Substance Abuse/Dependence


Levels of Care

Treatment Summary: Upon initial assessment the patient should be evaluated for not only the substance abuse disorder but also the presence of co-morbidities, this will determine the level of care needed in addition to what substances, how much and for how long they have been abusing. According to the American Society of Addition Medicine (ASAM) the four primary levels are: Level I - standard out-patient setting Level II - Intensive out-patient (along with Level I) Level III - Residential Level IV Hospitalization There is a need for eclectic or supportive counseling programs at each level depending on the client. This is in replacement to a "one-size-fits-all" approach. The additional counseling programs that could be applied congruently are Pharmacotherapy (which uses medications such as, buprenorphine, disulfiram, and naltrexone), Relapse Prevention Therapy, also known as Cognitive Behavioral Therapy, and the traditional 12 step programs.

  • Reference: Havivi, A. (2005). SUBSTANCE ABUSE IN TEENS: A CLINICAL APPROACH TO ASSESSMENT AND TREATMENT. Adolescent Psychiatry, 2933-53. Magura, S., Schildhaus, S., Rosenblum, A., & Gastfriend, D. (2002). SUBSTANCE USER TREATMENT PROGRAM QUALITY: SELECTED TOPICS. Substance Use & Misuse, 37(8-10), 1185.
  • Submitter: N/A

Motivational Interviewing

Treatment Summary: Motivational Interviewing (MI) is a method that can be combined with other counseling methods. When first utilized in the treatment setting MI was not considered an individual form of treatment, instead, a tool to prepare the clients for the chosen method. MI is considered beneficial to clients that are struggling with anger issues, resistance to treatment and in the pre-contemplation stage. The focus of MI is on the individual experience that the client has instead of the diagnosis. MI is effective in processing the denial that clients have with their substance abuse/dependence in a directive, client-centered style. MI is considered an evolved form of Rogers's person-centered method of treatment that strives to help clients overcome ambivalence to support behavioral change.

  • Reference: Mason, M.J. (2009). Rogers redux: relevance and outcomes of motivational interviewing across behavioral problems. Journal of Counseling and Development, 87. Retrieved from
  • Submitter: Liesa Pavoggi

Community Reinforcement Approach (CRA)

Treatment Summary: CRA is an individualized treatment approach designed to initiate positive changes in both lifestyle and social environment in order to overcome alcohol and drug use problems. This is a flexible treatment that is applicable to a wide range of client populations because it utilizes the client's own intrinsic reinforcers in the community by increasing the availability and frequency of reinforcement derived from alternative activities, particularly vocational, family, social, and recreational activities that are incompatible with substance abuse. The client, therapist and significant others work together to change the substance abuser's lifestyle with a social support system and activities so that abstinence becomes more rewarding than drinking or using drugs. CRA combines a variety of treatment strategies, such as increasing the client's motivation to stop drinking, initiating a trial period of sobriety, performing a functional analysis of the client's drinking behavior, increasing positive reinforcement through various measures, and rehearsing new coping behaviors.

  • Reference: Smith, J.E., Meyers, R.J., & Miller, W.R. (2001). The community reinforcement approach to the treatment of substance use disorders. The American Journal on Addictions, 10, 51-59.
  • Submitter: Melodi Howard

Methadone Maintenance Treatment (MMT)

Treatment Summary: Methadone Maintenance Treatment (MMT) is a drug replacement therapy used in the treatment of heroin addiction and addiction to other opiates. Methadone is a medication with traits similar to those of heroin. Methadone relieves withdrawal symptoms with few side effects and without providing the high a person would get from using heroin. MMT allows people addicted to heroin to be able to function more normally by reducing withdrawal symptoms, drug seeking behavior and the risk of over overdose associated with heroin use. Doses are strictly monitored and dispensed by physicians and clinics specializing in MMT. MMT is often criticized because it replaces one addiction with another. Despite these criticisms, methadone is still the most effective medication for the treatment of addictions. MMT has proven effective in reducing illicit drug use and criminal behavior as well as lowering the risk of HIV/AIDS and hepatitis by reducing needle sharing. Other studies have also linked MMT with reduced criminal behavior and reduced risk of homelessness.

  • Reference: Greenberg, B., Hall, D.H., Sorensen, J.L. (2007). Methadone maintenance therapy in residential therapeutic community settings: Challenges and promise. Journal of Psychoactive Drugs, 39, (3), 203-210. Retrieved February 16, 2011, from Schilling, R., Dornig, k, Lungren, L., (2006). Treatment of heroin dependence: Effectiveness, costs, and benefits of methadone maintenance. Research on social work practice, 16, 48-56.
  • Submitter: Devin Bove
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