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Sample Treatment Plan for SUD

A sample treatment plan for SUD (substance use disorder) with suggested goals, objectives, and interventions, as well as a recommended book list

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This is a generic, sample treatment plan for SUD (substance use disorder). It includes a suggested reading list as well as the National Institute on Drug Abuse’s principles of effective substance use treatment.

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CLIENT GOALS

Increase knowledge about addiction and treatment: Individuals should have a basic understanding of addiction, including the signs, symptoms, and the underlying factors associated with developing a SUD. Individuals should be introduced to multiple treatment approaches. (There is no “one-size-fits-all.”)

Develop coping and emotional regulation skills: Individuals should learn how to cope with stress, difficult emotions, and cravings without using substances.

Improve social support and develop effective interpersonal skills: Individuals should develop a strong support network of people who care about them and can help them in their recovery as well as learn how to communicate effectively.

Relapse prevention: Individuals should develop a written plan for how they will maintain their sobriety. Components of a strong relapse prevention plan include the following:

Identify triggers and warning signs: One of the first steps in relapse prevention is identifying triggers. Triggers can be internal (i.e., difficult emotions, thoughts about using, etc.) or external (i.e., people, places, events, circumstances, etc.) Warning signs are behavioral changes or changes in mood or thinking that may indicate the person is in “relapse mode.” Common warning signs include isolation, not attending 12-step meetings, sleeping too much or too little, irritability, etc. (Hint: The individual should consider asking significant others, close friends, or family members for help with identifying their warning signs.)
Develop a coping plan: Once the individual is aware of their triggers and warning signs, they can develop a plan for how they will manage them. This plan might include things like calling a friend, going to a meeting, or taking a walk. The plan should be individualized; things that work for one person may not work for other. The plan should also include coping or distraction techniques for cravings. (Consider this worksheet for tracking urges to use.)
Identify and avoid high-risk situations: If certain situations are likely to trigger the individual, it is best to avoid them if possible. This might mean not going to certain places or not hanging out with certain people. The individual should consider setting boundaries with loved ones who trigger them. If a situation is unavoidable, they may want to bring their sponsor or trusted person with them.
MAT (medication-assisted treatment): A psychiatrist or other licensed provider can prescribe medications such as naltrexone or buprenorphine to reduce cravings. (For locating a practitioner who specializes in MAT, see Buprenorphine Treatment Practitioner Locator | SAMHSA.)
Mental health treatment: If the individual has a mental health diagnosis, it’s important to take mental health medications as prescribed and attend all scheduled psychiatric appointments. It’s also important to understand how co-occurring disorders interact with substance use.
Stay connected to a support network: It is important to stay connected to a support system, such as a therapist, 12-step (or similar) group (e.g., Alcoholics Anonymous, NA, SMART Recovery, Celebrate Recovery, Women for Sobriety, etc.), peer support, or friends and family who are supportive of recovery goals. A recovery network can help the individual to stay on track.
Practice self-care: Self-care and wellness practices are important for everyone, but especially so for individuals in recovery. It’s crucial to get enough rest, eat healthy foods, drink plenty of water, attend to physical illness, and exercise regularly (at a minimum). Nutrition in recovery is especially important for heavy drinkers; the individual should consider seeing a nutritionist if they have a history of alcoholism.
Find hobbies or leisure activities to pursue: A strong recovery program is balanced and includes enjoyable activities. The individual should plan leisure activities or explore new hobbies and engage in them on a regular basis.
Explore spirituality: Many individuals find that spiritual practices such as attending church, seeking guidance from a spiritual leader or shaman, forest “bathing,” etc. enhance their recovery program.
Have patience: Relapse prevention can be a lifelong process. There may be times when slip ups happen. This does not take away from the time the individual maintained their sobriety. The important thing is to get back on track and not give up.

