Substance Use Disorder Services

Assessment for Substance Use Disorders

Programs that conduct an evaluation to determine whether an individual has a substance use disorder based on a pathological set of behaviors related to use of that substance as well as the nature and extent of the problem. Diagnostic criteria include inability to control or limit the amount taken or the frequency; intense cravings; continuing use despite problems with work, school or family/social obligations or interpersonal problems; risky use, e.g., diving a car or operating machinery while under the influence; or evidence of pharmacological indicators (tolerance and withdrawal symptoms), the adjustment the body makes as it attempts to adapt to the continued and frequent use of a substance.

Comprehensive Outpatient Substance Use Disorder Treatment

Supervised, structured programs that offer a wide range of outpatient services which may be coordinated by a case manager and may include individual and group counseling, 12-step meetings, social and recreational activities, educational and vocational services, life skills training, primary health care, perinatal health care, a program for family members, relapse prevention services, a continuing care program and supportive services (such as child care, transportation and parenting skills development) for individuals who have problems related to excessive use of alcohol and/or use of other drugs and need access to treatment to maintain their individual recovery plans but do not require the intensity of a day treatment program or 24-hour hospital care. Participants attend the program on a regularly scheduled basis at least once a month but usually more frequently depending on their individual needs. Intensive outpatient programs are usually available three or four days per week for three or four hours per day.

Detoxification

Programs that provide assistance and support for individuals who are physically dependent on substances of any kind during the withdrawal period. Detoxification is a medical regimen aimed at managing acute intoxication and withdrawal by systematically reducing the amount of the addictive substance in a patient’s body, providing reasonable control of active withdrawal symptoms and/or averting a life-threatening medical crisis related to the substance. Detoxification in generally conducted under the supervision of a physician, can take place in a wide variety of settings and at a number of levels of intensity within these settings and has three stages: evaluation, stabilization and fostering patient readiness for and entry into treatment.

DUI Offender Programs

Programs that provide mandated educational, treatment and/or other services for individuals who have been convicted of driving under the influence of alcohol or other drugs including prescription drugs and ordered by the court to seek assistance as part of state efforts to enforce DUI laws. Some DUI offender programs also include families.

Inpatient Substance Use Disorder Treatment Facilities

Health care facilities that provide structured treatment programs and support services in the context of a 24-hour, supervised environment for individuals who have problems related to excessive use of alcohol and/or use of other drugs. Included are hospitals that are totally devoted to treatment for substance use disorders and programs within general inpatient health care facilities.

Medication Assisted Maintenance Treatment for Substance Use Disorders

Programs that provide treatment which includes approved medication (e.g., methadone, buprenorphine, naltrexone, antabuse) to support the efforts of individuals with an opioid or alcohol use disorder to abstain from or reduce their use of opioids (usually heroin or painkillers such as oxycontin or morphine) or alcohol. The extended-release, injectable form of naltrexone (Vivitrol) may also be used. The objective of maintenance is to gradually reduce the amount of the substitute drug that is required in order to reduce and, if possible, eventually eliminate dependency altogether. Medication assisted maintenance treatment (MAT) may be provided in an outpatient treatment program (OTP) or OTP unit such as a pharmacy or physician's office, or for buprenorphine products (Bunavail, Suboxone, Subutex, Zubslov), a physician's office or other health care setting. Methadone maintenance treatment is provided in a clinic. It is recommended that medication assisted maintenance treatment be provided in combination with counseling and behavioral therapies.

Perinatal Substance Use Disorder Treatment

Programs that provide comprehensive treatment services on a residential, outpatient or day treatment basis for pregnant women who have a substance use disorder, women who are parenting children, generally age three or younger, and/or women who have babies who were exposed to drugs and/or alcohol during pregnancy. Services may include individual and group counseling, 12-step meetings, social and recreational activities, educational and vocational services, life skills training, primary health care, perinatal health care, HIV testing and counseling, AIDS prevention, a program for family members, relapse prevention services, a continuing care program and a wide array of supportive services such as child care, transportation and parenting skills development. The objective of the program is to help these women restructure their lives so that they can handle their parenting responsibilities as well as remain alcohol and/or drug free.

