The Long-Lived Maze of Substance Use Treatment

This article discusses substance use, mental disorders, and suicide. If you or someone you know is struggling with a substance use disorder, visit SAMHSA’s National Helpline Website or call 1-800-662-HELP (4357.) If you or someone you know is experiencing suicidal thoughts, or just need to talk to someone, call 988, text HOME to 741-741, or visit the 988 Suicide Lifeline Website. You can purchase Naloxone (Narcan) at CVS without a prescription, and the CDC provides online training for administration. I am glad you’re still here. Have a wonderful day.

This is the second installment in a two-part series on substance use disorders (SUDS.) This part is going to be focused on anti-drug laws and their history, tackling misconceptions and stigma, how stigmatization has been perpetuated by government initiatives and treatment programs, and general information on how to help treat SUDs. 

Much of the fault of failed programs can be traced back to misconceptions and fear mongering. With this stigma being perpetuated by initiatives such as the War on Drugs, medically unsafe treatment programs, and offering “one-size-fits-all” substance use disorder treatment, we are further harming a group of people who should be provided safe, personalized, and effective treatment. As we exit National Recovery Month, this article will deliberate stigmatization, programs, and recovery assistance.

History of Anti-Drug Laws

Substances such as marijuana, opium, and psychedelics have been — and are still widely used in many cultures — utilized for medicinal and spiritual purposes for millenia. As far as eight-thousand years back, hardened Sumerian clay tablets were found as the earliest list of opium prescriptions. Six-thousand years ago, psychedelics were first utilized as ancient antidotes and ceremonies. Marijuana had first originated as a healing plant in central Asia. Despite this, these substances, along with many others, have started facing scrutinization over the past two centuries, beginning with temperance and prohibition. With the average American over 15 years old consuming nearly seven gallons of pure alcohol a year, the temperance movement quickly began gaining traction in Protestant churches. Due to the movement being significantly sparked by women being affected by their husband’s alcoholism, in large part to having little rights, the Women’s Christian Temperance Union (WCTU), came to in tandem withwomen’s suffrage. This potential liberation and reduced reliance on their husbands to lead a meaningful life became a secondary goal of temperance. As they rallied for greater governmental influence, their lobbying resulted in Prohibition in 1919, making it illegal to produce, sell, or consume alcohol. Despite this, prohibition was an abject failure; through overregulation, underground bars, corruption, and confused oversight from government officials ensued. Consequently, prohibition had ended with the 21st Amendment in 1933.

Following this, anti-drug campaigns shifted their attention to narcotics, in light of heavy opium usage during the Civil War. Throughout the nineteenth century, narcotics use was largely unregulated, with states barely enforcing narcotics laws. Though Americans were initially less concerned about narcotics than they were about alcoholism, by the twentieth century, as many as 300,000 citizens were experimenting. Around the 1890s, anti-opium laws came into fruition, due in large part to the Chinese Exclusion Act, and the influx of Chinese immigrants bringing in opium. As well as this, opioid users were primarily middle-class women, with over sixty-percent of opium addicts being women. According to the New York Academy of Medicine (NYAM), “By 1900, use of narcotics was at its peak for both medical and non-medical purposes. Advertisements promoting opium- and cocaine-laden drugs saturated the newspapers; morphine seemed more easily obtainable than alcohol; and widespread sale of drugs and drug paraphernalia gained the attention of medical professionals and private citizens alike. State regulations failed to effectively curb distribution and use.” Eventually, medical personnel began taking addiction and alcoholism more seriously, arguing for the public recognition of a condition called “inebrity”, a condition which could require voluntary, or involuntary, institutionalization, as well as criminalization.

However, by this point, most Americans had not seen a need for criminalization,yet most government officials increasingly were. In 1908, Roosevelt appointed Hamilton Wright as the Opium Commissioner, with him claiming Americans had become “the greatest drug fiends in the world.” In 1909, The Smoking Opium Exclusion Act was passed, banning the possession, importation and use of smoking opium. Though opium was still allowed for medicinal purposes, opium was becoming increasingly illicit. In tandem, Wright began his campaign against opium, introducing a second bill in 1910, banning the non-medicinal use of opium and cannabis. In the end, the Harrison Act was passed in 1914, restricting the sale of narcotics. Less than forty years later, the remarkably stricter Boggs Act was passed, with officials claiming the real threat was not the communist party, but “communist opium.” Shortly after these restrictions, the government switched their focus to cannabis. 

