To address the spectrum of substance use problems and disorders, a continuum of care provides individuals an array of service options based on need, including prevention, early intervention, treatment, and recovery support ( Figure 4.1). 16 In contrast, severe, complex, and chronic substance use disorders often require specialty substance use disorder treatment and continued post-treatment support to achieve full remission and recovery. These common but less severe disorders often respond to brief motivational interventions and/or supportive monitoring, referred to as guided self-change. Mild substance use disorders can be identified quickly and reliably in many medical and social settings. A continuum of care may include prevention, early intervention, treatment, continuing care, and recovery support. An integrated system of care that guides and tracks a person over time through a comprehensive array of health services appropriate to the individual's need. A service or set of services that may include medication, counseling, and other supportive services designed to enable an individual to reduce or eliminate alcohol and/or other drug use, address associated physical or mental health problems, and restore the patient to maximum functional ability. This chapter provides an overview of the scientific evidence supporting the effectiveness of treatment interventions, therapies, services, and medications available to identify, treat, and manage substance use problems and disorders. 5 This is particularly true for the treatment of those with co-occurring substance use and physical or mental disorders. However, a number of barriers have limited the widespread adoption of these services, including lack of resources, insufficient training, and workforce shortages. The addition of services to address substance use problems and disorders in mainstream health care has extended the continuum of care, and includes a range of effective, evidence-based medications, behavioral therapies, and supportive services. With this recognition, screening for substance misuse is increasingly being provided in general health care settings, so that emerging problems can be detected and early intervention provided if necessary. Research shows that the most effective way to help someone with a substance use problem who may be at risk for developing a substance use disorder is to intervene early, before the condition can progress. The good news is that a spectrum of effective strategies and services are available to identify, treat, and manage substance use problems and substance use disorders. See Chapter 6 - Health Care Systems and Substance Use Disorders.
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