Genetic predisposition accounts for 40-60% of the vulnerability to addiction, highlighting its nature as a medical condition.
Factors like early exposure, trauma, and socioeconomic conditions play critical roles in the development of SUD.
Recovery from addiction is possible. This module provides a comprehensive overview of evidence-based treatment approaches, from pharmacotherapy to behavioral interventions to mutual support programs. Understanding the full continuum of care enables healthcare professionals to guide patients toward appropriate resources and support their recovery journey.
By the end of this module, you will be able to:
| Level | Setting | Intensity | Indication | |-------|---------|-----------|------------| | Early Intervention | Primary care, schools | Brief | At-risk use | | Outpatient | Office/clinic | 1-9 hrs/week | Mild-moderate SUD, stable | | Intensive Outpatient (IOP) | Clinic | 9-20 hrs/week | Moderate SUD, some stability | | Partial Hospitalization (PHP) | Hospital/clinic | 20+ hrs/week | Moderate-severe, need structure | | Residential | Treatment facility | 24/7 | Severe SUD, unstable environment | | Medically Managed Inpatient | Hospital | 24/7 medical | Medical withdrawal, comorbidities |
The American Society of Addiction Medicine (ASAM) criteria guide level of care decisions based on six dimensions:
| Medication | Mechanism | Evidence | Notes | |------------|-----------|----------|-------| | Naltrexone | Opioid antagonist | Strong | Reduces craving, heavy drinking days | | Acamprosate | Glutamate modulation | Moderate | Maintains abstinence | | Disulfiram | Aldehyde dehydrogenase inhibitor | Moderate | Aversive reaction if drinking |
Naltrexone:
Acamprosate:
Disulfiram (Antabuse):
| Medication | Mechanism | Setting | Evidence | |------------|-----------|---------|----------| | Buprenorphine | Partial agonist | Office-based | Very strong | | Methadone | Full agonist | OTP only | Very strong | | Naltrexone | Antagonist | Any | Strong |
Buprenorphine (Suboxone, Subutex):
Methadone:
Naltrexone (Vivitrol):
| Treatment | Efficacy | Notes | |-----------|----------|-------| | Varenicline | Highest | Partial agonist at nicotinic receptor | | Combination NRT | High | Patch + short-acting (gum/lozenge) | | Single NRT | Moderate | Patch, gum, lozenge, inhaler, spray | | Bupropion | Moderate | Also treats depression |
No FDA-approved medications
Under investigation:
Behavioral treatments remain primary approach.
Core Principles:
Key Components:
Evidence: Strong evidence across substances; effects maintained post-treatment.
Core Principles:
OARS Skills:
The Spirit of MI:
Evidence: Effective across substances; particularly useful for ambivalent patients.
Core Principle: Provide tangible rewards for objectively verified positive behaviors (negative drug tests, treatment attendance).
Implementation:
Evidence: Strongest evidence for stimulant use disorders; effective across substances.
Challenges:
Core Principle: Make a sober lifestyle more rewarding than substance use.
Components:
Often Combined With: Contingency management (CRA + Vouchers)
Alcoholics Anonymous (AA) founded 1935; model adapted for other substances:
The 12 Steps (summarized):
Research Findings:
Cochrane Review (2020):
Strengths:
Limitations/Concerns:
| Level | Target | Examples | |-------|--------|----------| | Universal | Entire population | School programs, media campaigns, policy | | Selective | At-risk groups | Children of addicted parents, trauma survivors | | Indicated | Early symptoms | Brief interventions for risky use |
Effective:
Ineffective:
Screening, Brief Intervention, and Referral to Treatment:
Evidence: Cost-effective, reduces risky drinking, increases treatment entry.
Definition: The sum of resources necessary to initiate and sustain recovery.
Domains:
Modern approach recognizes:
Peer Recovery Support Specialists:
Deepak, 42, presents for treatment of alcohol use disorder. He drinks 8-10 drinks daily, has tried to quit multiple times, and experienced withdrawal seizures once in the past. He is employed, married, and his wife is supportive. He has mild liver enzyme elevation but no cirrhosis. He is ambivalent about complete abstinence.
Discussion Questions:
Next Module: Ethics, Law & The Future of Addiction Treatment →
External links
Use one of the external tools below to explore "Treatment & Recovery: Evidence-Based Approaches". Check clinical claims against approved sources.
External links
Use one of the external tools below to explore "Treatment & Recovery: Evidence-Based Approaches". Check clinical claims against approved sources.