SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Implicit in this type of model is the integration of substance use services with services for other mental disorders as well as primary care. This approach is cost‐effective and person‐centered and facilitates integrated care of co‐occurring mental and general medical disorders in individuals with SUDs. At lower levels of need, individuals can receive informal community care through support of friends and family or self‐help groups.

Treatment programs

• Although most adolescents who use a substance do not develop a SUD, any level of use during this period is concerning, due to youth’s increased vulnerability to SUDs and the potential for long‐lasting brain changes.
• If people stop following their medical treatment plan, they are likely to relapse.
• Screening and monitoring of non‐lethal overdoses is clinically relevant, since they frequently precede lethal ones, but unfortunately this is not routinely done.
• One of the more common and most deadly complications of substance use disorder is overdose.
• Effective gender‐specific interventions targeting mothers and daughters also exist273.

Or ask for a referral to a specialist in drug addiction, such as a licensed alcohol and drug counselor, or a psychiatrist or psychologist. Withdrawal from different categories of drugs — such as depressants, stimulants or opioids — produces different side effects and requires different approaches. Detox may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, buprenorphine, or a combination of buprenorphine and naloxone. For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Sometimes called the “opioid epidemic,” addiction to opioid prescription pain medicines has reached an alarming rate across the United States.

Neuronal circuits that are disrupted in addiction are potential targets for neuromodulation. Specifically, strengthening of fronto‐cortical circuitry might help prevent relapse by enhancing self‐control, while inhibition of the insula (mediating interoceptive awareness) might decrease craving and discomfort, thereby facilitating remission. The self-help support group message is that addiction is an ongoing disorder with a danger of relapse. Self-help support groups can decrease the sense of shame and isolation that can lead to relapse. Many, though not all, self-help support groups use the 12-step model first developed by Alcoholics Anonymous.

The health and social effects of nonmedical cannabis use

Good communication and coordination of care are necessary to decrease the risk for undertreatment of pain. Patients on methadone should continue taking their verified daily dose, and short‐acting opioids can be added for relief of acute pain304. Some patients may need higher dosing of opioids (up to 1.5 times higher than usual), due to increased pain sensitivity and opioid cross‐tolerance, and they may require pain medications at shorter intervals. Medications are the most effective interventions for preventing overdose mortality and improving outcomes in patients with opioid use disorder187. There are three medications used worldwide and approved by the FDA – methadone, buprenorphine and naltrexone – but there are no evidence‐based guidelines to guide selection, which is most often constrained by availability188.

Treatment and recovery options

Moreover, it may be difficult to establish whether functional impairment or use of opioids in amounts larger than prescribed are the result of undertreated pain or represent symptoms of opioid use disorder171, 294. Universal interventions target an entire population (e.g., an age range or a community); for example, all students in a school may be trained to improve impulse control and self‐regulation. Selective preventive interventions target sub‐populations at increased risk of SUDs, such as those with high‐risk personality traits or living in low‐resource communities. Indicated prevention, also known as early intervention, targets individuals with early signs or symptoms of substance use problems but who do not yet meet full criteria for a SUD.

Health Care Providers

Although opioid overdose mortality was initially driven by heroin and prescription opioids, fentanyl overdoses have become progressively more important, due to their growing prevalence, difficulty of reversal, and overall lethality171. Treatment with naloxone – an opioid antagonist that can be administered intramuscularly, subcutaneously, intravenously or intranasally – is the most important short‐term intervention to reverse overdoses. In cases in which fentanyl is involved, higher doses or repeated administrations of naloxone may be necessary. The efficacy of naloxone in reversing overdoses might be reduced when the overdose is due to combination of opioids with other respiratory depressant drugs, such as alcohol, benzodiazepines or barbiturates. In this paper, we use the term “addiction” to correspond to moderate or severe SUDs as described in the DSM‐5.

