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Treatment and recovery for substance use disorders
Medicines, talk therapies, support groups and levels of care for alcohol and drug problems, and why a setback is part of recovery for many people.
Substance use disorders are treatable. Many people get better, and many stay well for years. Treatment can include medicine, talk therapy, peer support, or all three. The best mix depends on the person and the substance.1,4
This page explains each option in plain words. It does not give doses. Your doctor will choose those. If you are not sure where to start, a visit with your regular doctor is a good first step.
Key points
- Medicines work. There are approved medicines for alcohol use disorder and for opioid use disorder. They are not "trading one drug for another." They treat a long-term health condition.1,2
- Talk therapy helps. Cognitive behavioral therapy (CBT), motivational interviewing and contingency management all have research behind them.1,4,8
- Peer groups can add a lot. Alcoholics Anonymous and similar programs help many people, especially with other care.6
- Setbacks are common. A return to use does not mean treatment failed. It means the plan may need to change.4
- Free help is open all day, every day. Call SAMHSA at 1-800-662-4357, or search at findtreatment.gov.5,9
Where do I begin?
Many people start with a talk with a doctor, nurse or counselor. They will ask about your use, your health and your life. Then you make a plan together. You do not need to be "ready" in a perfect way. You only need to be willing to take a first step.
You can also call the SAMHSA National Helpline at 1-800-662-4357. It is free and private, runs every day of the year, and offers help in English and Spanish. It can connect you or a family member with treatment options.5 The website findtreatment.gov lists programs near you. SAMHSA's site also explains how to find care if you have Medicare, Medicaid, private insurance or no insurance.9
Alcohol and sedative withdrawal can be dangerous. If you drink heavily every day, or take sleeping pills or anti-anxiety pills (benzodiazepines) for a long time, do not stop suddenly on your own. Withdrawal can cause seizures and other serious problems. Get medical care first. See alcohol use disorder and cannabis, sedatives and stimulants.
Call 911 for a seizure, confusion, trouble breathing, or if someone cannot be woken up.
Medicines for alcohol use disorder
Three medicines are approved in the U.S. for alcohol use disorder: naltrexone, acamprosate and disulfiram. None of them is addictive.1 Doctors use them the way they use medicine for asthma or diabetes, to manage a long-term condition.1
Some doctors also use other medicines, such as topiramate, for drinking. Research finds that topiramate may cut drinking days, but it is not approved for this use.7,4 Ask your doctor what fits your health and other medicines. This matters most for older adults. See alcohol, medicines and older adults.
Medicines for opioid use disorder
Three medicines are approved for opioid use disorder: methadone, buprenorphine and naltrexone. The FDA says all three are safe and effective.2 Opioids include prescription pain pills, heroin and fentanyl. See opioids and overdose.
In studies, each of these medicines reduced opioid use more than no medicine did.10 People who stay in treatment with medicine do better than people treated without it.10
Rules have loosened since 2024. Clinics can now start buprenorphine after a phone or video visit. Methadone clinics can also give new patients up to 7 take-home doses, based on the clinician's judgment.3 This can make treatment easier for people with jobs, caregiving duties or trouble getting rides.
How long? There is no set end date. Some people take these medicines for months. Others take them for years, or for life. NIDA says methadone treatment should last at least 12 months.4 Do not stop on your own. Talk with your doctor or pharmacist before changing anything.
Stopping an opioid medicine or leaving a program can lower your tolerance. Then a dose you once handled can cause an overdose. Keep naloxone at home and never use alone. Naloxone is the nasal spray that reverses an opioid overdose.
Talk therapies
Talk therapy helps people understand what drives their use and build new habits. Three types are well studied. You can get them one on one or in a group.
Many people also have depression, anxiety or trauma along with a substance problem. Tell your care team about these, so they can be part of the plan. See depression and anxiety.
Mutual-help groups
Mutual-help groups are free groups where people with the same struggle support each other. Examples are Alcoholics Anonymous (AA), Narcotics Anonymous (NA), SMART Recovery and others. Meetings are held in person and online, in many languages and at many times of day.
