Substance Use Disorders

Overview

Combined approaches outperform single modalities. Engagement and ambivalence work (MI) precedes change-focused treatment. Medication-assisted treatment (MAT) is essential for opioid and alcohol use disorders.

First-line treatments

• MI — Motivational Interviewing

  Foundational — resolves ambivalence and engages clients into change.

• CBT — Cognitive Behavioral Therapy

  Relapse prevention (Marlatt) — high-risk situations, coping plans, lapse vs relapse.

Also consider

• DBT

  DBT-SUD adaptation for severe co-occurring emotion dysregulation.

• ACT

  Values-based engagement; defusion from urge thoughts.

• IFS

  Working with the using part as a protector of an exiled wound.

Cautions

• Coordinate with medical/MAT providers; avoid abstinence-only stance when MAT is indicated.
• Address co-occurring trauma — untreated trauma is a top driver of relapse.

Related tools

• AI Homework Builder

Related worksheets

• Pros & Cons of the Urge
• Values Compass
• Self-Compassion Break
• Weekly Mood & Energy Tracker