What does care for substance use problems look like?

What does care for substance use problems in the US look like? I don’t really know.

We hear a lot about substance use problem care dominated by an abstinence orientation. Is it?

What form does most substance use care take? I don’t really know.

When these statements are made, they are often focused on specialty Substance Use Disorder treatment models, programs, and systems.

Specialty SUD care is, without question, oriented toward more severe problems, and abstinence-oriented approaches are the norm for more severe problems. (It’s important to note that abstinence-oriented doesn’t necessarily mean abstinence-immediately, and a norm of abstinence-orientation doesn’t make it universal.)

What portion of substance use problem care in the US is provided by specialty programs? I don’t know.

I imagine the first stop with a substance use problem (primary or otherwise) for many people is a primary care physician or a generalist individual therapist. Do these settings have an abstinence default? I suspect not, particularly for legal drugs. For illicit drugs, maybe.

I imagine primary care physicians providing some education about safe consumption levels (where available) and coaching on a healthy lifestyle.

I imagine individual therapists often start with assumptions that maladaptive substance use is secondary to a primary issue, and do work to target the identified primary issue, develop coping skills, and pursue moderation or more healthy use.

All of that is speculation. I’ve never seen much information about how often care is provided in those settings, or what the care looks like.

Further, we’ve seen large expansions in care to emergency departments and community-based distribution of naloxone and drug testing kits.

None of this is meant to comment on the quality or appropriateness of the care across these settings. Rather, this is just to note that there’s a lot of care being delivered outside of the specialty SUD treatment system, and most of it probably looks nothing like specialty care.