Residential Substance Use Disorder Treatment Facilities

Community based residential facilities that provide treatment services in the context of a 24-hour, supervised drug and alcohol-free environment for people who have problems related to excessive use of alcohol and/or use of other drugs

Smoking/Vaping Cessation

Programs that utilize one or a variety of techniques including aversion therapy, hypnosis, acupuncture, acupressure, and individual and/or group therapy or mutual support groups to help people who wish to control their dependence on nicotine and give up regular cigarettes, e-cigarettes (vaping), cigars, pipe tobacco, chewing tobacco, snuff or other substances containing nicotine. Included are smoking "quitlines" which provide information and counseling about tobacco use for people who prefer a telephone-based service. While some people tout e-cigarettes as a way to give up smoking regular cigarettes, mounting evidence shows that teens and young adults who use e-cigarettes are far more likely to end up smoking traditional cigarettes one year later.

Substance Use Disorder Counseling

Programs that provide individual, group or family therapy for individuals who have problems related to the excessive use of alcohol and/or use of other drugs (and/or for their families) to help them better understand the nature of the disorder and support recovery efforts.

Substance Use Disorder Referrals

Programs that link people who are in need of drug and/or alcohol use disorder services with appropriate resources.

Substance Use Disorder Treatment Expense Assistance

Programs that provide subsidies which support all or a portion of the treatment costs for income eligible individuals who have or are at risk of an alcohol and/or other drug use disorder.

Adult Children of Alcoholics Support Groups

Mutual support groups whose members are adults who were reared by or had contact in their formative years with a parent or parent figure who had an alcohol use disorder and, as a result, have internalized both the excessive alcohol consumption and codependency patterns of coping which may interfere with positive adjustment in adult life. The groups meet in-person, by telephone or via the Internet, and allow participants to share their experience, strengths and hopes to solve the problems they have in common.

Codependents Support Groups

Mutual support groups whose members are people who have been in relationships, as children and as adults, with individuals who are involved in addictive, compulsive or other dysfunctional behavior with regard to any of a wide variety of problems including gambling, overspending, sex/love, relationships and overeating. The groups meet in-person, by telephone or via the Internet, and allow participants to share their experience, strengths and hopes to solve the problems they have in common, and to support the recovery of their loved one.

Families/Friends of Individuals With a Drug Use Disorder Support Groups

Mutual support groups whose members are the spouses/partners of people who have or are at risk of a drug use disorder; children of all ages whose parents, guardians or other parent figures are involved in drug use; and/or friends of those individuals. The groups meet in-person, by telephone or via the Internet; and allow participants to share their experience, strengths and hopes to solve the problems they have in common and support the recovery of their loved one.

Families/Friends of Individuals With an Alcohol Use Disorder Support Groups

Mutual support groups whose members are the spouses/partners of people who have or are at risk of an alcohol use disorder; children of all ages whose parents, guardians or other parent figures are involved in excessive alcohol use; and/or friends of those individuals. The groups meet in-person, by telephone or via the Internet; and allow participants to share their experience, strengths and hopes to solve the problems they have in common and support the recovery of their loved one.

General Addictions/Substance Use Disorder Support Groups

Mutual support groups whose members are people who have any type of behavioral addiction or a substance use disorder involving alcohol or other drugs. The groups meet in-person, by telephone or via the Internet; provide emotional support, information and resources to help those who participate modify their behavior; and may include faith-based and secular 12-step groups as well as non-12 step groups.

Substance Use Disorder Education/Prevention

Programs that provide information about substance use disorders (including the substances most commonly used and their effects, the diagnostic criteria for substance use disorders, screening and diagnostic procedures and methods of treatment) and/or which offer any of a variety of services that focus on substance use prevention for people of all ages who are at risk. Included may be printed materials or videos that address the subject; psycho-educational and skill building activities; structured groups which focus on family dynamics, problem-solving, self-esteem and similar issues; and presentations in schools and agencies and to family groups regarding the dangers of alcohol and drug use and smoking, the signs of substance use disorders, the legal consequences of illegal substance use and how to get help.

Gambling Addiction Helplines

Programs that provide immediate assistance for people who are concerned about their own gambling or the gambling of a friend or family member which may include short-term emotional support, an opportunity to ask questions and discuss alternatives and referrals to confidential treatment services. Helpline staff are generally available via telephone, email, chat and/or text.

General Crisis Intervention Hotlines

Programs that provide immediate assistance for people who are emotionally distressed with the objective of defusing the crisis, ensuring the person's safety and helping the person to take the next immediate steps toward resolving the problem. General crisis intervention hotlines are available to anyone who is experiencing a crisis rather than focusing on people with particular types of problems such as domestic violence, mental health or child abuse. Hotline staff are often trained volunteers who are available via telephone, email, chat and/or text.

