Treatment for substance use disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.

What works?

  • Adolescent drug use and disruptive behaviour are effectively reduced with family-based treatments. Behavioural therapies can also help, namely with cognitive behavioural therapies, both individual and in groups, as well as integrated models combining different approaches
  • Continuing care, i.e. interventions following the initial period of more intensive care aimed at managing and sustaining recovery can help to improve treatment outcomes, irrespective of the duration and intensity of the programme
  • Internet-based interventions (usually unguided stand-alone internet interventions and internet interventions as an add-on to regular treatment) may help to reduce substance use (mainly opioids) in some target groups

What's unclear?

  • It is not clear if residential interventions can improve treatment outcomes
  • It is not clear if motivational interviewing can reduce illicit drug use in adolescents
  • Emergency department-based brief interventions showed promising effects in reducing use (mainly alcohol) and related harms, but a definitive statement about ‘what works’ cannot be made at this stage
  • It is not clear if culturally sensitive treatment interventions for racial/ethnic minority youth help in reducing drug use
  • Internet-based interventions seem not to have an effect in reducing stimulant use

What doesn't work?

  • Compulsory drug treatment does not seem to improve treatment outcomes (drug use and criminal recidivism), with some studies suggesting potential harms

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