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Substance use problems: Treatment overview

Acute setting

Appropriate treatment of intoxication and withdrawal can be an ideal way to engage the patient in discussion about rehabilitation. Poorly treated withdrawal can perpetuate addiction as patients know how to relieve uncomfortable symptoms by resuming use of their drug of choice.

Withdrawal management

Determine whether the patient requires medically supervised withdrawal management. Consider these factors:

  • Alcohol and benzodiazepine withdrawal generally require medical treatment due to risk of seizure.
  • Patients with multiple medical problems are best monitored in a medical setting.
  • Patients who are pregnant or those at risk of suicide should not be treated in an outpatient setting.
  • Most other patients can be treated at a non-medical withdrawal management centre.

Is office-based or home withdrawal management appropriate?

  • Management of uncomplicated alcohol or opioid withdrawal can often be done in a physician's office. 
  • Home withdrawal management should only be attempted if the patient has stable housing, has a supportive family member or friend, and is able to follow up in subsequent days.
  • A degree of trust and background knowledge of the patient is strongly recommended.

Have a follow-up plan for rehabilitation before or early in withdrawal management. On its own, managed withdrawal is ineffective in maintaining long-term remission.

Rehabilitation

Early engagement of the patient is important for treatment retention. It is associated with improved outcomes because active treatment is required to help the patient maintain a drug-free life. This is usually a life-long commitment with increased intensity in the first year and gradual tapering of involvement as the person is able to maintain his or her goal.

In harm reduction paradigms, the goal is to improve functioning in all domains without requiring complete abstinence from drug use.

Treatment formats and setting

Tailoring treatment to the patient's lifestyle and other responsibilities has a greater chance of success and patient retention. Treatment programs are often organized by substance of use or other demographic factors (e.g., women-only groups, patients with concurrent psychiatric illness).

Treatment formats and settings include:

  • Outpatient day or evening programs: These programs are often affiliated with hospitals or social service agencies.
  • Residential programs: Duration varies from short (21-day) to long-term (up to six months) programs. Residential programs often provide ongoing group or individual support after completion of program.
  • Mutual aid groups: Twelve-step-based mutual aid groups may have a spiritual or religious focus, or they may be secular.