Substance Use Disorder Hotlines

Programs that provide immediate assistance for people who have problems related to excessive use of alcohol and/or use of other drugs or are at risk of a substance use related disorder. Services may include defusing the crisis, ensuring the person's safety and information about alternatives the person may explore to begin recovering. Substance use related hotlines are also typically available to significant others of people who are involved with drugs and/or excessive alcohol use. Hotline staff can generally be reached via the telephone, email, live chat, texting and/or instant message (IM).

Talklines/Warmlines

Programs that offer a telephone service that enables people who are troubled to talk confidentially about their personal problems with an empathetic listener. These programs are often staffed by volunteers who can offer referrals for ongoing treatment, if needed.

Case/Care Management

Programs that develop plans for the evaluation, treatment and/or care of individuals who, because of age, illness, disability or other difficulties, need assistance in planning and arranging for services; which assess the individual's needs; coordinate the delivery of needed services; ensure that services are obtained in accordance with the case plan; and follow up and monitor progress to ensure that services are having a beneficial impact on the individual. Case management is a collaborative process characterized by communication, advocacy and resource management to promote high quality, cost-effective interventions and outcomes.

Recovery Homes/Halfway Houses

Community-based, peer-group-oriented, residential facilities that provide food, shelter and recovery services in a supportive, non-drinking, drug-free environment for people who have completed a hospital or residential substance use disorder rehabilitation program and need continued support in a residential setting to sustain their recovery. Services may include case management, relapse prevention counseling, 12-step meetings, educational and vocational planning, recreational activities and assistance in obtaining health, social, vocational and other services available in the community. Residents are expected to abide by house rules which vary from facility to facility. The objective is to help people who are recovering from an alcohol and/or other drug use disorder bridge the gap between intensive treatment and independent sober living.

Sober Living Homes

Alcohol and other drug-free residences (which may be single family dwellings, duplexes, multiplex apartment buildings or communal residential facilities) for people who are recovering from an alcohol and/or other drug use disorder and need a sober environment in order to sustain an abstinent lifestyle. Residents are free to organize and participate in support group meetings or any other activity that helps them maintain sobriety, but neither the homes nor the residents provide treatment, recovery, detoxification services or other supportive services; and supervision of individual recovery is not provided. Because they provide no services, sober living homes do not require a license but are generally subject to landlord/tenant laws.

Alcohol Use Disorder Support Groups

Mutual support groups whose members are individuals who have or are at risk of an alcohol use disorder. The groups meet in-person, by telephone or via the Internet; provide emotional support, information and resources to help participants overcome their disorder; and may include faith-based and secular 12-step groups as well as non-12 step groups, and groups for anesthetists, pharmacists, psychologists, physicians or other health care professionals who are recovering from an alcohol use disorder.

Drug Use Disorder Support Groups

Mutual support groups whose members are individuals who have a disorder involving the use of drugs including prescription drugs and over-the-counter medication. The groups meet in-person, by telephone or via the Internet; provide emotional support, information and resources to help participants overcome their disorder; and may include faith-based and secular 12-step groups as well as non-12 step groups, and groups for anesthetists, pharmacists, psychologists, physicians or other health care professionals who are recovering from a drug use disorder.

Gambling Addiction Support Groups

Mutual support groups whose members are people who are having difficulty controlling their compulsion to gamble. Families and friends may also be welcome. The groups meet in-person, by telephone or via the Internet; provide emotional support, information and resources to help participants come to terms with their addiction; and may include faith-based and secular 12-step groups as well as non-12 step groups.

Peer Support Services

Mental health agencies, counseling centers and independent, peer-run organizations that offer, as a component of their programming, the services of peer support providers with lived experience who have been trained and certified to work with individuals who have struggles pertaining to mental health or psychological trauma. Peer support specialists work with individuals as they develop and implement a personal recovery plan, which can also serve as a contract for engagement, and function as a complement to traditional clinical care. Tasks may include assisting their peers in articulating their goals for recovery and learning and practicing new skills, helping them monitor their progress, supporting them in their treatment, modeling effective coping techniques and self help strategies based on their own recovery experience, and supporting them in advocating for themselves to obtain effective services. Peer support services are an evidence-based mental health model of care that is recognized by the Center for Medicare and Medicaid Services (CMS) as an important component in the delivery of effective treatment.