Cannabis and cocaine restrictions had significant racial motivations. Drugs had begun recirculating into global trade in light of the recession that plagued the 1930s, yet many were not satisfied with the perceived recreational drug use they observed. With reformers seeking punishment for immigrants and black farmers, sociologist Carl Reinaman states that, “In order to gain the support of Southern Congressmen for a new federal law that might infringe on ‘states’ rights,’ State Department officials and other crusaders repeatedly spread unsubstantiated suspicions.” As well as this, Latin immigrants were rushing the job market, with many handling marijuana. From this, anti-Black rhetoric consolidated with anti-Mexican sentiments, making a perfect storm for officials and the public to rally against cannabis. Despite many officials understanding that many of the claims were unsubstantiated, including the claim that marijuana could be addictive, they pushed for increasing criminalization, leading to marijuana being classified as a Schedule I drug. As twenty-nine states had banned marijuana by 1931, the “Marihuana Tax Act” was passed six years later, introduced by Rep. Robert L. Doughton of North Carolina. This act imposed hefty taxes on those who broke the rules. 

Race and the War on Drugs

By the 1960s, substances had become synonymous with rebellion, in light of the anti-drug laws. In the midst of political dissent, Nixon swiftly began the global “War on Drugs” in 1971, ballooning the amount of federal drug agencies to an unprecedented amount, additionally calling for mandatory prison sentences. In an address to Congress, Nixon states, “If we cannot destroy the drug menace in America, then it will surely in time destroy us. I am not prepared to accept this alternative.” In 1972, despite advisors agreeing that substances such as marijuana should be decriminalized, Nixon was adamant on keeping marijuana a Schedule I drug. At this point, states were in a push-and-pull battle between decriminalizing marijuana and increasing concerns from parents. With Raegan assuming office, the war on drugs only expanded. Reagan ushered in the era of severe penalties imposed on substance users, with mass incarceration hitting Americans at a rate higher than any other country. In 1981, Ronald’s wife, Nancy Raegan, launched the infamous“Just Say No” campaign. As the War went on, we begin to see the cracks forming in the “zero-tolerance” policy.

Among many criticisms, many analysts criticize that the genesis of the War on Drugs was spurred with racial motivations. Indeed, the War on Drugs invariably hit African-Amerian and Latin communities disproportionately. As well as this, previous substance control initiatives had a racial component, at least to some extent. According to the ACLU, black people make up 35% of those arrested for drug possession, 55% of those convicted, and 74% of those imprisoned, despite being 13.6% of the population. The racial component of the War on Drugs can even be observed by the amount of arrests for substances.  In 2020, despite increasing legality, an estimated 350, 150 arrests were made for marijuana-related offenses, with Black people being 3.6 times more likely to be arrested than white people. As well as this, a cumulative 247, 655 Americans were arrested for heroin and cocaine, substances typically associated with white communities. Moreover, despite there being mostly white users, black people are inconceivably linked with crack cocaine. These simple possession arrests can lead to sentences from two years to decades. 

Minorities as a whole are unjustly linked to a myriad of crimes. Racial profiling is the practice in law enforcement agencies of scrutinizing a person’s behavior and/or crime on thebasis of race. This practice is ingrained in police officers and drug control agencies, including the Drug Enforcement Agency (DEA.) The process of discrimination occurs at all levels for minorities. At the first level, a traffic stop, is the purported notion of “driving while black.” In North Carolina, minority drivers are cumulatively four times more likely to have their license revoked; in Wake County, it is seven times higher. Similarly in North Carolina, according to the University of South Carolina,  black people are “63 percent more likely to be stopped even though, as a whole, they drive 16 percent less.” In Philadelphia, twenty-seven out of one-hundred black people are stopped in comparison to ten stops for every one-hundred drivers. In Saint Paul, it is twenty-two black drivers in comparison to seven white drivers. From this, police officers routinely engage in Terry frisks, a law stating that police officers do not need a warrant to search individuals if they are suspected of a crime, often evoked in police brutality such as Elijah McClain’s death.