A major Cochrane review looked at 27 studies with 10,565 people. It found that structured programs that help people join AA often led to more continuous time without alcohol than other well-known treatments. Less structured programs did about as well as other treatments.6 Moderate evidence
Groups work best alongside care from a health professional.1,4 A group that does not feel right is not a failure. Try another meeting, or another kind of group. Some groups welcome medicine, and some members may not. Your treatment plan is between you and your doctor.
Levels of care
Treatment comes in steps. People can move up or down as their needs change.
| Level | What it is | Who it may suit |
|---|---|---|
| Withdrawal management (detox) | Medical care while a substance leaves the body. Needed more often with alcohol, sedatives and opioids. | People at risk of unsafe withdrawal. It should be followed by more treatment.4 |
| Residential | Living at the program with daily care, for a few weeks up to many months. | People who need a safe, structured place or have little support at home.4 |
| Intensive outpatient or day treatment | Many hours of care on many days a week. You live at home. | People who need strong support but can stay safe at home.4 |
| Outpatient | One or two visits a week with a counselor or doctor, plus medicine if needed. | People with steady support, or those stepping down from higher care.4 |
NIDA reports that most people need at least 3 months of treatment to cut down or stop use in a lasting way. Very short stays under 90 days have limited effect.4 Treatment after a first stay, like follow-up visits or groups, helps protect gains.
Relapse is part of recovery for many people
Addiction is a chronic condition, like diabetes or high blood pressure. People with these illnesses can have flare-ups. NIDA says return to use is common and does not mean treatment failed. It means the plan should be restarted, changed or swapped for another.4
If you or someone you love slips:
- Be kind to yourself or them. Shame makes things harder.
- Reach out quickly to a doctor, counselor or sponsor.
- Look at what led to it. Stress, grief, pain, loneliness or old routines are common causes.
- Keep naloxone nearby if opioids are involved.
A setback is a signal to get more support, not a reason to give up. Many people try more than once before things settle.
Treatment for older adults
Age does not close the door on recovery. Older adults may also be dealing with pain, sleep trouble, grief or loneliness. Ask the program about their experience with older adults, and share a full list of your medicines. Read more in alcohol, medicines and older adults.
Questions people ask
Is taking buprenorphine or methadone just swapping one drug for another?
Do I have to quit completely right away?
Not always. Some programs aim for stopping altogether. Others help you cut down and lower harm first. Counselors who use motivational interviewing meet you where you are.1 Be careful with alcohol and sedatives. Cutting down fast can cause withdrawal, so ask a doctor.
What if I cannot afford treatment?
When to get help
- Call 911 if a person has trouble breathing, will not wake up, has a seizure, or shows signs of overdose.
- Call or text 988 if you or someone you know is thinking about suicide. Help is available at any hour.
- Call 1-800-662-4357 for free treatment referrals at any time.
- See your doctor if you want to cut down or stop and are not sure how to do it safely.
You can also use the help page, the safety plan tool and the signs of a substance use problem page. Return to the substance use overview.
Sources
- National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help. NIAAA, NIH. NIAAA booklet (PDF)
- U.S. Food and Drug Administration. Information about Medications for Opioid Use Disorder (MOUD). FDA. FDA
- Substance Abuse and Mental Health Services Administration. Medications for the Treatment of Opioid Use Disorder (final rule, 42 CFR Part 8). Federal Register, 2024. Federal Register
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition. NIDA, NIH. NIDA (PDF)
- Substance Abuse and Mental Health Services Administration. National Helpline. SAMHSA. SAMHSA
- Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev, 2020. Cochrane
- Jonas DE, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 2014. Full text (PDF)
- European Union Drugs Agency. Contingency management to reduce stimulant use (evidence summary). EUDA. EUDA
- Substance Abuse and Mental Health Services Administration. Find Treatment. SAMHSA. SAMHSA
- Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder, Treatment Improvement Protocol (TIP) 63. NCBI Bookshelf. NCBI Bookshelf
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.