Screening and

Interventions
of Substance
Dependence
SADAF AMBREEN SAIYAD

ASSISTANT PROFESSOR

AIBAS, AUM
 • Screening, diagnosis, motivation to
change, change without formal treatment
• Professional treatment: individual
counselling, the family and drug
addiction, Family counselling.
Index
• Self-help groups: alcohol anonymous and
narcotic anonymous
• Systemic intervention: demand
reduction, supply reduction and harm
reduction
SCREENING
Lab Based Drug
Testing
Urinalysis

• These tests depend on a chemical

reaction between the specimen
and an antibody designed to react
to a specific drug.
• The chemical reaction causes a
change in the specimen’s
transmission of light, which is
measured by a machine.
• If the reading is higher than a
given standard, the specimen is
positive for the drug.
Hair Analysis

• Hair analysis has been used for some time to detect exposure to such toxic
metals as mercury and lead.
• In a process similar to that of urinalysis, dissolved hair shafts reveal whether
drugs are in the blood.
• Because of the unique qualities of hair growth— about one-half inch a month—
it may be possible to determine the amount of drug use over a period of
several months and whether it is increasing or decreasing.
• Although it can reveal drug use within the prior three months, it cannot be
used to detect recent usage.
• Hair analysis has been suggested as an initial screening method for drug use,
positives to be corroborated by urinalysis
 For this type of test, a Band-Aid-like
patch is attached to the skin to collect
sweat for up to seven days and is
subsequently lab-tested for drug
residue.
If the patch is removed, it cannot be
reattached.

Sweat
Patch This test is often used by probation and
parole agencies.

However, drug molecules from clothes

or other people can penetrate the patch
and trigger a false positive
 • Portable devices that detect drug
residues are used in the workplace
and schools.
• They can identify vapors from
minuscule particles of heroin,
cocaine, and methamphetamines.
• Samples are gathered at such critical
Drug areas as doorknobs or desktops by
Residues cloth or vacuum cleaners and are
analyzed through gas
chromatography, a process that
separates out compounds according
to their boiling points; a readout
indicates the type of substance that
is detected.
Psychological
Screening Tests
Alcohol Use
Disorder
Identification Test
(AUDIT)
• 10-item screening tool
developed by the World Health
Organization (WHO) to assess
alcohol consumption, drinking
behaviors, and alcohol-related
problems.
• Both a clinician-administered
version (page 1) and a self-
report version of the AUDIT
(page 2) are provided.
• Patients should be encouraged
to answer the AUDIT questions
in terms of standard drinks.
AUDIT

• A chart illustrating the

approximate number of standard
drinks in different alcohol
beverages is included for
reference.
• A score of 8 or more is considered
to indicate hazardous or harmful
alcohol use.
• The AUDIT has been validated
across genders and in a wide
range of racial/ethnic groups and
is well suited for use in primary
care settings.
 • A comprehensive screening tool
developed by the WHO to assess
use of alcohol, tobacco, cannabis,
cocaine, and other drugs.
• It screens for problematic
Alcohol, substance use across multiple
Smoking and substances, including both legal
Substance and illicit drugs.
• It assesses the level of risk
Involvement associated with each substance,
Screening helping healthcare providers
determine the level of intervention
Test (ASSIST) needed.
• Based on scores, the tool helps
guide whether brief intervention,
counseling, or further treatment is
recommended.
ASSIST

• The questionnaire typically has 8 questions for each substance, covering areas
such as: Lifetime and recent (past three months) use of each substance;
Frequency of use in the past three months; Cravings for the substance; Impact
of use on health, relationships, responsibilities, and legal issues; Failed attempts
to quit or cut down on the substance; Risky behaviors while under the influence
• The ASSIST produces a risk score for each substance:
• Low Risk: Indicates that substance use is not likely to cause harm and may not
require intervention.
• Moderate Risk: Suggests that use is risky, and a brief intervention may be
needed.
• High Risk: Indicates a higher likelihood of dependence or harmful use, and may
require referral to specialized treatment.
 CRAFFT Screening
Tool for Adolescents
• Specifically designed for adolescents
and young adults to identify high-risk
alcohol and drug use. Each letter in
"CRAFFT" represents a key area
related to substance use. Here’s what
it stands for:
• C - Have you ever ridden in a Car
driven by someone (including
yourself) who was "high" or had been
using alcohol or drugs?
• R - Do you ever use alcohol or drugs
to Relax, feel better about yourself,
or fit in?
• A - Do you ever use alcohol or drugs
while you are Alone?
CRAFFT

