What to expect during substance use disorder diagnosis and treatment

Substance use disorder affects millions of people in the U.S. If you live with substance use disorder, you may have tried to stop using substances or found recovery in the past — only to end up in unhealthy use again later on. Breaking the cycle of addiction can be hard. But you don’t need to do it alone.

Research shows many treatment methods for substance use disorder to be highly effective — especially treatment programs lasting 18 months or more. Substance use disorder treatment can be a lengthy (and sometimes lifelong) journey, and getting the right diagnosis is an important step you can take.

With treatment, you can give yourself a better chance at breaking away from substance use disorder for good and building a life that feels fulfilling to you.

How is substance use disorder diagnosed?

Substance use disorder can be diagnosed by a health professional, including mental health professionals (like psychologists and therapists) and medical professionals like nurse practitioners and physicians. Who diagnoses you usually depends on who you seek support from first. For example, if you tell your therapist about your substance use, they may be the one to diagnose you. If you go to the emergency room due to withdrawal or overdose, it could be the ER physician who diagnoses you first.

To diagnose substance use disorders, health professionals may ask you questions and compare your symptoms and experiences with the diagnostic criteria that’s listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the text that health professionals use to make psychiatric diagnoses and treatment decisions.

Health professionals may also consider their own observations of your symptoms and physical exam results to help them make a diagnosis. For example, if you present with symptoms of being under the influence or in withdrawal, that might guide their diagnosis decisions.

Some of these symptoms they will be on the look out for are:

• Taking more of the substance than you intend to — for example, you set out to have only one drink, only to come home after having many more
• Wanting or trying to cut down on or stop using the substance, only to find that you can’t manage it on your own
• Having cravings and urges to use the substance 
• Not being able to fulfill your responsibilities at work, school, or home because of substance use
• Continuing to use substances even when it causes significant problems in your life or relationships
• Giving up important activities in favor of substance use — for example, deciding not to attend a family birthday party because you want to get high instead
• Continuing to use substances even when it puts you in danger
• Developing a tolerance to the substance and needing more and more of it over time to get the same effect
• Experiencing withdrawal symptoms, like agitation or physical symptoms, when you stop using substances

Substance use disorder diagnosis specifiers

There are also current “specifiers,” which are terms that more specifically describe your unique symptoms of substance use disorder.

For example, severity specifiers allow practitioners to note how severe your symptoms are. 

• If you meet two to three of the diagnostic criteria, you may be diagnosed with “mild” substance use disorder.
• If you meet four to five of the criteria, you can be diagnosed with “moderate” substance use disorder.
• If you meet six or more of the criteria, you may have “severe” substance use disorder.

The diagnosing professional can also add indicators of other aspects of your situation. For example, they can indicate that you’re “in early remission” (you’ve refrained from using substances for over three months but less than a year) or “sustained remission” (you’ve refrained from using for over a year). Or they can indicate that you’re “in a controlled environment,” meaning that you’re in a facility, like a rehab, where you don’t have access to drugs and alcohol.

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How are substance use disorders treated?

There are many effective treatment methods for substance use disorder. Your healthcare provider will work with you to recommend the best option for you. This can depend on many factors, including what substance you use, what you’ve already tried, if you have other mental health conditions (like depression or anxiety), whether you’re experiencing physical withdrawal symptoms, and the resources (including time and finances) that you have available.

Medical detox

If you’re currently using substances or in withdrawal, you may need medical detox treatment. During detox, you’ll stay at a facility — usually a hospital or inpatient rehab facility — while your body gets rid of remaining traces of the substance. This can be an important first step in treatment for certain substances, like alcohol, that can cause severe and even potentially deadly withdrawal symptoms. Withdrawing in a medical detox facility can make sure you’re safe and taken care of.

Therapy

One of the most common and effective types of substance use treatment is outpatient therapy, or counseling. You can meet with a therapist — either online or in their office — to talk about your substance use symptoms, explore underlying causes and triggers, and learn new strategies to fight cravings and cope with painful emotions in healthier ways.

