Outline of an Initial, Evidence-Informed Treatment Plan for Substance Use Disorder

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-1

“Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs.”
National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health (NIH), 2018

Treatment Plan Goal: To assist individuals in living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society.

Objectives listed in priority order:

1 – Medical Care

  • Physical exam and diagnostic lab work
  • Assessment for suitability for medications for:
    – Substance use disorders (SUDs), including nicotine replacement therapy
    – Co-occurring mental illnesses
    – Physical illnesses
    – Physical pain
    – Sleep disturbances
    – Nutrition and diet
    – Assessment for neuroatypicality: sensory sensitivity and under-sensitivity (Unbroken Brain, Chapter 4); attention challengesautism spectrum
  • Assessment for suitability for follow-up care, additional treatment, and referrals

2 – Mental Health Care

Mental Health Assessment

  • Trauma (2/3 of all people with SUDs have experienced trauma)
  • Co-occurring mental illnesses (over 1/2 of all people with SUDs have at least one co-occurring mental illness)
  • Current stressors
  • Needs assessment


3 – Support Services

  • Connect individuals with social services agencies to assist with current stressors and needs: employment, housing, transportation, child care, legal issues, etc.
  • Income: Assist individuals with finding jobs or applying for disability benefits.

4 – Social Support

  • Interests and preferences assessment
  • Experimentation with diverse interest groups, clubs, religious groups, support groups and/or other sources of social connection based on individual interests and preferences

. . . . .

The content of this treatment plan is based on a synthesis of extensive literature reviews that I and Laurel Sindewald have conducted on substance use disorders and their treatment. The treatment plan is highly informed by Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, released in November, 2016.

The Surgeon General’s Report is current as of November, 2016, with these exceptions: In terms of treatment effectiveness, research data does not support inclusion of 12-step approaches or rehab, nor does it support inclusion of naltrexone, or extended release naltrexone, as a primary treatment for opioid use disorder, equivalent to methadone and buprenorphine. Naltrexone may be contraindicated for those with liver disease and can be associated with depression. According to Buchel et al., November, 2018, “blocking opioid receptors decreases the pleasure of rewards in humans.”

We link to primary sources reporting research data as available, and authoritative secondary sources that cite multiple primary sources. Our reports are here. Since nearly every word in this post could be linked to a source, I have only linked to sources for terms or concepts that may be unfamiliar to some. Feel free to contact me with questions or feedback.

The goal of substance use disorder treatment is to assist individuals with living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society. A treatment plan describes how a person hopes to reach this goal, or to get help with reaching this goal, through specific steps, termed objectives.

Above is a brief outline of evidence-based treatment components for an individual beginning treatment for substance use disorder.  This treatment plan is evidence-informed, not evidence-based, because it, as a stand-alone protocol, has not been subject to research.

I define evidence-based treatment as what research reports works for most people, most of the time, better than other treatments, and better than no treatment. Specifically, that means the treatment is supported by numerous, peer-reviewed scientific experiments with rigorous methods that include control groups, randomization of subjects to experimental conditions, and bias-free samples, with statistically significant results. Some treatments that are evidence-based to work for groups may not be helpful to a particular individual, however. It is an imperative that counselors and individuals continually monitor an individual’s condition and progress while engaged in treatment.

I contrast research data – the evidence resulting from research experiments – with “anecdotal data.” I define anecdotal data as an individual’s personal experience. Data from a sample size of one does not provide sufficient information from which a generalization can be made about a group or population. Principles believed to account for outcomes from inspirational individual stories, practitioner wisdom, or theories based on logic, cannot be safely applied to others without first subjecting those principles to rigorous research.

This report may also be of interest:

A Guide for Clinicians to Initial Treatment for Alcohol Use Disorder

Last updated 11/20/18

The views expressed are the author’s alone and do not necessarily reflect the positions of the author’s employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

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