• F - Do you ever Forget things you did while using alcohol or

drugs?
• F - Do your Family or Friends ever tell you that you should cut
down on your drinking or drug use?
• T - Have you ever gotten into Trouble while you were using
alcohol or drugs?
• A score of 2 or more on the CRAFFT indicates a need for further
assessment and possibly intervention, as it suggests higher risk
behaviors related to substance use.
 ICMR
Substance Use
Screening Tool
• Screening instrument developed by
the Indian Council of Medical
Research (ICMR) to identify and
assess substance use disorders in
India.
• It was created to address the need for
a culturally relevant tool that fits the
unique socio-cultural and
demographic characteristics of the
Indian population.
• This tool is particularly useful for
assessing substance use in primary
healthcare and community settings
across India.
• Helps in early detection of substance
use and assists healthcare providers
ICMR

The tool typically includes questions on both lifetime and current use of
various substances.

Questions assess the frequency and patterns of substance use, including

quantity and impact on daily functioning, relationships, and health.

The tool is specifically adapted to Indian cultural contexts, taking into account
the stigma and sensitivities around substance use in India.

Designed to be administered by healthcare workers with minimal training,

making it accessible for use in resource-limited settings and by community
health workers.
ICMR

• Low Risk: Occasional or low-frequency use, suggesting that no

immediate intervention may be necessary.
• Moderate Risk: Regular use or any use that begins to show
negative effects on health or lifestyle, indicating the need for
brief intervention or counseling.
• High Risk: Daily or heavy use, or use with significant impact on
mental or physical health, which may require further assessment
and potential referral to specialized treatment services.
Drug Abuse
Screening Test (DAST)
• A brief, self-report screening tool
designed to assess drug use and
identify potential drug-related
problems and the severity of drug
misuse.
• Developed in 1982, the DAST is widely
used in both clinical and research
settings for quickly screening
individuals who may be at risk of
substance use disorders.
• It focuses specifically on drug use,
excluding alcohol and tobacco.
DAST

Versions:

DAST-20: The original 20-item version with yes/no questions.

DAST-10: A shorter, 10-item version that maintains effectiveness for

screening but requires less time to complete.
DAST-28: A more comprehensive 28-item version for in-depth
assessments.
DAST-1: A single-question version used in some settings for very
brief screening.
 • Structure:
• The DAST is a series of yes/no
questions covering various
aspects of drug use, including:
• Frequency and patterns of use.
• Impact on relationships,
DAST responsibilities, and daily
functioning.
• Physical and mental health
consequences.
• Attempts to cut down or
control use.
• Legal issues and risk-taking
behaviors associated with
drug use.
DAST
• Each "yes" answer is scored as 1
point, and the sum of "yes"
responses indicates the severity of
drug use.
• The DAST is often used in primary
care, mental health clinics,
substance abuse treatment
programs, and research studies.
• It provides a quick assessment of
drug use that can be administered
by clinicians or completed by the
patient as a self-report.
• Typically takes 5–10 minutes to
complete.
CAGE Questionnaire

• A brief and widely used screening tool for identifying potential

alcohol use disorders.
• It consists of four simple questions that can quickly indicate if
a person may have an alcohol problem.
• Its name, CAGE, is derived from keywords in each question,
making it easy to remember.
• Useful in identifying potential problems with alcohol in a
variety of settings, including primary care, mental health, and
emergency departments.
• It is not a diagnostic tool but serves as a quick screen to flag
individuals who may need further assessment.
 • The CAGE Questionnaire consists of
four yes/no questions:
• Cut down: "Have you ever felt you
should cut down on your drinking?"
• Annoyed: "Have people annoyed you
by criticizing your drinking?"
CAGE • Guilty: "Have you ever felt bad or
guilty about your drinking?"
• Eye-opener: "Have you ever had a
drink first thing in the morning (an
'eye-opener') to steady your nerves
or get rid of a hangover?"
 CAGE