The notions of Black and LatinX communities being avid substance users matriculates in more arrests and harsher sentencing. In 1984, the Sentencing Reform Act changed judge’s discretion in sentencing. That same year,  the Comprehensive Crime Control and Safe Streets Act removed parole at the federal level, leaving many with life-sentences, and increasing older prisoners.  Recalling the previous powder cocaine and crack laws, the 1986 Anti-Drug Abuse Act brought about mandatory minimum sentencing, resulting in 100-to-1 ratios between crack and powder cocaine sentences. This meant that five grams of crack cocaine — not even a bit of a sandwich bag —  was the equivalent to five-hundred grams of powder cocaine.  Two years later, vague conspiracy definitions were mixed in, along with simple possession of crack being a federal crime. Rather than assisting in learning from their behavior, those who were arrested were now placed in a punitive system, bent on keeping criminals there as long as possible. At least, such was the case for minorities — Black people convicted of crack offenses often got twice the sentence length of white offenders. Despite increasing legalization, marijuana dicrimination remains just as bad; conversely, racial disparities in marijuana arrests have increased in 31 states since 2010. In New York City, as of 2016, Blacks and Latines made up ninety-two percent of the marijuana possession arrests in public housing units.

With all of this, in 1994, former Nixon advisor John Elhrichman admitted in an interview that the War on Drugs had a significant racial component: “You wanna know what this [the war on drugs] is really about?” he begins, “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.” A video with the Drug Policy Alliance from Jay-Z and talented artist Molly Crabapple discusses the Nixon and Reagan era vilification of youth of color, Rockefeller Laws, and the “crack is black” mentality. 

Failure and the War on Drugs

On top of this, the War on Drugs has been ineffective. Simply incarcerating anyone who disobeys the laws is not going to make substance use go away; it disobeys the laws of supply and demand. In economics, supply and demand is a form of determining prices in the market. Typically, if the supply decreases, the price drops, and the demand goes up. However, with substances, the demand remains the same regardless, making most supply initiatives useless.  Furthermore, this leads users to seek a supply regardless of how dangerous it may be, leaving a group of people more vulnerable than they already are. In tandem, this leads those who are in the drug business to employ more people, or force people into the business, making another group of people not only more susceptible to harm, but making the passing of substances actually easier. Though it may work if all countries agreed to stop selling illicit drugs — a likely impossible feat due to cultural differences, political instability, and corruption — it will generally just lead to people jumping back and forth between suppliers. 

When banning a substance, those who work underground to continue selling the substance have the opportunity to make the substance more potent. Such was the case with prohibition, where restricted alcohol use only allowed the substance to become stronger and more unregulated. In tandem, violence became more likely, and the same is true today. Violence becomes the only way to settle a score when there are no legal or medically safe ways to do so. Thus, homicides and brutality become synonymous with substance crime. In Mexico, it is estimated that 150,000 murders have occurred since 2007. Globally, the War on Drugs leads to greater deaths from HIV/AIDS, gang violence, and overdoses.According to the CDC, in 2020, 91,799 drug overdose deaths occured in the United States.

The era of prohibition saw a lot of corruption, primarily from law enforcement, public officials, and civil servants. Bribery was rampant, particularly due to the high profile — and profit — that alcohol was beginning to assume. Along with the willingness to earn extra cash, the growing violence that substance sellers were beginning to assume, public officials were more willing to accept bribes, lest they theraten themselves and their families. From this, we begin to see parallels to the modern War on Drugs. In addtion to the aformentioned racial profiling, law officers have been historically documented to sell substances themselves. A couple examples include a case in July 2016, where a jail guard in Alabama was charged with trying to smuggle drugs into the jail by concealing them inside a Bible. A few years later, there was selective enforcement in traffic stops cases against minorities for marijuana. Back to 2016, a former jail guard in Philadelphia was sentenced to four years in federal prison for selling drugs to inmates. Back to 2022, in light of seven consecutive  cases of police corruption, civilians are raising questions about the culture of the department. 

This is a map determining if civil asset fortitude laws are good in your state.