CLIENT OBJECTIVES

Client will abstain from or reduce the use of mood-altering substances.
Client will identify the consequences of their addiction.
Client will identify their triggers, high-risk situations, and warning signs.
Client will develop a plan for coping with cravings and triggers.
Client will identify, challenge, and replace destructive thought patterns with positive, reality-based self-talk.
Client will attend 12-step meetings (or other support groups) regularly. (For online support groups, see The 7 Best Online Sober Clubs.)
Client will develop a support system of people and organizations that are supportive of their recovery.
Client will find a job or start school.
Client will maintain a healthy and balanced lifestyle that includes pleasant activities and self-care.
Client will manage their finances.
Client will resolve any legal issues.
Client will maintain healthy relationships with supportive family and friends.
Client will develop a written relapse prevention plan.

THERAPIST INTERVENTIONS

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Assess for the following:

Suicide risk
Cognitive deficits (either as a result of long-term use and/or overdoses or pre-existing conditions that may impair individual’s insight)
Co-occurring disorders
Pregnancy
Trauma – If severe, individual would benefit from evidence-based trauma treatments, such as CBT, EMDR, CPT (cognitive processing therapy), or TF-CBT
Conditions that lead to “self-medicating” (e.g., insomnia, chronic pain)
Recent events (divorce, death of a loved one, etc.) or circumstances (poverty, disability, etc.) that may directly influence substance use
Family of origin problems – Especially in younger individuals, family therapy should be considered as part of the treatment plan
Safety concerns – Screen for domestic violence, unsafe living environment (e.g., staying at a homeless shelter), at high-risk f or overdose, etc.
Stage of change – Consider harm reduction for individuals who are not ready to commit to sobriety (e.g., Narcan, fentanyl strips, etc.) (For an evidence-based guide on enhancing motivation for change, see TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment | SAMHSA.)

Evidence-based therapeutic approaches:

Motivational interviewing
Motivational enhancement therapy
Mindfulness-based therapies
CBT
DBT
MAT (refer to)
Behavioral therapy
Family or couples therapy
Trauma therapy (EMDR, CPT, Seeking Safety, etc.)
Experiential therapies
Contingency management

Therapeutic interventionS:

Complete a thorough biopsychosocial assessment.
Assess for severity of addiction and for the need for medical detox services; refer as needed. (Consider using the ASAM criteria.)
Refer client to a medical provider for a physical/wellness exam and STI testing (as needed).
Refer client to a psychiatrist for an evaluation and medication management, including MAT, (as needed).
Individualize treatment (or refer to a specialist) for co-occurring disorders.
Assess the severity of impairment in the individual’s different life areas to guide a collaborative treatment plan.
Link client to community resources for deficits in education, employment and/or finances and for legal help (as needed/appropriate).
Explore how past events or circumstances (as appropriate) may have impacted the individual’s addiction.
Provide client with education on addiction (risk factors, signs and symptoms, addiction science, long-term and permanent consequences, complications, etc.)
Provide client with education on various treatment options and approaches (i.e., harm reduction, abstinence, moderation, etc.)
Assist client in identifying their risk factors, triggers, high-risk situations, and warning signs.
Help client to identify consequences and benefits of use.
Help client to identify coping skills.
Assist client with the development of a crisis plan (including things they can do, people they can contact, hotlines, etc.)
Teach assertiveness, anger management, and distress tolerance skills.
Teach mindfulness practices, grounding techniques, and self-soothing activities.
Recommend local 12-step and/or support groups.
Educate client on the benefits of peer support and link client to a peer recovery center or a peer recovery support specialist.
Assess for case management needs (e.g., transportation, childcare, etc. that may impact client’s ability to attend outside meetings), and link client to appropriate resources.
Assist client in identifying supportive persons in their life and maintaining a strong support network.
Help client to identify activities they find meaningful and/or pleasurable.
Explore spirituality with individual.
Teach problem-solving and decision-making skills. (For additional problem-solving worksheets, see 10 Best Problem-Solving Therapy Worksheets & Activities (positivepsychology.com).
Explore the role of shame and guilt in addiction.
Explore values and motivation for recovery.
Teach self-compassion and explore self-care practices. (For more on self-compassion, see Homeworks and Handouts for Clients (actwithcompassion.com).)
Explore making amends (including “living amends”), forgiveness, and self-forgiveness.
Assess for self-esteem problems and assign strengths-based homework or review client’s accomplishments and strengths in sessions.
Utilize CBT techniques for irrational thought patterns that impact client’s ability to stay sober.
Teach and role play refusal skills.
Teach conflict resolution skills.
Challenge and develop discrepancy with clients in the later stages of change.
Consider implementing a reward system for attending therapy appointments; this works well with individuals who misuse stimulants. (See Counselor’s Treatment Manual for more on stimulant use treatment.)
Assist client in developing a written relapse prevention plan. (Consider this free workbook from Between Sessions.)
Assign homework to support the individual’s goals.
Use bibliotherapy for addiction recovery. (See suggested reading list below.)
If client relapses, revisit the relapse prevention plan, problem-solve, and amend as needed.