• Each "yes" response is scored as 1 point, for a total score range of

0 to 4.
• A score of 2 or more is considered a positive screen, suggesting
that further assessment for alcohol use disorder may be
warranted.
• Higher scores indicate a stronger likelihood of an alcohol problem.
• Often used as an initial screen in healthcare settings to identify
individuals who may need further evaluation or intervention.
• Can be part of routine health assessments, especially in
populations where alcohol misuse may be a concern.
 • A structured diagnostic interview used for
identifying a variety of psychiatric
disorders based on the DSM and ICD
criteria.
• The MINI includes a specific Substance
Use Disorders (SUD) module that
screens for potential substance-related
MINI (Mini
International disorders, making it valuable for assessing
Neuropsychiatric substance use in clinical settings.
Interview) –
Substance Use • Offers a standardized, structured
Disorders Module approach for assessing a range of
substance-related issues across multiple
substances.
• Can be used to determine the presence of
a substance use disorder and the need for
further intervention or treatment.
MINI

• The Substance Use Disorders module consists of yes/no

questions that address the diagnostic criteria for
substance abuse and dependence.
• Focuses on behaviors, symptoms, and consequences
related to substance use within a specific timeframe
(often the past 12 months).
 MINI
• Components Assessed:
• Frequency and Pattern of Use: Includes questions on how often and how
much of each substance is used.
• Cravings and Loss of Control: Examines cravings, unsuccessful attempts
to reduce use, and any loss of control over use.
• Physical and Psychological Dependence: Identifies signs of
dependence, such as tolerance (needing more of the substance to achieve
the same effect) and withdrawal symptoms.
• Impact on Life: Screens for the negative impact of substance use on
various aspects of life, including work, school, family relationships, and
social activities.
• Risky Behaviors and Consequences: Assesses risk-taking behaviors and
adverse outcomes, like legal issues or accidents related to substance use.
MINI

Scoring and Diagnosis:

Responses help determine whether the individual meets the diagnostic criteria for
substance abuse or dependence (or a substance use disorder, according to DSM-5).

Depending on the version (DSM-IV, DSM-5, ICD-10), the MINI provides a structured
way to confirm the diagnosis.

Diagnoses may be categorized based on severity, often as mild, moderate, or severe,

to inform treatment planning.
Diagnostic
Process
 Clinical Interview
• The clinical interview is a fundamental
component of the assessment process in
mental health and substance use
treatment.
• It involves a structured or semi-structured
conversation between a healthcare
professional (such as a psychiatrist,
psychologist, or counselor) and a client.
• The primary purpose of the clinical
interview is to gather comprehensive
information about the individual's history,
symptoms, and functioning, which is
essential for accurate diagnosis and
treatment planning.
 Interview – key concepts

• Establishing Rapport:
• Building a trusting relationship with the client is crucial. The interviewer
should create a comfortable environment where the client feels safe to
share sensitive information.
• Effective communication skills, empathy, and active listening are vital
for establishing rapport.
• Gathering Demographic Information:
• Basic information such as the client's name, age, gender, marital status,
occupation, and educational background is collected at the beginning.
• This helps in understanding the context of the individual's life and can
influence treatment.
 Interview – key concepts

Presenting Problem:

The interviewer asks the client to describe their current issues or concerns, often referred to as the "chief
complaint."
Understanding the client’s perspective on their problems is critical, as it informs the assessment and
subsequent interventions.
Substance Use History:

A thorough assessment of the client’s substance use patterns is conducted.

Psychiatric History:

Exploration of any previous mental health issues, diagnoses, and treatments.