One incentive for this corruption is civil asset forfeiture, the act of law enforcement and prosecutors seizing assets they believe — or claim to believe — are part of a crime, such as cars, homes, and money.  In many cases, those who have their assets seized may not be charged for the crime. Furthermore, these assets flow back to the department, increasing difficulty for those whose property was seized to get their assets back. With pertinence to substance use, this makes abuse all the more plausibly deniable, and all the more lucrative. Picture a person being stopped for suspicion of marijuana or other illicit substances in their car. Not only can the car be seized, but the money in the person’s wallet, or emergency savings in the glove compartment can be seized. One top of this, even if the person is proven to not have substances on their person, one can argue that they can do a more thorough search of their vehicle at another location. Their car and money then get seized, and are then cycled through the police department. Such as the case in Virginia, state police were allowed to keep 80 percent of the In Virginia, state police were allowed to keep 80 percent of the $28,000 confiscated from the car of a church secretary, for transporting cash to buy property for the church.

Some Americans argue that the War on Drugs is beneficial because decriminalization would lead to higher rates of abuse. In actuality, criminalization can lead to greater rates of abuse, particularly among teenagers, in a phenomenon known as the forbidden fruit effect. If a substance is illegal, this can compel younger people to do it more for rebellion’s sake. As well as that, if a substance is unregulated, that makes it all the easier to be dispensed to anyone and can create more potent products, leading to higher rates of use, then more people using a substance, going through unsafe methods, and building a tolerance that can lead to overdose.

Misconceptions and Stigma 

On top of these consequences, a stigma has been born from hardline policy initiatives. By winding up the public with flawed, harmful information surrounding substance use, we enter a lose-lose scenario: the public acquires a false perception of substance users, and substance users are stigmatized, likely pushing them to consume more substances. In some cases, substance use advertisements can lead to an unintended consequence of encouraging people to use substances. By not offering a multifaceted perspective on substance use, its causes, and why people would choose to use these substances, we are robbing the public an opportunity to increase their empathy for people with a SUD, informing them of the science behind these substances, and ultimately vilifying a group of people who are already vulnerable.

Throughout the Raegan era, substance misuse advertisements became the new wave. Combining a common pastime with histrionic narratives of substance use, these advertisements reigned supreme in the mid to late 80s. Anti-drug campaigns such as Partnership for a Drug Free America and Drug Abuse Resistance Education (DARE) gripped schools, teens programming, and local advertisements. With regard to DARE, a study from the American Psychological Association pooled from 1002 participants who received DARE schooling in sixth grade, studying their usage as an adult. The results were not promising –DARE was found to have no significant impact on their substance use. Many studies also claim that substance use only increased with DARE. For critics, the DARE program failed for a plethora of reasons — politics, policy, mass hysteria — but perhaps one of more egregious ones was the faulty curriculum. One of DAREs main problems was that it gave kids information about drugs they otherwise would not have known. By giving students more knowledge about substances, this leads to a counterproductive effect, where they now know more substances they can try, how it will make them feel, and the most likely places they will find them. As well as this, critics argue that by scaring some children by bringing in police officers, and writing reportedly out-of-touch, fear mongering literature for parents, the program lost much of the positive effect it could have had. As well as that, it did not address the root causes for why children would want to try substances in the first place. 

DARE, and many drug campaigns as a whole, did not address that a primary factor for children and adults choosing to use substances is escapism. With pertinence to mental disorders such as depression, bipolar, or PTSD, and traumas such as grief and abusive upbringings, substances can be a maladaptive coping skill. There are many reasons why people would want to use a substance, as touched on in the first installment of this series. But in the end, people don’t use substances to feel bad, and most people don’t use substances because they’re bad people. Most people who use substances can look or appear relatively “normal,” far from our perceptions of substance users being slumped over on a park bench, or disheveled and homeless. Indeed, though that is a portion of people, a person with an SUD can look and behave several ways. But when we do not address this, this leaves many people who are struggling left behind, or believing they do not have a problem, because they are not homeless, destitute, or necessarily impoverished. They are still in college, they are still holding their job, and they are still relatively present in their families lives — if one is still managing that, then what’s the harm?

