The first step in the treatment of a substance use disorder is to make an accurate diagnosis. To do this, the practitioner must conduct a thorough examination considering the symptoms and signs, the presence of tolerance and withdrawal, the person’s life experiences and personality, current medications (including those for non-psychiatric reasons), the medical history, the social history, the family history, and the stressors impacting that person’s life. The practitioner’s experience in treating substance use disorders is important so that the right questions are considered. If the person has not already been evaluated for medical complications of chronic substance use, laboratory testing is conducted to rule out common associated illnesses.
The second step is to relieve the severity and frequency of the manifestations of the substance use disorder. This is the reason that the person seeks treatment and is a prerequisite for restoring adequate social and occupational functioning. Substance use disorders are chronic illnesses so the practitioner should adopt a strategy optimizing long-term outcome rather than jumping to an approach that will only have short-term results. Medications may be necessary to treat withdrawal or to reduce craving. The practitioner’s experience in treating substance use disorders is valuable in determining which medications and techniques are likely to help different patients with different types of substance use disorders and which general medical illnesses or medications will have an added impact.
The next step is to address underlying basis of the substance use disorder. This is a complex and long-term process. It involves not only learning about the substance use disease but also addressing coping skill deficit and frustration intolerance. Treatment also involves addressing underlying psychiatric difficulties to minimize the chances of relapse. In addition to individual therapy, group therapy is a treatment modality that increases the individual’s chances of recovery.