There is no single “best therapy” for every person with a substance use disorder. Effective treatment matches the therapy, medication, level of care and recovery support to the substance involved, the person’s risks, co-occurring conditions, goals and circumstances.
Evidence-based treatment can include psychological therapies, medications and practical recovery support. A programme should be able to explain what approach it uses, who is qualified to deliver it, what problem it targets and how progress will be reviewed.
Medical note: Therapy is not a substitute for urgent medical assessment during overdose, severe withdrawal, seizures, hallucinations, severe confusion or immediate risk of harm.
What does “evidence-based” mean?
An evidence-based treatment has support from research and is used with clinical expertise and the patient’s preferences. It is not simply a popular activity, a motivational lecture or a programme’s trademarked method. Good care also considers culture, language, family context, physical health, mental health and practical barriers.
Treatment should be individualised and reviewed. When a person is not improving, clinicians should reassess the diagnosis, level of care, medication, treatment fit and recovery environment rather than assuming that the patient lacks willpower.
Cognitive-behavioural therapy
Cognitive-behavioural therapy (CBT) helps people identify situations, thoughts, emotions and behaviours linked with substance use. Treatment may teach skills for managing cravings, solving problems, coping with stress, refusing offers, changing routines and responding to a lapse before it becomes a longer return to use.
CBT is used across a range of substance use disorders and can be delivered individually or in groups. A good CBT programme is structured and collaborative; it is more than general discussion or advice.
Motivational interviewing and motivational enhancement
Motivational interviewing (MI) is a respectful, collaborative approach that helps a person explore mixed feelings about change and strengthen their own reasons for taking action. Motivational enhancement therapy applies similar principles in a more structured series of sessions.
These approaches can be useful when a person is uncertain, feels pressured into treatment or has experienced repeated conflict about substance use. They should not be used to manipulate or shame someone into agreement.
Contingency management
Contingency management provides clearly defined, immediate rewards for measurable treatment goals such as attending sessions or providing substance-negative tests. The rewards are part of a structured clinical intervention, not a bribe.
Contingency management has particularly strong evidence for stimulant use disorders, including cocaine and methamphetamine use. It can also be combined with CBT, community reinforcement and other care. Programmes should use transparent rules and safeguards so incentives are fair and clinically appropriate.
Community reinforcement approaches
The community reinforcement approach helps make a substance-free life more rewarding by addressing relationships, work, recreation, coping skills and practical problems. It may be combined with contingency management. A related family-based approach teaches concerned family members how to support treatment engagement while protecting their own wellbeing.
Family, couples and adolescent therapies
Substance use affects and is affected by relationships. Family or couples treatment can improve communication, reduce conflict, support medication and recovery plans, and help relatives respond consistently to risk.
For adolescents, developmentally appropriate family-based treatment is often important because parents or caregivers influence transport, medication, school, supervision and the home environment. Family involvement should respect consent, privacy and safety; it is not appropriate to assume that every family relationship is supportive.
12-step facilitation and mutual-support groups
12-step facilitation is a professional treatment designed to help a person engage with 12-step mutual-support groups. Mutual-support groups themselves are peer-led rather than clinical therapy. They can provide belonging, routine and long-term support, but participation should not be presented as the only valid route to recovery.
Secular, faith-based and other peer-support options may be available. The person’s values and preferences matter, and peer support should complement—not replace—medical or psychiatric care when those are needed.
Medications are also evidence-based treatment
Medication is not the opposite of recovery. For some substance use disorders it reduces withdrawal, cravings, overdose risk or return to use and can make psychological treatment easier to engage with.
Opioid use disorder
Methadone, buprenorphine and naltrexone are recognised medication options for opioid use disorder, subject to clinical suitability and local regulation. SAMHSA’s TIP 63 describes all three as evidence-based treatments. Medication choice should consider current opioid use, withdrawal status, other medicines, pregnancy, liver function, access and patient preference.
Stopping medication simply to meet a programme’s “drug-free” philosophy can increase risk. Medication duration should be a clinical decision rather than a fixed rule.
Alcohol use disorder
Medications used internationally for alcohol use disorder include naltrexone, acamprosate and disulfiram, although availability and approval vary by country. They may be used with behavioural treatment and mutual support. A prescriber must assess contraindications, interactions and the patient’s treatment goal.
Tobacco use disorder
Nicotine-replacement therapy and other medicines can be combined with behavioural support. Treating tobacco use during addiction care does not have to wait until every other substance problem is resolved.
Stimulant and cannabis use disorders
There is no medication with broad international approval specifically for stimulant or cannabis use disorder. Behavioural treatment is therefore central. For stimulant use disorder, contingency management has the strongest established evidence. Research continues into medication options, and clinicians may treat associated symptoms or conditions without claiming that those medicines are established cures.
Integrated treatment for co-occurring conditions
Depression, anxiety, trauma-related disorders, psychosis, attention problems, chronic pain and other conditions may occur alongside substance use. Treating only one condition can leave important risks unaddressed. Integrated care coordinates addiction treatment with medical and mental-health treatment rather than requiring the person to “finish rehab” before receiving help for another condition.
Symptoms should be assessed carefully because intoxication, withdrawal, sleep loss and prescribed medicines can resemble or worsen psychiatric conditions.
Trauma-informed care
Trauma-informed care is an approach to safety and service delivery, not one specific therapy. It seeks to avoid humiliation, threats, unnecessary coercion and practices that may recreate traumatic experiences. It should include clear information, consent, choice where possible, respectful boundaries and staff trained to respond safely.
Trauma-focused therapy may be appropriate for some people, but timing and method should be determined by a qualified clinician. A programme should not pressure patients to disclose traumatic experiences publicly.
What is not enough on its own?
- Detox alone: withdrawal management does not provide the full treatment for a substance use disorder.
- Lectures and confrontation: education can help, but aggressive confrontation is not a substitute for structured treatment.
- Unstructured groups: peer discussion can be valuable, but clinical groups should have a clear purpose and qualified facilitator.
- Religious or spiritual activity alone: it may support some patients, but it should not replace needed medical, psychiatric or psychological care.
- Exercise, yoga or recreation alone: wellness activities can support recovery but are not complete treatment.
- Promises of a cure: no therapy can guarantee permanent recovery or a fixed success rate.
How to choose a therapy or programme
- Start with a comprehensive assessment rather than selecting a therapy from an advertisement.
- Ask what diagnosis and treatment goals the approach is intended to address.
- Verify the clinician’s qualifications and registration.
- Ask how medication is assessed and coordinated.
- Confirm how co-occurring mental-health and medical conditions are treated.
- Ask how progress is measured and when the plan will change.
- Review consent, privacy, complaints and patient-rights procedures.
- Ensure there is a continuing-care plan after residential or intensive treatment.
Related guides
- What is a drug rehab center?
- Phases of drug rehabilitation
- How rehabilitation differs by substance
- Alcohol rehabilitation and treatment options
Authoritative sources
- National Institute on Drug Abuse: Principles of Drug Addiction Treatment
- SAMHSA: Treatment Options for Substance Use Disorder
- SAMHSA TIP 63: Medications for Opioid Use Disorder
- NIAAA: Treatment for Alcohol Problems
- World Health Organization: Brief Psychosocial Interventions for Drug Use Disorders
- National Institute on Drug Abuse: Cocaine Research Report
Last clinically reviewed: 29 July 2026.