Inquiry about past psychiatric hospitalizations, therapy, medications, and any history of suicide attempts
or self-harm.
 Interview – key concepts

• Medical History:
• Assessment of the client’s physical health, including any chronic
illnesses, medical treatments, and medications currently being taken.
• Understanding medical history is important, as certain health
conditions can influence or be influenced by substance use.
• Family History:
• Gathering information about family history of substance use
disorders, mental health issues, and other relevant health problems.
• Family dynamics and support systems can impact the client’s
recovery process.
Interview – key concepts

Social and Environmental Factors:

Understanding the client’s social support network, including relationships with family, friends, and
significant others.

Assessment of the client's living situation, employment status, and any environmental stressors
(e.g., financial issues, legal problems).

Mental Status Examination:

A brief assessment of the client's cognitive and emotional functioning, including appearance,
behavior, mood, thought processes, and orientation.

Helps identify any immediate concerns that may need to be addressed (e.g., severe depression,
psychosis).
 Interview – key concepts

• Risk Assessment:
• Evaluation of potential risks, including suicidal ideation, self-
harm, and harm to others.
• Understanding the client’s level of risk is essential for safety
planning and determining the urgency of treatment.
• Treatment Goals and Preferences:
• Discussing the client’s expectations for treatment and any
goals they wish to achieve.
• Exploring the client's motivation for change can help tailor
the treatment approach.
Interview - types

1 2 3
Structured Interviews: Semi-Structured Unstructured Interviews:
Follow a predetermined set of Interviews: Combine More informal and
questions with little deviation. standardized questions with conversational. The
They ensure consistency the flexibility to explore topics interviewer guides the
across interviews and are in more depth based on the discussion based on the
often used in research client’s responses. This format client's responses, which can
settings. Examples include the allows for a more lead to discovering
Structured Clinical Interview individualized approach while unexpected issues or insights.
for DSM Disorders (SCID) and still covering essential areas.
the MINI.
Assessment

Physical Examination and

Screening Tools: Laboratory Tests: In some
Standardized screening tools cases, a physical
(e.g., CAGE, AUDIT, ASSIST, examination and laboratory
DAST) may be used to assess tests may be necessary to
the severity and potential evaluate the health effects of
impact of substance use. substance use and rule out
other medical conditions.
 Collateral Information: Information
from family members, friends, or other
healthcare providers may provide
additional context regarding the
individual’s substance use and its
impact on their life.

Final steps
Cultural Considerations: Cultural
and social factors should be
considered, as they may affect the
individual’s substance use patterns,
perceptions of use, and readiness for
treatment.
 1 2 3 4
Treatment Monitoring Preventing Facilitating
Planning: Progress: Tracking Relapse: Identifying Support: Engaging
Understanding the changes in substance specific triggers or the individual in
severity and specific use and recovery over issues related to support networks,
needs of the time. substance use that therapy, and
individual helps tailor may contribute to community resources.
interventions and relapse.
treatments.

Importance of Accurate Diagnosis

MOTIVATION TO
CHANGE
Motivation
• Motivation to change is a critical
factor in the treatment and recovery
process for individuals with substance
use disorders (SUDs).
• It refers to the willingness and
readiness of a person to modify their
behavior, particularly regarding
substance use, and can significantly
influence the effectiveness of
treatment interventions.
• Understanding and enhancing
motivation can lead to better
outcomes in recovery.
 Stages of Change
Developed by Prochaska and DiClemente, the Transtheoretical Model of Change outlines
several stages that individuals typically go through when making behavioral changes. These stages
include:
Precontemplation: The individual is not yet considering change and may be unaware of the
negative consequences of their substance use.
Contemplation: The individual recognizes the potential need for change but is ambivalent about
taking action.
Preparation: The individual intends to change soon and may begin to make small steps toward
that goal.
Action: The individual actively engages in behaviors to change their substance use patterns.

Maintenance: The individual works to sustain the changes made and prevent relapse.