The harm is the increased physical illness, overdoses, and mental health consequences that become of it. What advertisements such as “Faces of Meth,” “Drug abuse is the new slavery,” “Reefer Madness,” “It’s the Money” and other anti-drug campaigns had previouslyy done was not only highly ineffective, but also highly stigmatizing. In many substance use advertisements, descriptors such as “lazy,” “loser,” “stupid,” “snakes,” and comparing substance users to a myriad of disparging things, results in a lose-lose scenario, where the user becomes upset and saddened and sinks into their usage further, and the public are no better informed than they were prior to seeing the advertisement. Most people know that using substances such as crack cocaine or heroin are not good or healthy, but simply saying they are not good does not address the root cause of the problem, and feeds into the narrative that SUDs are the result of moral failure, lack of willpower, and total personal choice. This narrative then transcends the general population, leaking into healthcare professions, subsequently resulting in poor healthcare.  Ironically, the behaviors we associate with substance users can dissipate with the proper treatment for the person in place. However, if we are not able to get there due to our narratives of addiction — “once an addict, always an addict” — then people with SUDs cannot get there. When combined with insufficient living arrangements, impaired judgment, interrupted neurotransmitter pathways, stigmatization from friends and family, and poor insurance even if treatment is okay, the end result for many people is suicide. 

Stigma can be reduced. Western society is slowly becoming more understanding towards mental health issues like depression and anxiety. This increasing de-stigmatization has led to more people being open to receiving help, being more willing to go to therapy, and a more positive outlook for research on depression and anxiety. Borderline personality disorder (BPD) is also becoming increasingly recognized. Tough de-stigmatization can also occur for other mental health conditions, such as severe mental health conditions (SMHCs) like bipolar or schizophrenia, PTSD, and other personality disorders, advocacy groups and the general public are becoming more aware of these conditions, with many changing their vernacular (eg. reduction of terms such as “schizo” “crazy” and “psycho.”) The same can and should happen for SUDs; more personalized programs should exist for people with SUDs.

12 Step Programs

Perhaps we have established that attempting to cut off the supply of substances and mass incarceration has not helped substance misuse. But what about programs specifically designed to help people with SUDS? Treatments such as Alcoholics and Narcotics Anonymous, two programs designed to help treat addictions. Both programs are peer-led, anonymous resources designed with the twelve-step program, a list of steps to follow including “admitting to being powerless against alcohol,” and “making a list of people you have harmed, and making amends with them,” and “prayer and meditation.” 

The twelve-step program began in 1935, with New York stockbroker Bill Winston, and Dr. Robert Smith, an Akron surgeon. The two created the twelve-step program largely from their own experiences; Winston becoming sober with the spiritual guidance of an old-friend, and both learning to become sober from the Oxford group. With the help of other doctors, they then began pooling from other’s experiences, resulting in them opening three original trial groups from 1935 and 1939, resulting in one-hundred sober alcoholics. In the midst of the temperance movement, Alcoholics Anonymous argued that alcoholism was a chronic, incurable disease, where abstinence could be the only solution. Twelve-step programs grew astronomically in the 1990s, when neuroscience and psychiatry were in their infancy.  

The twelve-step program has significant roots in spirituality, driving many people away from this program. Indeed, though God is mentioned in five-of-the-twelve steps, the core message can be interpreted as, to some extent, secular. Yet, this opens up another can of worms. 

One of the main problems for some with Alcoholics Anonymous is the false dichotomy that one drink would be all you need to send you over the edge. The abstinence or alcoholic mindset is what drives many away from the program. As well as this, some argue that new research is counteracting the Alcoholics Anonymous “abstinence” mentality. Current research, such as neurogenesis and epigenetics, detailing our brain’s, our environments, our genetics, and how they coalesce to nurture our behaviors, were not available at the genesis of twelve-step programs. Furthermore, the mechanisms that Alcoholics Anonymous uses are, by definition, difficult to study. Alcoholics Anonymous cannot exactly prove their methods work — dy definition, members are anonymous, and often do not want to participate in research highlighting their attendance. Instead, most research shows the outcomes, but not the methods. 

The case for twelve-step programs ends with a hung jury; many claim it is incredibly effective, while others claim it does more harm than good. The research is lacking, and what is available is mixed. A study from Lee Ann Kaskutas states that the evidence is generally positive for Alcoholics Anonymous in terms of abstinence, with rates of abstinence are about twice as high among those who attend AA. Stanford researcher Keith Humphry, as well as two associates, contend that AA is more effective than cognitive behavioral therapy and motivational therapy. Humphry appears to be of the opinion that it is the social component that makes Alcoholics Anonymous so effective, claiming “if you want to change your behavior, find some other people who are trying to make the same change.” Support groups are a great way to find people who are going through a similar struggle as you, but they are not a replacement for therapy. 

