Substance Use Treatment - Mental Health
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Substance Use Treatment

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Substance Use

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help treat substance use.   

Evidence-based therapies are among the most effective treatments for substance use. They can include the following — which are in many cases available at a local VA medical center.

  • Cognitive Behavioral Therapy (CBT) helps Veterans with substance use disorders develop more balanced and helpful thoughts about themselves, others, and the future. It can help Veterans manage the urge to drink or use drugs, refuse opportunities to use substances, use a problem-solving approach to deal with substance use, and achieve personal goals.
  • Motivational Interviewing (MI) helps Veterans with substance use disorders by focusing on conversations between the Veteran and their provider to detect and strengthen personal motivations for change. This therapy looks at the reasons behind your desire to make a change and the potential benefits of that change.
  • Motivational Enhancement Therapy (MET) helps Veterans with substance use disorders by focusing on conversations between the Veteran and their provider to detect and strengthen personal motivations for change. This therapy looks at the reasons behind your desire to make a change and the potential benefits of that change. MET is a version of MI that focuses specifically on changing alcohol and/or substance use.

Explore more potential treatment options at VA by visiting the Learn About Treatment page.

Medications

Substance use disorder is disease that needs treatment, medication, and sometimes counseling, just like other diseases such as diabetes and high blood pressure. VA offers proven options for controlling alcohol and drug addiction. These options include medications that can reduce cravings, prevent relapse, and reduce the risk of death related to substance use:

For Opioid Use Disorder
  • Methadone
  • Buprenorphine/Naloxone
  • Naltrexone Injection
For Alcohol Use Disorder
  • Acamprosate
  • Disulfiram
  • Naltrexone
  • Topiramate
For Tobacco Use Disorder
  • Nicotiine Replacement Therapy
  • Bupropion
  • Varenicline
Methadone

What does it do?

  • Methadone prevents and relieves withdrawal symptoms.
  • Methadone reduces cravings for opioids without the high associated with other opioid drugs.

How do I take it?

  • Take by mouth once daily.

Where do I get it?

  • Only certified programs known as opioid treatment programs can prescribe methadone for opioid use disorder.

What are possible side effects?

  • Constipation
  • Upset stomach or vomiting
  • Feeling drowsy or sleepy
  • Lower testosterone
  • Increased risk of overdose when combined with sedatives (including alcohol) or other opioids

What side effects should I report to my provider?

  • Allergic reaction or swelling
  • Chest tightness, heart palpitations, or trouble breathing
  • Extreme dizziness, weakness, or sweating
  • Seizures or cold clammy skin
  • Slow or uneven heartbeat
Buprenorphine/Naloxone

What does it do?

  • Buprenorphine/naloxone prevents and relieves withdrawal symptoms.
  • Buprenorphine/naloxone reduces cravings for opioids without the high associated with other opioid drugs.

How do I take it?

  • Dissolve under the tongue once daily, or ask your provider about an extended-release option that is injected into the abdomen.

Where do I get it?

  • Doctors or other providers with a DEA waiver may prescribe buprenorphine/naloxone, which can be obtained from licensed opioid treatment programs.

What are possible side effects?

  • Constipation
  • Upset stomach or vomiting
  • Feeling drowsy or sleepy
  • Lower testosterone
  • Increased risk of overdose when combined with sedatives (including alcohol) or other opioids
  • Injection site pain (if using the extended-release option)

What side effects should I report to my provider?

  • Extreme stomach pain, vomiting, or diarrhea
  • Dark or tea-colored urine
  • Light-colored bowel movements
  • Yellowing of eyes or skin
Naltrexone Injection

What does it do?

  • Naltrexone suppresses opioid craving by blocking the effects of opioid drugs.
  • If you miss a dose or stop naltrexone, you may be more vulnerable to a fatal overdose if you take an opioid again.

How do I take it?

  • Inject into the buttocks muscle every month.

Where do I get it?

  • Doctors or other providers with a DEA waiver may prescribe naltrexone, which can be obtained from licensed opioid treatment programs.

What are possible side effects?

  • Change in appetite
  • Back, muscle, or joint pain
  • Constipation or diarrhea
  • Injection site pain

What side effects should I report to my provider?

  • Allergic reaction or swelling
  • Chest tightness or trouble breathing
  • Anxiety, trouble sleeping, depression, or unusual thoughts
  • Dark or tea-colored urine
  • Yellowing of eyes or skin
Additional Medicine Information

While you’re on these medicines:

  • Do not drink alcohol or take sedatives, tranquilizers, or other drugs that slow breathing (such as benzodiazepines) unless you are otherwise instructed by your provider.
  • Ask your provider for naloxone, emergency medication used to reverse an opioid overdose.

Signs of an overdose (too much medication) include:

  • Trouble breathing, including slow or shallow breathing
  • Snoring, gurgling, or choking sounds
  • Extreme tiredness or heavy nodding
  • Clammy, sweaty skin
  • Bluish or grayish lips, fingernails, or skin

You may take any of these the medications for days, months, or years — as long as is needed to prevent relapse. Talk to your provider about your treatment plan.

A relapse does not mean your treatment has failed. Instead, it means a change in your treatment plan is needed.

Opioid Use Disorder Treatment

Research has shown that behavioral therapy in combination with medication (commonly referred to as medication-assisted treatment, or MAT) is the most effective treatment for opioid use disorder. Patients undergoing therapy who also use MAT are more likely to remain in treatment and see improvements in social functioning. Talk to your VHA provider today to learn more about treatments for opioid use disorder.

If you or a Veteran you know has been diagnosed with opioid use disorder, it is important to learn about naloxone, an emergency overdose medication.

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