Relapse: This stage involves returning to substance use after a period of abstinence; individuals
can cycle back to earlier stages as they navigate their recovery journey.
Intrinsic vs. Extrinsic Motivation

Intrinsic Motivation: Refers to internal drives to change, such as personal values,

self-efficacy, or the desire for improved well-being and quality of life. Individuals with
strong intrinsic motivation are more likely to commit to long-term recovery.

Extrinsic Motivation: Involves external factors that drive behavior change, such as
pressure from family, legal consequences, or employment issues. While extrinsic
motivation can initiate change, it may not sustain long-term recovery without internal
motivation.
 Motivational Interviewing (MI):

Strategies to MI is a client-centered, directive approach

Enhance designed to enhance intrinsic motivation for

change by exploring and resolving

Motivation ambivalence.

Key techniques include reflective listening,

open-ended questions, affirmations, and
summarizing. The goal is to help individuals
articulate their reasons for change and
strengthen their commitment to recovery.
Goal Setting:
• Collaboratively setting achievable, specific,
and meaningful goals can provide direction and
motivation. Breaking larger goals into smaller,
manageable steps helps build confidence and
momentum.
Psychoeducation:
• Providing information about the effects of
substance use and the benefits of recovery can
enhance awareness and motivation.
Understanding the science behind addiction
can help individuals recognize the need for
change.
Building Support Networks:
• Encouraging participation in support groups
(e.g., Alcoholics Anonymous, Narcotics
Anonymous) fosters a sense of community and
accountability. Sharing experiences with others
in recovery can motivate individuals and
reduce feelings of isolation.
Addressing Barriers to Change:
• Identifying and addressing
obstacles that may hinder
motivation (e.g., mental health
issues, financial stress, lack of
support) can help individuals feel
more empowered to pursue
recovery.
Celebrating Progress:
• Recognizing and celebrating
small achievements in recovery
reinforces positive behavior and
can sustain motivation.
Encouraging individuals to reflect
on their progress fosters a sense
of accomplishment.
 CHANGE
WITHOUT
FORMAL
TREATMENT
What is it?

This phenomenon, often referred to as natural recovery or self-change,

occurs when a person successfully reduces or stops their substance use on their
own without participating in structured treatment programs or formal support
groups.

Although formal treatment can be very beneficial, research and clinical

experience show that some people achieve recovery independently, using
personal strategies and informal support.
 Contributing
Factors

Life
Personal
circumstances
motivation and Supportive social Self-efficacy and Spontaneous
and
readiness to networks coping skills remission
environmental
change
change
Personal Motivation and Readiness to
Change

A strong intrinsic motivation and readiness to change can drive

individuals toward recovery.

Some may reach a point where the negative consequences of

substance use outweigh the perceived benefits, which
motivates them to stop or reduce their use.

Key events, like health scares, relationship crises, or job loss,

can act as "wake-up calls" that prompt individuals to re-
evaluate their substance use.
Supportive Social Networks

• Support from family, friends, or

community members can make
a big difference.
• Many individuals find motivation
and accountability in informal
support systems, which can
replace some of the functions of
formal treatment.
• A strong social network can
provide encouragement, help
individuals stay accountable,
and reduce feelings of isolation
during the recovery process.
High Levels of Self-Efficacy
and Coping Skills
• People with high self-efficacy, or confidence in
their ability to make positive changes, may be
better able to self-manage cravings and avoid
relapse without formal support.
• Those with well-developed coping skills may
be able to handle stress, social pressures, and
negative emotions without turning to
substances.
• These skills can be strengthened by life
experience, self-help resources, or past
attempts to quit.
 Life Circumstances and
Environmental Changes
• Changes in environment, such as moving to a new
location, starting a new job, or changing peer
groups, can disrupt established patterns of
substance use.
• Positive life changes, like engaging in a fulfilling
career, developing new hobbies, or becoming
involved in meaningful relationships, can provide
alternative sources of satisfaction and purpose,
reducing the desire to use substances.
Spontaneous Remission

