Missed Opportunities in Treating Substance Use Disorder

When looking at research on the effectiveness of different treatment protocols, one will encounter the phrase “Treatment as Usual (TAU)”. In various areas of science and medicine, TAU would indicate the use of best practices, or practices that include ESTs, Empirically Supported Therapies, which are those therapies that studies have deemed safe and effective for clinical use. In the substance use disorder treatment field, we have a problem when it comes to defining TAU. In the early years of substance use disorder understanding, such as the early 1900s to the 1940s and 1950s, Treatment as Usual may have been things like institutionalization or imprisonment and may have even included things like electroconvulsive therapy or “shock treatment”.

As the paradigm shifted towards group-centered discussion, such as Alcoholics Anonymous, that remained the prevalent TAU until recently. We now use a mixed bag approach, with inpatient and outpatient treatment modes being equally prevalent, and with different types of therapies being popular with different groups. At the best drug and alcohol rehab in Florida, Florida Springs in Panama City, we employ both the best current understanding of medical science, as well as knowledge gleaned from more “spiritually” based approaches like Alcoholics Anonymous and Narcotics Anonymous, as well as important behavior therapies that are prevalent in psycho-social intervention techniques like Cognitive Behavior Therapy. It is not uncommon to see programs based around religious teachings as well, although a medical understanding of addiction disease has become most usual, and in my opinion is particularly important as we continue to address stigmas that are still prevalent in the addiction medicine field. Not all religion-based treatment programs are guilty of increasing disease stigmatization, but all medical interventions for substance use disorder that I have seen help to reduce stigmatization in some way. Substance use disorder is a disease, not a moral failing, and sometimes that message can be confused when religious messaging is an important concern.

Defining and Implementing Best Practices

According to work published in the Journal of Substance Abuse Treatment, “Despite increased emphasis on broadening the implementation of empirically supported therapies (ESTs) to improve standard clinical practice and patient outcomes, objective descriptions of what actually constitutes standard practice in community-based drug abuse treatment do not exist.” This statement follows with what I have seen in my experience in this area. I may even have my own clearly defined ideas about what treatment-as-usual should be, but it may not be as concrete as is necessary to further scientific understanding in the field.

These experts present data from independent ratings of 379 audiotapes drawn from the “treatment-as-usual” arm of two multisite randomized effectiveness trials in the National Institute on Drug Abuse Clinical Trials Network. According to those studies, “the most frequently occurring strategies involved assessing the participant’s substance use and social functioning, asking open-ended questions, discussing problems and feedback, and giving advice and direction. However, a number of interventions associated with ESTs were very rarely implemented in these early sessions. These data suggest missed opportunities for optimally engaging patients in the early stages of treatment and enhancing substance use outcomes and only moderate success to date of efforts to bridge the gap between research and practice.”

It is important for both new and old substance use disorder treatment programs to look at research on best practices and treatment as usual, and it is important that we define Treatment-as-Usual in the field of substance abuse treatment. If a new community-based program is being started, we would like to see those new patients get the best possible treatments and interventions for their disease. Likewise, even places like Florida Springs, the best drug and alcohol rehab in Florida, must continually evaluate approaches to early treatment. If data suggests that psycho-social interventions, like CBT, should be used more and used sooner, that information is important for all types of providers. At a time when the vast majority of patients do not have the means to pay for the treatment they need, it is incredibly important that the treatments that do receive funding are using up-to-date best practices.

We do not have room for missed opportunities in substance use disorder treatment. With the coronavirus pandemic worsening the opioid and addiction crisis, it is time for all treatment providers to learn and adapt for the long fight ahead. If you or a loved one needs drug or alcohol abuse treatment, the best drug and alcohol rehab in Florida is Florida Springs Wellness and Recovery Center in Panama City, and our experts are available at the number listed above.

By T.A. Cannon (Contact me at TACannonWriting@gmail.com)


Santa Ana, Elizabeth J et al. “What is usual about “treatment-as-usual”? Data from two multisite effectiveness trials.” Journal of substance abuse treatment vol. 35,4 (2008): 369-79. doi:10.1016/j.jsat.2008.01.003