For example, individuals can be diverted from the justice system at pre‐arrest and linked to clinical and social services, including harm reduction or case management. Individuals can also be referred to the treatment system through drug courts352. Individuals with SUDs are more likely than other people to come into contact with the justice system342. Well over half of people in state prisons and jails in the US have a SUD, and drug use – including injection drug use – is very prevalent in prisons.

In patients with opioid use disorder accustomed to high doses of heroin or fentanyl or who have been maintained on high doses of methadone, buprenorphine can precipitate acute withdrawal, as it is a partial mu opioid receptor agonist191. Treatment of such patients might be initiated with methadone and, after a slow taper of the dose, continued with buprenorphine. Buprenorphine is less likely than methadone to depress respiration, but it can still be lethal, particularly if it is combined with other central nervous system depressants.

• Implicit in this type of model is the integration of substance use services with services for other mental disorders as well as primary care.
• In general, pharmacotherapies should be reserved for adolescents with moderate or severe SUDs who have not responded to psychosocial treatments.
• According to the United Nations Standard Minimum Rules for Non‐Custodial Measures354, imprisonment should always be the last resort.
• Over time, substance abuse can lead to changes in brain function, making it harder to stop without professional help.

Complications & Consequences

We are not aware of any controlled trials of medications for alcohol use disorder in pregnant women. Chronic pain is significantly more prevalent among people with SUDs than in the general population, and this is a factor that can contribute to drug‐taking292, 293. Managing patients with co‐occurring chronic pain and SUD – particularly opioid use disorder – presents unique challenges294, 295, including sometimes lack of trust between patients and clinicians regarding symptoms of pain and patterns of opioid use. Patients may fear that clinicians are unwilling to continue prescribing opioids or are going to reduce the amount prescribed. Clinicians may be concerned that patients deny or minimize aberrant patterns of opioid use or other symptoms of opioid use disorder, or that they may obtain medication through doctor shopping or from the illicit market.

International Standards for the Treatment of Drug Use Disorders

Another consideration when selecting a medication for opioid use disorder is whether there are any co‐occurring disorders. For example, naltrexone is also effective in treating alcohol use disorder129, whereas buprenorphine’s kappa opioid receptor antagonist properties may offer benefits for individuals with comorbid depression. Methadone or buprenorphine are recommended for pregnant women, as there are insufficient data on naltrexone’s safety in this population. For patients with a history of cardiac arrhythmias, methadone might be contraindicated, due to its QT‐prolongation effects, which do not occur with buprenorphine or naltrexone.

Drug checking, including through use of fentanyl test strips, allows people to test whether a drug they are planning to consume contains fentanyl or some of the common fentanyl analogues266. Twelve‐step mutual aid groups, such as Alcoholics Anonymous and Narcotics Anonymous, can help promote abstinence on their own or as part of a more comprehensive plan243, 244. Mechanisms underpinning the efficacy of these programs245 include peer support, role modeling of successful recovery, and sponsors’ mentoring and oversight. The sense of belonging to a community of peers appears to help diminish shame, loneliness and guilt, while exposure to successes of others can inspire and instill hope.

Some protocols for faster supervised medical withdrawal (formerly known as detoxification) have been developed, but further research is needed before they can be adopted in routine clinical practice. The prevalence of SUDs is high and varies across countries and the type of drugs used (highest for tobacco and alcohol use disorders) as well as by demographic and socioeconomic characteristics of the populations. The rates of SUDs are higher for males than females and higher for younger people, with rates decreasing as both men and women age1. For most of history, persons suffering from a substance use disorder (SUD) have been viewed as individuals with a character flaw or a moral deficiency, and stigmatized with labels such as “addict” or worse. Advances in neuroscience have expanded our understanding of the brain changes responsible for this condition and have provided the basis for recognizing SUD as a progressive, chronic, relapsing disorder that is amenable to treatment and recovery. If you’re not ready to approach a health care provider or mental health professional, help lines or hotlines may be a good place to learn about treatment.

Drug use can have significant and damaging short-term and long-term effects. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes, among others, heroin, morphine, codeine, methadone, fentanyl drug addiction substance use disorder diagnosis and treatment and oxycodone. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.