• In some cases, individuals naturally reduce their use

over time without intervention, a phenomenon known
as spontaneous remission.
• This may occur due to physiological, psychological, or
social changes that alter the person's relationship with
substance use.
Strategies for Self-
Change in Substance Use
Disorders
Self-help literature and resources
• Books, online resources, and guides on
addiction and recovery can provide valuable
insights and strategies for change. Many
people find that learning about addiction and
recovery helps them develop effective self-
management strategies.
Behavioral Strategies:
• Self-monitoring substance use, setting limits,
and creating a plan for avoiding high-risk
situations are common self-help strategies.
Some use mindfulness, exercise, or other
techniques to manage cravings and reduce
stress.
Informal Support Networks:
• Friends, family, or community members who
provide emotional support can make a
significant difference in recovery efforts.
Some people may also participate in online
support communities that provide
encouragement and accountability.
Strategies for Self-
Change in Substance Use
Disorders
Developing New Habits and
Interests:
• Building new routines, engaging in
hobbies, and finding new sources of
enjoyment and fulfillment can
replace the role substances
previously played in a person’s life.
Reflection and Personal Growth:
• Some people focus on self-reflection,
goal-setting, and creating a
meaningful life as part of their
recovery. This often includes
identifying core values, setting long-
term goals, and pursuing personal
 Limitations and Risks of Self-Change
Lack of Support for Severe Cases: For individuals with severe SUDs,
especially those with co-occurring mental health disorders or physical
dependence, professional support and medical supervision are often crucial for
safe and sustained recovery.

Relapse Risk: Without structured support, the risk of relapse can be

higher, especially during stressful periods or when facing significant
triggers.

Limited Coping Resources: Formal treatment often provides individuals

with skills for managing cravings, emotional distress, and social pressures.
Without these, it can be harder to maintain change.

Medical Risks of Withdrawal: For certain substances (e.g., alcohol,

benzodiazepines), quitting suddenly without medical supervision can lead to
dangerous withdrawal symptoms. In these cases, professional help is
recommended.
PROFESSIONAL
TREATMENT
 Individual counseling is a key component of
treatment for substance use disorders, providing
a one-on-one therapeutic relationship between a
client and a trained counselor or therapist.

This form of counseling aims to help individuals

Individual understand the underlying causes of their
substance use, develop effective coping
Counselling mechanisms, and build motivation and skills for
recovery.

Individual counseling is personalized, meaning

that sessions are tailored to address each client’s
unique needs, challenges, and goals.
Goals of Individual
Counselling
Understanding Substance Use Patterns:
• The therapist works with the client to explore their history of substance
use, including triggers, consequences, and the role that substance use
plays in their life. This understanding helps the client recognize patterns
that contribute to their addiction.
Identifying Underlying Issues:
• Many people with SUDs struggle with underlying issues such as trauma,
mental health conditions (like depression or anxiety), low self-esteem, or
relationship problems. Counseling provides a safe space to explore and
address these underlying issues.
Building Coping Skills:
• Individual counseling teaches practical skills for managing cravings, stress,
and negative emotions. These skills are essential for maintaining sobriety
and preventing relapse.
Enhancing Motivation and Commitment:
• Counselors help clients increase their motivation to change through
techniques like motivational interviewing (MI), which focuses on resolving
ambivalence and strengthening commitment to recovery.
Developing a Relapse Prevention Plan:
• Counselors work with clients to develop strategies for handling high-risk
situations and preventing relapse. Clients learn to recognize warning signs
and have a plan in place for maintaining sobriety.
Collaborative Goal Setting:
• In counseling, clients work with their therapist to set specific,
realistic goals for recovery. Having clear goals helps to guide the
treatment process and keeps clients focused on their progress.
Therapeutic Alliance:
• The relationship between client and therapist, known as the
therapeutic alliance, is central to successful counseling. A strong
alliance, characterized by trust, empathy, and respect, increases
client engagement and helps them feel supported in their recovery
journey.
Skill-Building and Practice:
• Counseling sessions often involve practicing new coping skills,
problem-solving techniques, and relapse prevention strategies.
Key Elements
Clients are encouraged to apply these skills outside of therapy in
real-world situations. of Individual
Monitoring and Adjusting Treatment:
• Recovery from SUDs is an ongoing process that may require
Counselling
adjustments to treatment as the client progresses. Effective
counselors continuously monitor the client’s progress and adapt the
treatment plan as needed to address emerging challenges or
changing goals.
Encouraging Accountability:
• Individual counseling helps clients stay accountable to their recovery
goals. Regular check-ins with a therapist provide opportunities for
self-reflection, progress assessment, and course correction when
needed.
Motivational Enhancement Therapy
(MET)
Motivational Enhancement Therapy (MET) is a client-centered counseling
approach designed to help individuals with substance use disorders (SUDs) increase
their intrinsic motivation to change and develop a commitment to recovery.