NIDA’S PRINCIPLES OF EFFECTIVE TREATMENT

Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased.
No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients.
Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical.
Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.
Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.
Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.
Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery.
Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s).
Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
Treatment does not need to be voluntary to be effective.
Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.
Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.

Source: Principles of Drug Addiction: A Research-Based Guide (Third Edition) (nih.gov)

Interview: Breakfast Beers, Bloating, & Blackouts

“Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work.” This was the daily routine for JMS, who wore his alcoholism as a badge and didn’t plan to live past 30. In this interview, a recovering alcoholic discusses addiction, sobriety, what everyone should know about alcoholism, and why you might be a jerk if you believe a common myth.

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Interviewer: Cassie Jewell, LPC

JMS, a recovering alcoholic, has been sober for nearly six years. He started drinking at the age of 13. He continued to drink throughout his 20s, a “dark and miserable existence,” and didn’t think he’d live to be 30. In 2012, a suicide attempt nearly claimed his life. He woke up in a psych unit, having no memory of what happened, and decided he wasn’t ready to die.

JMS’s “official” recovery date is July 5, 2012. The following is an interview about how he got sober, why AA isn’t for everyone, and why you’re a shitty person if you believe addiction is a choice.

What’s your definition of recovery?

JMS: I don’t see recovery as an end goal. To me, recovery is a path towards my end goal, which is contentment. I have found that I will never be content and happy with my life if I am using some sort of substance. For me, recovery is complete sobriety from all mentally and physically altering substances. I have tried and learned that I cannot pick and choose what to use. It does not work for me. More than just abstinence, recovery is a way of life. It is about being accountable for your actions, admitting when you are wrong, trying your best, and letting things go. Just trying to be a better person than I was yesterday.

Is alcoholism a disease?

It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.

JMS: I feel the word “disease” can be quite polarizing when discussing addiction. Alcoholism is chronic, progressive, and fatal. Much like diabetes, alcoholism is a relapsing disorder that needs a lifetime of monitoring and treatment. Based on these facts, yes, alcoholism is a disease. I feel this is a difficult idea for people to swallow. Much of addiction has been seen as a moral issue or a failing of willpower. It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.Obesity holds a similar stigma, though fat shaming has started to catch a bad rap.

When did you realize you had a drinking problem?

I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old

JMS: Hmm, that’s a tough question to answer. My gut response here is to say when I went to jail for my 3^rd DUI in 2010, which is when I started to actually try to get sober. But if I am honest with myself, I was well aware that there was a problem years before that. I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old.I lived a really dark and miserable existence for most of my 20s. I could identify story after story about when I should have realized that there was a problem. Destroyed friendships, arrests, hospital visits, blackouts, poor choices, breakfast beers, etc. The truth is, I knew that I drank differently from my friends when I was a kid. When we would wake up hung over after a party, I was the one that would sneak vodka shots. So, I think somewhere in there, I was always aware that it was a problem. I come from a family of alcoholics. My father, his sisters, and his parents are/were all alcoholics. So it was almost a badge of honor to be another alcoholic [last name].

In active addiction, how did alcohol affect your health and appearance?

I learned that it is not normal to have diarrhea everyday for 10+ years.

JMS: I lost 60 lbs. when I stopped drinking. I changed absolutely nothing other than cutting out beer and dropped 60 lbs. I looked and felt a lot less bloated. I also learned that it is not normal to have diarrhea everyday for 10+ years. Honestly, the biggest physical change I experienced, that I am still grateful for today, is acid reflux. While drinking, I kept TUMS in business. I never went anywhere without them. Today, I need to eat some TUMS when I eat pizza or spicy food… you know, like a normal person. I never noticed the impact that drinking had on my sleep until I was no longer drinking. The first few months I really struggled to sleep well since I never had healthy sleep hygiene. Allow me to paint you a picture. Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work. Shower or not, I always reeked of alcohol, so showering was not a top priority. I always thought that I never got hangovers, but once sober I realized that I only thought that because being hung-over was my normal and I was experiencing them every morning. Ugh, the physical impact that had on my life is really something I do not miss.

