April 18, 2025

Treatments for SUD have varying levels of intensity depending on the severity of disease. Ultimately, there is no “right way” to treat an SUD. Often, a combination of several treatment pathways is necessary. As the level of intensity of treatment increases, the setting of care—along with clinical resources and cost—will likely advance as well.

The SUD treatments listed below are grouped according to settings of care where they can be delivered with the fewest clinical resources. Generally, treatments that can be delivered in the home or community setting can also be done in outpatient or residential centers.

Pharmaceutical Treatments

For many people with SUD, medication-assisted therapy (MAT), provided concurrently with behavioral health interventions, can be beneficial.¹ For opioid use disorder, extended-release of naltrexone, buprenorphine and methadone can help individuals in acute detox situations wean themselves from prescription opioids or heroin. MAT is also used for active ongoing treatment to help patients with SUD live a functional life. For alcohol use disorder, naltrexone and acamprosate are effective for many people as a way to prevent a return to drinking. Many MATs can be taken at home.

MAT is often associated with methadone clinics, which are highly stigmatized and associated with criminality.² Methadone, along with other MAT options, are evidence-based and beneficial for a significant number of SUD patients. Unfortunately, this stigma has led to under-prescribing and a dearth of providers in many areas.

Community and Home Care

Providing treatment in the community (e.g., YMCA, church, etc.) or the home can be beneficial because it gives patients and providers the ability to address some of the environmental risk factors that facilitate substance use, like peers or family members who may also have SUD. Inpatient treatment is necessary for some people, but there is a risk: removing people from the normal context of their lives to recover, followed by putting them right back in that situation after discharge, may lead to a relapse. Community and in-home care eliminate this concern.

SUD treatment for lower acuity patients can be delivered in the home by visiting nurses and/or virtually. Treatment can include in-home drug testing, MAT injection, counseling and other services. In-home care may be more convenient depending on how far someone lives from the nearest providers, or less stigmatizing for people uncomfortable with seeking treatment in a medical facility. Care in the home should be coordinated with a patient’s behavioral health and primary care providers.

Individual and group counseling is the most common treatment for SUD. It can be delivered in community settings, the home or outpatient treatment facilities. Counseling focuses on skill-building to reinforce positive behaviors, cognitive behavioral therapy (CBT) and motivational enhancement. Evidence suggests that 12-step programs and other peer support groups like Alcoholics Anonymous offered in the community improve rates of sobriety by just as much, if not more, than many clinical interventions.³

Outpatient Treatment Centers

Outpatient treatment centers provide many of the same treatments as those listed above but are often used for intensive care at the beginning of a patient’s SUD treatment. This may involve several treatment sessions a week before a patient is prepared to move toward community and home care.

Residential Treatment Facilities

Residential treatment facilities are reserved for patients with the greatest risk for serious adverse events (e.g., overdose) and those in need of 24-hour supervision. Patients may commit themselves to several days or weeks of treatment during which they are monitored, receive intensive therapy, and are often helped through withdrawal symptoms that can be intense and dangerous.

Unfortunately, not all residential treatment facilities adhere to evidence-based treatment, and some have unethical or even fraudulent practices.⁴ For example, some facilities advertise spa-like treatment facilities to encourage patients and their families to travel for this type of treatment. There are some providers who offer to waive a patient’s cost sharing while charging the plan significant sums of money for treatment not coordinated with the patient’s health care providers in their home community.⁵ This ends up costing large sums of money and usually leads to readmission. Other facilities that own their own labs have been flagged for running unnecessary urine and blood tests on their SUD patients; health plan precertification should catch unnecessary or excessive testing, but implementation is inconsistent. These practices underscore the importance of helping patients who need residential treatment find high-quality centers.

Virtual Care Services

Virtual care can extend the reach of existing SUD providers, as well as provide supports for people at home to manage their SUD outside of clinical settings. Approximately 57% of SUD treatment organizations used virtual care for screening and assessment services in 2022, a decrease from the 73% usage during the height of the pandemic in 2020.⁶ However, despite this decline, the persistent utilization rates confirm telehealth's role as a cornerstone in the continuity of care for individuals with SUD.

Several virtual health vendors offering treatment for SUD contract directly with employers, and in others they are made available to employees and their families through their employee assistance program (EAP) or health plans. SUD-tailored programs often use technology that allows them to stay in touch with patients between visits (e.g., text or chat) and create additional levels of accountability through at-home sobriety testing linked to an app.

Related Resources

• Overcoming the Addiction Crisis
• Value-based Primary Care
• Value-based Virtual Care

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