The type of substance use therapy that works for you depends on many factors, including your age, the severity of your symptoms, and any other co-occurring mental health conditions you live with. Teens who live with substance use disorder, for example, might benefit from family therapy.

Some therapy methods often used for substance use disorder include:

• Cognitive behavioral therapy (CBT): CBT is a common therapy technique used for a variety of mental health conditions, including substance use disorder. This approach helps you reframe unhelp thought patterns and develop healthier coping mechanisms. 
• Motivational interviewing (MI): MI helps you uncover your internal motivations for continuing and wanting to stop substance use. This therapy technique reminds you that you’re the expert of your life — only you know why you started using substances and what it would take for you to quit.  
• Dialectical behavior therapy (DBT): DBT is another approach useful for treating substance use — especially if you experience intense emotions or impulsivity. Through this therapy approach, you’ll learn emotional regulation, distress tolerance, and interpersonal effectiveness. 

Inpatient treatment

Some people with substance use disorder might benefit from inpatient or residential treatment programs, where you live in a facility and receive treatment at the same time. Some inpatient treatment programs are in hospitals, but many residential programs are in comfortable home-like settings. This can be especially helpful for you if your home environment is a substance use trigger for you.

Medication

Sometimes, medication is an important part of recovering from substance use disorder. For example, certain medications can help reduce cravings and withdrawal symptoms for people who live with opioid use disorder. It’s important to work with your provider to decide if medication is the right option for you. 

Relapse prevention

If you’re already in remission from substance use disorder, your treatment might focus more on relapse prevention, or making sure you don’t start using substances again. Your treatment provider can help you create a personalized relapse prevention plan that you can use when you face urges to use, including supportive people in your life you can count on and coping skills you can use to fight the cravings.

Preparing for substance use disorder treatment

Substance use disorder treatment can feel intimidating, but with the right support and preparation, you can set yourself up for success. Remember that treatment professionals aren’t there to judge you or control you. You’re still the driver of your own life, and they’re simply there to be a helpful guide. If you ever feel that a healthcare professional is judging you for substance use, it might be a good idea to switch providers if possible.

Start by reflecting on your substance use history — including when it began, what substances you use, how often, and any attempts you’ve made to stop. Write down any physical or emotional symptoms you’ve been experiencing, like withdrawal symptoms, cravings, or impacts on your daily life.

It’s also helpful to think about your goals for treatment. Are you hoping to stop using substances entirely, reduce your use, or gain better control over your cravings? Knowing your goals can help guide your conversations with your provider and ensure that you’re both working toward the same outcomes.

Your first appointment for substance use disorder treatment is often about gathering information and building trust with your provider. The healthcare professional you meet with will likely ask you detailed questions about your substance use, medical history, mental health, and current life circumstances — especially if you don’t have a diagnosis yet. 

Some questions they might ask include:

• What substances do you use, and how often?
• Have you experienced withdrawal symptoms when you try to stop using?
• Have you faced any physical health problems, like liver issues or trouble sleeping, because of substance use?
• How has substance use affected your relationships, work, or daily life?
• Do you have a family history of substance use or mental health disorders?

You’ll also get the opportunity to ask any questions that you have about the treatment process or get clarifications for any worries you might have. You might ask questions like:

• What are the treatment options available for me, and what do you recommend based on my situation?
• How long will treatment typically last?
• How much will treatment cost? Will my insurance plan cover it?
• How will we measure progress in treatment?
• Are there any support groups or community resources you can connect me with?

Don’t be afraid to be honest with your provider — they’re better equipped to help you if they have a complete picture of what you’ve been going through.

Find care with Rula

Substance use disorder is a painful but treatable condition. With the right combination of therapy, support, and resources, you can break free from the cycle of addiction and rebuild your life. Recovery is possible — and every step you take toward healing is a step worth celebrating.

If you or someone you love are ready to prioritize mental well-being and recovery, Rula is here to help. Rula’s network of 10,000+ licensed therapists provides compassionate, evidence-based care for substance use disorder and related mental health concerns.

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