How (and why) did you get sober? Who and/or what helped? Also, share about some things that were not helpful to you.

JMS: I got sober because I did not want to die. I tried to kill myself the last time that I drank. I do not remember what happened, but I remember waking up in a psych unit in the hospital. There are a bunch of people that were integral to the success of my sobriety at this time. My family is number one. They never gave up on me, despite the hell I put them through. I moved back into my mom’s house when I got out of the hospital. She and my siblings were nothing but supportive of me then and still to this day. I do not know if I would be sober today without their unconditional love and support.There are four other people that I owe my life to at this point. My therapist, my addiction counselor, Bob, my friend Alex, and my friend Jon. I had been working with my therapist for a few years prior to my last drinking adventure. She has always been willing to challenge me and has been a safe space for me to work through some of my biggest fears. She has really helped me understand the nature of my addictions and helped me reframe my thinking and processing of my emotions.

I didn’t buy into [AA].

I have been through multiple addiction treatment programs in my life and none of them stuck. I always approached them with a cynical eye and was just going through the motions to get my family or the courts off my back. A condition of my discharge from the hospital was to enroll in an intensive outpatient program. This is where I met Bob. I figured this was another bullshit program that I was going to have to work through to keep people off my back. Bob was different. He encouraged us to go to 12-step meetings. Of course, I refused. I didn’t buy into those programs. Bob challenged me here. He asked that I attend one meeting in the coming week and write a list of everything that I hated in the meeting. I gladly did this and came back and an entire 8.5×11 sheet of paper full of my gripes. Bob listened to my list and challenged me to go to another one the next week and make a new list with different complaints. I rose to this challenge and did it again, glad to prove my point that AA was stupid and not for me. Bob again listened to my list (without arguing against any complaints) and provided another challenge. Bob asked me to go to another meeting and make a list of the things that I liked from the meeting. I did and, as any alcoholic can tell you, you are bound to hear things in an AA meeting that resonate with you, whether you buy in to the program or not. Bob continued to challenge me to go to meetings, not to go and drink the kool-aid and say some prayers, but to see what I can find that I like. There were other aspects of Bob that I couldn’t figure out why I liked him until one day, I walked into an AA meeting and he was sitting at the front table leading the meeting. Bob is an alcoholic. In that moment I knew that he understood my struggle. Bob was sober and doing meaningful work. Bob was ok. I wanted to be like Bob.

I owe my life to Alex.

I met Alex in the IOP [program] that Bob ran. Alex and I came from different worlds (he was smoking crack on the streets in Baltimore [and] I was drinking in bars in DC), but we had the same reality of sobriety or death. Alex went with me to those AA meetings [around the time that] Bob was challenging me. Alex also brought me to the meeting that would become my home group and introduced me to the people that would soon be my AA family. I owe my life to Alex. I would be remiss not to pay homage to Alex. Alex was murdered in an Oxford house a year in to our sobriety. Alex died sober, which was something he never believed would happen. I miss him every single day.

Finally, my friend Jon; he and I started drinking together as kids. He and I lived together after college and blossomed into the full fledged alcoholics we became. And he and I got sober around the same time on different coasts of the country. When I got out of the hospital, Jon moved back east from California and moved into my mom’s basement. He and I went to AA meetings daily, often more than just one each day. We then spent that first year of sobriety living together trying to figure out how to live.

I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter.

What was not helpful? Counselors who tried to tell me about sobriety that clearly did not understand addiction. Ultimatums also did not help. I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter. Probation was useless. The biggest impact the state had on my drinking was when I was sent to jail.

What prevents you from going back to drinking?

There is nothing in your life that a drink can’t make worse.