Some argue that if support is the primary reason one is going to Alcoholics Anonymous, there are alternatives if the messages that twelve-step programs deliver are not appealing. From this, group therapy can be an excellent tool in recovery from SUDs. Though there are some hindrances such as lack of evidence-based group-specific treatments and limited training sessions, enhancements such as quality of group member relationships, and a great relationship with a therapist and a group can make group-therapy a great course of treatment. Many say it is amazing to feel they can be vulnerable with a group of substance users, get feedback for their progress, and communicate with others more effectively.

 With so many types of group therapy, there are many options for those who find it a good option.

“One Size Fits All” Substance programs 

The bigger problem with twelve-step programs is their one-size-fits-all  approach to recovery. Recovery from SUDs is considerably lacking, with few medical professionals being well-versed in SUD treatment. In the US, the AMA estimates that only 582 out of nearly 1 million doctors identify as addiction specialists, though this can be skewed by subspecialities.   And when other treatment methods are brought up, such as prescription drugs for reducing alcohol use or comorbid mental health issues, or motivational interviewing and cognitive behavioral therapy, these solutions are often shut down by many leaders of individual groups. Twelve step programs such as AA and NA are not typically run by therapists or mental health professionals, they are run by peers. Peers who are not equipped to dole out medical advice for comorbidities, peers who only have their anecdotes to go off of when advising other people. And if one suggests that there are other methods to their peer leader, or contends that the treatment is not working for them, they are blamed, shunned and told that their disorder has flown them too far. They are told that they “aren’t working hard enough,” they leave treatment, they relapse, and they are hospitalized or forced back into treatment, where they are cycled through the twelve-step program again.

 Their friends and family are then told that they just have not “hit rock bottom,” and once they get there, they will learn. This mentality is laughably flawed, yet it’s one our society has continued to push. This mentality is akin to telling a person with anxiety that they can seek treatment once they have had a few more panic attacks, or someone who is depressed only getting help after attempting suicide. By that point, a person may not even want to get better, believing that there is no longer a point in recovery. 

Of course, this is not to say that twelve-step programs do not work. Conversely, for some people, twelve-step programs are incredibly effective. The key part is for some people, not for everyone. For some people, twelve-step programs have put them in more dangerous situations, and left them in a more vulnerable state than before. For others, it was a band-aid — it worked for some time, and they fell off the wagon.  The problem with the rehab industry is that substance use disorders exist on a spectrum, yet it is treated with an all-or-nothing mentality. With alcohol for instance, only fifteen percent of users are identified on the severe end of an alcohol use disorder (AUD,) with the majority falling in the mild or moderate category. Note that the spectrum in and of itself is not a diagnostic tool, rather a way for people with SUDs to identify where they are. The rehab industry needs to adopt a multifaceted approach for treatment. For some people, recovery means a twelve-step program. For some people, recovery means therapy. For some people, recovery means medication, or medication with therapy. For some people, recovery happens on their own, without any rehab needed. As well as that, the CDC stated in 2020 that 75% of people recover from their illness. Another study claimed something similar for AUDs, but added that of the 75 percent recovery rate, only a quarter had gotten any type of help, such as AA, and many were now drinking in a low-risk manner as abstinent.

What other treatment options are there for substance use disorders?

 Despite a more empathetic, sensible approach to SUDs today, substance users are still facing a myriad of disparities. Mass incarceration continues to be a significant problem, and systemic problems are keeping many from getting treatment. Despite this, there are still things we can do to try to shift the tide. 

Naltrexone is increasingly being used for opioid use disorders (OUDs) and alcohol use disorders (AUDs.) Naltrexone is available by prescription, but is also available as generic tablets online — note that many websites can sell counterfeit pills, and most will still require a prescription. Naltrexone works by blocking the euphoric and sedative effects of opioids and alcohol, making the substance unappealing. Despite this, it is not recommended that one continues taking opioids or alcohol with the substance. Though, many people do, and report finding the substance unappealing, and stop quickly — this method was advised by the creator of this treatment approach, John Sinclair. If one quits taking naltrexone for a period of time and goes back to using a substance, it may result in reduced tolerance, creating a dangerous scenario for an overdose. You cannot become dependent on naltrexone, and there is a certain amount of motivation required to continue taking it. 

