Interventions That Can Lead To The Best Recovery Rates

Recovery from a substance use disorder can take many different forms. There are several evidence-based pathways to recovery, each with its own strengths and weaknesses. Ultimately, the effectiveness of any intervention comes down to the individual. Every person’s path to recovery will have advances and setbacks, and trying more than one approach might be necessary. Below are some interesting facts on recovery rates for folks challenged by substance use, as well as an overview of common intervention methods. 

Why is treatment necessary for so many people with substance use disorders?

Drug and alcohol addiction isn’t a simple behavioral problem. People who struggle to avoid consuming certain substances are managing more than a simple craving. Many people think of cravings as benign urges that can be overcome with simple willpower, such as telling yourself not to have a second donut if you’re watching calories. However, cravings become much more substantial and intense when driven by an addictive substance. 

Much like some other chronic diseases, substance use causes changes in the structure of the brain and disrupts the brain’s reward system. In effect, the brain is “reprogrammed” to prioritize the consumption of a certain substance. In some cases, such as opioid use disorder, the body might become neurochemically dependent on the substance. Suddenly stopping opioid use could result in serious withdrawal effects, including death. Because of the significant physiological changes that occur in addiction, it can often be difficult or impossible to overcome a substance use problem without support. 

Ongoing substance use concerns can lead to adverse effects on mental and physical health. For example, a person with alcohol use disorder  - one of the most commonly used addictive substances - might experience liver problems, digestive problems, increased blood pressure, cardiovascular disease, and increased mental health concerns. Someone with an alcohol addiction who becomes pregnant is at a higher risk of introducing adverse effects, such as fetal alcohol spectrum disorders.

The Recovery Research Institute, an organization that collects and analyzes data regarding the effectiveness of addiction treatment, indicates that recovery from substance use is possible, but it is often much easier with adequate support. Evidence suggests that the brain may be able to completely or partially reverse the damage caused by prolonged substance use, eventually returning to baseline levels. However, for that healing to occur, a person generally needs to reach a point of total abstinence from the substance of concern.

What interventions are known to be effective?

In 1935, the first meetings of what would eventually become Alcoholics Anonymous (AA) took place. At the time, substance use was seen as a behavioral concern caused chiefly by a lack of willpower, but some were starting to acknowledge that alcohol and drug abuse were a disorder of the mind, emotions, and body. AA still operates today, along with Narcotics Anonymous (NA), a similar program that focuses on drugs other than alcohol. 

NA and AA are both 12-step programs, which used to be heavily focused on the spiritual element of substance abuse but have become more focused on peer support in recent years. AA, NA, and other peer support groups are considered helpful and effective for treating addiction, although other resources and treatment methods may also be helpful to support recovery. 12-step programs will likely continue to evolve and incorporate evidence-based methods into their approach. Some other common interventions that are known to be effective are summarized below: 

Cognitive behavioral therapy (CBT)

CBT works by helping a patient to realign their thoughts, feelings, and behaviors. Decades of psychological research have demonstrated that changes in one domain promote changes in another. For example, a person dealing with challenging emotions would work on changing their thoughts and behaviors to improve their mood, or they might leverage positive feelings to adjust their behavior. CBT has a demonstrated history of treating many substance use concerns, including alcohol treatment. A person trying to lower their alcohol consumption might undergo CBT to identify what prompts their alcohol cravings and learn to avoid or adjust factors in their life that promote alcohol consumption.

Contingency management (CM)

CM is a behavioral approach that directly reinforces abstinence from substances with material rewards. A person might receive prizes, cash incentives, or vital resources if they remain sober. CM is common in drug rehab facilities, offering a framework to encourage desired behaviors and continued participation. The major benefit of CM is likely its potential to help mitigate treatment dropout, one of the most significant concerns when a person first begins to reduce their substance use. 

While CM can help directly motivate a person to reduce their substance intake, the literature supporting its effectiveness is mixed. Detailed CM interventions applied with high fidelity are likely more effective than more informal or inconsistent programs. The most effective CM interventions tend to be designed by mental health professionals who are highly educated in behaviorism and behavioral modification. 

Dialectical behavior therapy (DBT)

DBT was originally developed in the 1970s and 80s to help those diagnosed with borderline personality disorder (BPD). BPD is characterized by unstable interpersonal relationships, compulsive behaviors, and excessive emotional reactions. DBT was originally designed to help those with BPD develop distress-tolerance skills and increase their emotional regulation. Research into adapting DBT for use with substance use concerns began after clinicians noted a substantial decrease in substance use problems in those whose BPD was being treated by DBT. 

Traditional DBT consists of four modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. Evidence suggests that working to improve those domains in someone with a substance use problem substantially lowers their consumption and may also be effective at lowering other impulsive behaviors, like gambling or risky sexual encounters. DBT traditionally has both individual therapy and group therapy components, but modern adaptations may modify the structure considerably. 

Eye movement desensitization and reprocessing (EMDR)

EMDR is a relatively new technique that has shown substantial promise in treating those with post-traumatic stress disorder (PTSD). PTSD and substance use problems often appear together, and many people who develop substance use concerns have significant trauma histories. EMDR leverages a dual attention stimulant, typically eye movement. During therapy, a qualified professional has their patient track and follow an object with their eyes. While the patient tracks the object, the therapist works with them to address the source of their PTSD. 

The exact mechanism that makes EMDR work is still being investigated. Evidence suggests that EMDR is a highly effective treatment for trauma disorders, and early investigations into its treatment of substance use concerns have demonstrated that it is likely a viable treatment. Much of the current research focuses on recovery statistics of those with comorbid substance use and trauma disorders, but investigations into those with only substance use problems are ongoing.  

Seeking individual support

The most effective substance treatment methods likely take a combined approach to recovery. Elements like individual therapy, group therapy, peer support, inpatient rehabilitation, or medication might all be appropriate depending on a person’s individual circumstances. While substance use treatment can involve many elements, it doesn’t need to start that way. If a person is challenged by substance use concerns, they might consider starting a path to recovery by simply reaching out to a mental health professional. 

One of the lowest barriers to entry is likely online therapy. A person can visit with an online therapist from their home without traveling to a clinic or medical facility. Online therapists have the same training and credentials as in-person therapists and are well-qualified to help someone start their recovery journey. While a person may need to consult with other professionals as they recover, an online therapist can use empirically-supported techniques to support their recovery process, such as cognitive behavioral therapy, a proven substance use intervention.