JMS: My life now. I love the person I am today. When I was drinking, I hated myself. I never want to be that person again, and I don’t have to be as long as I don’t drink. I have come to the realization that my worst day sober is infinitely better than my best day drinking. I don’t attend AA meetings anymore, but many of the slogans still bounce around in my head. The most important one I ever heard was, “There is nothing in your life that a drink can’t make worse.” I’m not going to lie and say that now I am sober, life is easy and happy and super fun all the time. It’s not. However, I am better equipped to handle the bullshit in life with a clear head. I would be lying to say that I don’t experience cravings but I know that a drink is not the solution to life’s problems.

What’s something you wish you had known before you became addicted to alcohol? (If you could go back in time and have a word with your younger self, what would you say?)

JMS: I feel like most people will expect me to say something like, “I would slap that first drink out of my hand!” That is not true for me at all.I am the person I am today because of my history with drinking. I am proud of the person I have become and I am not sure I would be who I am without the struggles I went through. I would want to assure myself that it was going to turn out okay and that I would not be that miserable forever. I do wish I had understood and cared about (at the time) the severity of the pain and worry I put my mom and siblings through.

What something you wish everyone knew about alcoholism?

JMS: It is not a choice. Alcoholics don’t drink the way they do because they don’t care about you or their families. They drink the way they do because they cannot control the cravings and urges and are overcome by guilt/shame/fear/pain. I am fairly confident that if every alcoholic could “just stop drinking” they would. Alcoholism is exhausting.

What are your thoughts on AA?

JMS: AA can save lives. I attribute my sobriety to the teachings of, and people I met in, AA. That being said, AA does not work for everyone. I like to [view] AA [as] a religion. AA meetings are akin to going to church, the Big Book is the bible, and sobriety is heaven. Some people need to go to church daily to find their way to heaven. Others only need to read the text to understand the tenets of the religion to find their way there. And some people find their way into heaven following other religious texts or none at all. There is no wrong way to get sober. I do have complaints about AA and I feel there are aspects of it that prevent people from finding their way to sobriety. The focus on actual religion in AA is a major turn-off for people. While AA espouses that it is non-denominational and that we alcoholics are welcome to choose the God of our understanding, we are then thrown into a prayer circle to recite the Lord’s Prayer at the end of the meeting. For a low-bottom newly sober person, it is difficult to believe that there is a God that would allow us to sink so low and experience so much pain. But as I mentioned above in my story about Bob, he challenged me to find what I hated (and you better believe that GOD was written in huge letters on that first sheet of paper) and taught me to focus on what I liked.

If you are struggling, try it.

So, my thoughts? If you are struggling, try it. Ignore the God part for now. Listen to other people tell your story and see that it is possible to get better.

How do you feel when people drink around you?

JMS: In a word, annoyed. Slurred speech, glassy eyes, stumbling, and repetitive stories are not a cute look for anyone. I often feel embarrassed for the people I am around as well. It is always a nice reminder of why I don’t drink. I see absolutely nothing attractive to it and I am glad I don’t do that to myself anymore.

What’s the worst thing about being in recovery? The best?

JMS: The worst part [about] being in recovery is trying to explain to people that they don’t have to behave differently around me once they find out. I can’t count the number of times people have asked me if it is okay to drink around me or warned me that there was going to be alcohol at their house. You don’t ask a person with Diabetes if it is okay if you eat a Twinkie, you don’t have to ask me if it is ok for you to have a beer.

There is just an indescribable freedom that comes along with [sobriety].

The best part is being free. I was a slave to my addictions for years. I do not have that struggle anymore. I do not have to worry about where I will find money to buy alcohol. It is a huge struggle in my life that does not exist anymore. There is just an indescribable freedom that comes along with it.

In your opinion, what’s the biggest misconception out there about addiction?

[If you believe addiction is a choice], that just makes you a shitty person.

JMS: I mentioned it above; that addiction is a choice. That idea is closed-minded and short-sighted. And I think it speaks volumes about the person [who] believes that. I cannot fathom believing that someone would do this voluntarily. It is not fun, it does not feel good, and does not make us proud. In my eyes, the belief that this is a choice tells me that you could choose to behave in this manner if you wanted to, and that just makes you a shitty person.

Please share your thoughts on addiction and recovery in a comment!

Tag: alcohol recovery