If naltrexone does not help, for AUDs, there is disulfiram (Antabuse.) Disulfiram brings uncomfortable reactions after consuming alcohol, such as dizziness, nausea, and chest pain. Methadone is another drug used to treat opioid addiction used to manage opioid dependence, though it is only available at certain opioid treatment programs (OTPs.) Buprenorphine is available at doctor’s offices and OTPs.

If you or someone you know is dealing with a substance use disorder, it is not recommended that you or others are entered in a Narconon program. Narconon is a scientology-run program with many researchers claiming it is a sham. Though it claims to be effective, most studies claim the evidence is inconsistent at best, and most research typically does not place Narconon in a good light. In a Swedish study, seventy-seven percent of participants did not complete the program, fifty-percent of those who completed the program went back onto drugs afterwards, fifty-four percent who did not complete it went back onto drugs, and 6.6% of enrollees said they had stayed totally drug free for one year afterwards. One website critical of Narconon contends that other studies have come out with a similar message.

Harm reduction may be one of the safest, cheapest, and most effective methods of recovery. Harm reduction can include medically supervised substance use, job assistance, and housing for people with substance use disorders. Though it may seem far-fetched, it is certainly possible; many countries have employed harm reduction strategies. Eighty-six countries have employed a harm reduction strategy against drug use, including Switzerland, the Netherlands, Germany, Canada, the United Kingdom, and Portugal. In the 1980s, Switzerland had an issue with heroin, leading to a stark increase in HIV/AIDS, and heroin overdoses. After opening harm reduction treatment centers, heroin overdoses dropped by half, and HIV/AIDS rates dropped dramatically. The U.K has adopted heroin maintenance programs since the 1920s, and is slowly moving back towards it after a stint of restrictive programs in the 50s and 60s. Still in the U.K, harm reduction for cannabis has been employed to stop driving while intoxicated cases. Tying back to our mention of decriminalization above, harm reduction and decriminalization does not increase rates of drug use. Conversely, harm reduction reduces disease rates, overdoses, and crime. 

A growing number of states are approving the use of fentanyl test kits. However, nineteen states — mainly in the South, including Texas, Florida, and Kansas — are still classifying the controlled testing kits as “drug paraphernalia,” thereby making it illegal. If your state has not approved fentanyl testing kits, there are still things one can do to mitigate the risk of an overdose. 

Alternative substance use treatment centers:

SMART (Self-Management and Recovery Training) Programs. This treatment method is a four-point self help support group focused on abstinence and empowerment. Their four-point program includes: Obtaining and maintaining motivation, learning to manage urges, handling emotions, thoughts, and behaviors, and finding and striking balance in life.This program utilizes scientific and psychological research, and does not adopt one approach for addiction. However, they do combine science with experience, hoping to strike a balance between the research and what has worked for attendants; attendants can also include veterans and first responders, LGBTQ+ people. 

Secular Organizations for Sobriety. A nonprofit program that prides itself on subscribing to the newest research, with no specific religion. Their organization has support groups that also include food addiction.

Evidence-based treatment (EBT) is treatment that focuses on following previously successful results. These include cognitive behavioral therapy (CBT), Eye Movement and Desensitization and Reprocessing (EMDR), and Rational Emotive Behavior Therapy (REBT). Though twelve-step programs can be considered an EBT, there are alternatives.

Lifering takes a different approach from twelve-step by asking the attendants to find strength within themselves. Lifering helps to find attendants find their own way through recovery. One can also attend meetings through an email service called ePals

Women for Sobriety: A non-profit recovery group specifically for women, based on thirteen acceptance statements focusing on personal, spiritual, and emotional growth, positivity, and growth of self-esteem. Women for Sobriety are of the opinion that thoughts cause actions, and if one can change their thoughts, they can change their actions and behavior. Women for Sobriety also focuses on meditation, healthy eating, and self-care activities. Members’ information is confidential.  

Holistic Therapy resources: Non-medicinal treatment methods that aim to bring the mind, body and spirit together.

American Psychological Association Psychologist Locator.

Therapy Tribe: a therapist, psychologist, and marriage counselor program.

Dual diagnosis treatment programs: these treatment programs offer specialized, personal treatment for people with a SUD and a comorbid mental disorder.

Harm reduction advocacy: 

National Harm Reduction Coalition. 

SAMHSA Harm Reduction Coalition:

Drug Policy Alliance Strategic Plan:

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