significant change and that this change is required as soon as possible. As the stigma of addiction and other mental health conditions lifts, more people will seek treatment earlier, providing a faster road to recovery. If there is life, it is never too late to recover.
It is important for family members to have realistic expectations about recovery. People still often view addiction as an acute illness, but it is a chronic disease. It needs to be managed over time, like other chronic illnesses. Although it is possible, it is unusual for a person to recover and never return to use.
Addiction is a progressive disease. This means that if it is left untreated it tends to get worse over time. The sooner someone begins to recover, the better the outcome. Many people in active addiction do things they would never do otherwise. This creates negative social consequences that make many aspects of their lives (relationships, employment, education and finances) much worse. If they don’t have post-traumatic stress disorder (PTSD) when their addiction begins, they may have it before it ends. In other words, their experiences in active addiction can add to the work that must be done in recovery.
The majority of people with addiction at any given time do not seek treatment. That is another reason it is so important that they receive help as soon as they decide that they need it. Where the drugs being used are illegal and can be laced with anything, the next use could be fatal. A wait list can be a death sentence.
Addiction is a chronic illness that should be managed over a lifetime just as other chronic illnesses like diabetes or hypertension are managed. In the case of mild SUD, it is possible that a brief intervention with counselling to develop coping skills is all that will be required. At the severe end of addiction treatment may involve withdrawal management, residential treatment, outpatient treatment while in a sober home, and ultimately reintegration into the community with ongoing supervision by professionals of medications and involvement with self-help groups.
The length of treatment required, whether residential or outpatient, depends on the severity and duration of a person’s SUD and other mental health conditions. Longer treatment periods are associated with better treatment outcomes.
People need time to learn how to manage their condition. Similarly, family members need to learn how to manage their expectations. A few returns to use are to be expected. While that is certainly cause for concern, consider focusing on the time your loved one has been working to be well instead of the times they have returned to use.
Often persons need to start with withdrawal management. It may need to be medically supervised when someone is detoxing from alcohol or benzodiazepines as stopping either of these drugs cold turkey can be fatal. Withdrawal management is simply the first step. On its own, it is rarely sufficient to maintain recovery.
Detox is contraindicated for people with opioid use disorder (OUD). The standard of care for those with OUD is opioid agonist therapy (OAT). For more information, see the Medications section of this website.
There are medications that help minimize the pain of withdrawal from substances and to deal with cravings. These medications have been approved for alcohol, nicotine and opioids .For other drugs like cannabis and stimulants like cocaine and methamphetamine, no medications have been approved but they are being researched. See the Medications section of this website for more information.
Individual, group and family therapy may be a part of treatment. Group therapy is most frequently used. Various behavioral therapies may be used such as cognitive behavioral therapy, dialectical behavioral therapy and motivational interviewing. These therapies address the underlying reasons that people use substances to cope with life and help them develop effective coping skills. Since this involves not just stopping old habits but developing new ones, it takes time. Therapy and medications are the two core components to treatment.
Where there are no approved medications for certain substances (stimulants like cocaine and methamphetamine) contingency management has good evidence of effectiveness. Contingency management is a treatment approach where people earn small rewards for making healthy choices—like attending appointments, taking medication as prescribed, or having drug‑free urine screens. It’s based in positive reinforcement. When someone gets recognized or rewarded for a healthy behavior, they’re more likely to repeat it.
People should be assessed for other mental health conditions. Heavy and chronic use of some drugs can result in a temporary psychosis that can last for months or years if a person continues to use and does not receive treatment. If a person has anxiety or depression and concurrent substance use, a psychiatrist can’t immediately make a definitive diagnosis as to whether the mood disorder is primary or secondary. Short term treatment programs of 21 to 28 days may not be sufficiently long to assess and address co-occurring conditions unless it is clear that these condtions preceded the struggle with SUD.
It is widely accepted that SUD and co-occurring mental health conditions should be treated at the same time. Addressing one without the other is generally not effective. However, it is often difficult to get concurrent treatment. Mental health and addictions have historically been separated in our health care system and these silos still exist.
People should be screened for infectious diseases such as Hepatitis B and C, HIV/Aids, and sexually transmitted diseases.
People starting recovery have often led chaotic lives. They may not have a home or job and may have legal problems. It is important to assist them with all of these issues to overcome stress and feelings of hopelessness. “Housing First” is a program that has been piloted in many locations, including Canada, and has had good success. The evidence is that people struggling with addiction and other mental health conditions are in a far better position if they have somewhere to live and support. Recovery while dealing with the stress of living on the streets is highly unlikely.
The principles of effective treatment for adolescents are very similar to that for adults. The most significant differences include:
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