MET is rooted in the principles of motivational interviewing (MI) and focuses on

enhancing motivation by helping individuals resolve ambivalence about changing
their substance use behavior.

MET is typically short-term, with sessions focusing on engaging clients in discussions

that help them see the benefits of change and develop personal goals that align with
their values and aspirations.
Cognitive Behavioural Therapy (CBT)

• Cognitive-Behavioral Therapy (CBT) is an evidence-based treatment for

substance use disorders that focuses on identifying and modifying problematic
thought patterns and behaviors that contribute to substance use.
• CBT is highly effective and is widely used to help individuals manage cravings,
develop healthy coping skills, and prevent relapse.
• By examining the connections between thoughts, emotions, and behaviors,
CBT empowers clients to recognize and change their habitual responses to
stressors, which can reduce reliance on substances.
 Contingency Management
• Contingency Management (CM) is a
behavioral treatment approach for
substance use disorders that uses
rewards or incentives to reinforce
positive behaviors, such as abstinence,
attendance in treatment sessions, and
treatment adherence.
• The main idea behind CM is based on the
principles of behavioral psychology,
where behaviors that are rewarded are
more likely to be repeated.
• CM is particularly effective in treating
SUDs, including those involving
substances like opioids, stimulants,
Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a structured, evidence-based

treatment that has been adapted effectively for substance use disorders,
especially when SUDs co-occur with other mental health conditions like
borderline personality disorder (BPD).

Originally developed by Dr. Marsha Linehan for treating BPD, DBT combines
cognitive-behavioral techniques with mindfulness practices to help individuals
regulate emotions, tolerate distress, and improve relationships.

In treating SUDs, DBT’s primary goals are to reduce substance use, manage
triggers, develop coping skills, and enhance emotional regulation.
Family Counseling

By involving family members

Family counseling is a in the recovery process,
Family counseling for SUDs
critical component of family counseling aims to
acknowledges the importance
treatment for substance use reduce enabling behaviors,
of the family unit in both
disorders (SUDs), as improve communication,
contributing to and helping to
substance use often affects strengthen family bonds, and
resolve issues surrounding
not only the individual but the create a supportive
addiction.
entire family system. environment that fosters long-
term recovery.
 Goals of Family Counseling
• Understanding Substance Use and Its Effects on the Family: Family counseling educates
members about the nature of addiction, addressing myths and misconceptions that may fuel
stigma or shame. This helps family members develop a compassionate understanding of their
loved one’s challenges.
• Improving Family Dynamics: Substance use can strain relationships, lead to poor
communication, and create an atmosphere of mistrust. Family counseling works to repair these
dynamics by teaching healthy communication, establishing boundaries, and resolving conflicts.
• Identifying and Reducing Enabling Behaviors: Family members sometimes unintentionally
enable substance use, often by covering for the individual or avoiding confronting them about
the impact of their behaviors. Counseling helps family members recognize enabling behaviors
and find healthier ways to support their loved one’s recovery.
• Supporting Relapse Prevention: Families play a crucial role in supporting relapse
prevention. Counseling helps family members recognize signs of relapse, understand triggers,
and create a home environment that supports sobriety.
• Building a Support Network: Family therapy encourages family members to become active
supporters in their loved one’s recovery process, promoting long-term healing and resilience.
 Techniques Used in Family Counseling
for SUDs
Problem-Solving Training:
Psychoeducation: Educating Communication Skills Training:
Families are taught strategies to
families about addiction, Families learn to express
address problems constructively
treatment, and recovery helps themselves openly and listen
rather than resorting to blame or
them understand that SUDs are actively. This can reduce
avoidance. These skills help the
complex health issues rather than misunderstandings, increase trust,
family manage stress and
moral failings. This reduces and allow for a more open
conflicts without resorting to
stigma and encourages families to dialogue about needs,
patterns that may encourage
adopt supportive attitudes. expectations, and concerns.
substance use.

