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Treatment

Seeking Substance Abuse Treatment:  Know What to Ask

Substance abuse treatment is intended to help addicted individuals stop compulsive alcohol/drug seeking and use. Treatment can occur in a variety of settings, take many different forms and last for different lengths of time. Because alcohol or drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient. For many, treatment is a long-term process that involves multiple interventions and regular monitoring.

There are a variety of evidence-based approaches to treating addiction.  Treatment can include behavioral therapy (such as cognitive-behavioral therapy or contingency management), medication-assisted therapy (pharmacotherapies) or a combination. There are also specific substance abuse treatment approaches for adolescents including behavioral approaches, family-based approaches, and addiction medications. The specific type of treatment or combination of treatments will vary depending on the patient’s individual needs, age, and often, on the types of substances they use. In the case of adolescents, an additional consideration may be an approach that is best suited to the adolescent and his or her family. For additional information on approaches to treatment, please see http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment

The goal of drug abuse treatment is to stop drug use and allow people to lead active lives in the family, workplace and community. One continual challenge, however, is keeping patients in treatment long enough for them to achieve this goal.

That is why finding the right treatment for a person’s specific needs is critical. Drug abuse treatment is not “one size fits all.” Treatment outcomes depend on the:

  • extent and nature of the person’s problems;
  • appropriateness of treatment;
  • availability of additional services; and
  • quality of interaction between the person and his or her treatment providers.

Family and friends can play important roles in motivating people with drug problems to enter and remain in treatment. However, trying to identify the right treatment programs for a loved one can be a difficult process.

There are a few basic questions that can be used to narrow your search as you start the process of looking for a treatment program:

  1. Does the program take insurance? If yes, what kind and are there any limitations? Is there a sliding fee scale? Are there payment options?
  2. Does the program have particular population restrictions? (i.e., age, gender, co-occurring disorder, families only, children only, adults only, etc.)
  3. Is the program residential or outpatient or both?
  4. What is the location of the program? Are there multiple locations?
  5. Does the program focus on particular substances? If yes, what substances are addressed?
  6. Is the program licensed by any accrediting body? If yes, what type of license is held? 

Once you have narrowed your search, the next series of questions created by the National Institute on Drug Abuse (NIDA) can be used to help you select a treatment program. https://www.drugabuse.gov/

1. What kind of treatment does the program or provider offer and do they use treatments backed by scientific evidence?

Effective substance abuse treatments can include behavioral therapy, medications, or, ideally, their combination. It is important to gauge if the facility provides all the currently available methods or relies on one approach. You may want to learn if the program or provider offers medication and if mental health issues are addressed together with addiction treatment. Behavioral therapies vary in focus and may involve:

  • addressing a patient’s motivation to change;
  • providing incentives to stop taking drugs;
  • building skills to resist drug use;
  • replacing drug-using activities with constructive and rewarding activities;
  • improving problem-solving skills; and
  • building better personal relationships. 

Examples of Behavioral Therapies

  • Cognitive Behavioral Therapy. Seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
  • Motivational Incentives. Uses positive reinforcement such as providing rewards or privileges for remaining drug free, for participating in counseling sessions, or for taking treatment medications as prescribed.
  • Motivational Interviewing. Uses strategies to encourage rapid and self-driven behavior change to stop drug use and help a patient enter treatment.
  • Group Therapy. Helps patients face their drug abuse realistically, come to terms with its harmful consequences, and boost their motivation to stay drug free. Patients learn how to resolve their emotional and personal problems without abusing drugs. 

Medications are an important part of treatment for many patients, especially when combined with counseling and other behavioral therapies. Different types of medications may be useful at different stages of treatment: to stop drug abuse, to stay in treatment, and to avoid relapse. Medical detoxification is a necessary first step in the treatment of certain addictions, but by itself does little to change long-term drug use. Currently, medications are available to treat opioid, tobacco, and alcohol addictions:

  • Methadone, buprenorphine, and naltrexone are used to treat people addicted to opiates (e.g., heroin, prescription pain relievers);
  • Nicotine patches, gum, lozenges, nasal spray, and the medications varenicline (Chantix) and bupropion (Wellbutrin) are used to treat tobacco addiction; and
  • Disulfiram, acamprosate (Campral), naltrexone, and topiramate (Topamax) are used for treating alcohol dependence.

2. Does the program tailor treatment to the needs of each patient?

No single treatment is right for everyone. The best treatment addresses a person’s various needs, not just his or her substance abuse. Matching treatment settings, programs, and services to a person’s unique problems and level of need is key to his or her ultimate success in returning to a productive life. It is important for the treatment approach to be broad in scope, taking into account a person’s age, gender, ethnicity, and culture. The severity of addiction and previous efforts to stop using drugs can also influence a treatment approach. It is also important to ask what is expected of the patient. You will want to understand what will be asked of you in order to decide what treatment best suits your needs. The best programs provide a combination of therapies and other services to meet a patient’s needs. In addition to substance abuse treatment, a patient may require other medical services, family therapy, parenting support, job training, and social and legal services.

Finally, because addictive disorders and other mental disorders often occur together, a person with one of these conditions should be assessed for the other. And when these problems co-occur, treatment should address both (or all conditions), including use of medications, as appropriate.

3. Does the program adapt treatment as an individual’s needs change?

Individual treatment and service plans must be assessed and modified as needed to meet changing needs. A person in treatment may require varying combinations of services during its course, including ongoing assessment. For instance, the program should build in drug monitoring so the treatment plan can be adjusted if relapse occurs. For most people, a continuing care approach provides the best results, with treatment level adapted to a person’s changing needs. 

An individual’s needs for support services, such as day care or transportation, should also be met during treatment.

4. Is the duration of treatment sufficient?

Remaining in treatment for the right period of time is critical. Appropriate time in treatment depends on the type and degree of a person’s problems and needs. Research tells us that most addicted people need at least three months in treatment to really reduce or stop their substance abuse and that longer treatment times result in better outcomes. The best programs will measure progress and suggest plans for maintaining recovery. Recovery from alcohol or drug addiction is a long-term process that often requires several episodes of treatment and ongoing support from family or community. You may also want to ask how and if treatment success is measured.

5. How does the program or provider handle relapse?

Relapse is common and you will want to know how it is addressed. Relapse Does Not Mean Treatment Failure. The chronic nature of addiction means that relapsing to substance abuse is not only possible, but likely, similar to what happens with other chronic medical illnesses—such as diabetes, hypertension, and asthma—that have both physical and behavioral components. And like these illnesses, addiction also requires continual evaluation and treatment modification if necessary. A relapse to substance use indicates a need to re-instate or adjust treatment strategy; it does not mean treatment has failed.

6. How do 12-step or similar recovery programs fit into drug addiction treatment?

Self-help groups can complement and extend the effects of professional treatment. The most well-known programs are Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model. This group therapy model draws on the social support offered by peer discussion to help promote and sustain drug-free lifestyles.

Most alcohol and drug addiction treatment programs encourage patients to participate in group therapy during and after formal treatment. These groups offer an added layer of community-level social support to help people in recovery with abstinence and other healthy lifestyle goals.

Information Provided by:
National Institute on Drug Abuse. Seeking Drug Abuse Treatment:  Know What to Ask.
NIH Publication No. 13-7764. Printed November 2011. Revised June 2013. https://www.drugabuse.gov/sites/default/files/treatmentbrochure_web.pdf

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