Setting Boundaries: Family

Relapse Prevention Planning:
counseling helps establish Emotional Support: Families
Family members work with
boundaries between family learn how to provide non-
therapists to identify triggers,
members, ensuring that each judgmental emotional support,
early warning signs, and effective
person’s role is defined and which is essential for building
responses to potential relapse.
respected. Boundaries help family trust and encouraging the
This helps families feel prepared
members avoid enabling individual with SUD to stay
and confident in supporting
behaviors, promoting healthier engaged in their recovery journey.
recovery efforts.
interactions.
 Behavioral Couples Therapy (BCT)
• Designed for individuals in committed relationships,
BCT involves both partners and emphasizes building
mutual support for recovery. This approach
encourages open communication, joint problem-
solving, and consistent, positive reinforcement of
sobriety.
• Techniques include creating a recovery contract,
where both partners agree to support abstinence and
hold each other accountable for specific recovery-
related behaviors.
Multidimensional Family Therapy (MDFT)
Types of • MDFT is often used for adolescents with substance
Approaches use disorders and focuses on multiple domains of a
young person’s life, including family, peers, school,
and community. MDFT helps families address issues
that may contribute to the adolescent’s substance
use, such as poor communication or conflict, and
provides the adolescent with support in areas of their
life outside the family.
• The therapist works with the adolescent individually
and with family members to build stronger, supportive
relationships and address external factors that
influence the youth’s behavior.
 Family Systems Therapy
• This approach views the family as an interconnected system in
which each member influences and is influenced by others.
Family Systems Therapy aims to understand how family roles,
rules, and boundaries affect the individual with SUD and explores
ways to shift unhealthy patterns.
• By examining and adjusting family dynamics, this approach helps
families establish healthier ways of interacting and provides tools
to better support their loved one’s recovery.

Types of
Approaches
Community Reinforcement and Family Training
(CRAFT)
• CRAFT focuses on teaching family members practical skills to
support their loved one in seeking treatment and maintaining
recovery, without using confrontation or ultimatums. CRAFT
provides tools to reinforce positive behaviors and improve
communication, helping the individual recognize the benefits of a
substance-free life.
• This method empowers family members by showing them how to
encourage treatment entry, how to reward non-using behaviors,
and how to effectively manage high-stress situations.
 Multisystemic Therapy (MST)
• MST is an intensive, family-based therapy often used
for adolescents with serious substance use or
behavioral issues. MST targets multiple aspects of the
adolescent's environment, such as family, peers,
school, and community, aiming to address various risk
factors that influence substance use.
• MST involves frequent family sessions and
interventions with other parts of the adolescent’s life,
focusing on building support systems, improving
Types of behavior, and preventing substance use.

Approaches Structural Family Therapy (SFT)

• SFT focuses on reorganizing family structure, roles,
and boundaries. The therapist helps families examine
the current structure and identify areas where
adjustments are needed, such as shifting roles that
may contribute to enabling behavior.
• SFT is effective in establishing clearer roles within the
family, empowering parents or guardians, and
reducing any role confusion that may contribute to
SUD-related behaviors.
SELF HELP GROUPS: AA
& NA
 Definition
• Self-help groups are voluntary, informal
gatherings where individuals facing similar
challenges come together to support one
another.
• Unlike traditional therapy, self-help groups are
typically peer-led, meaning members provide
mutual aid without professional facilitators
(though some groups do have professionals on
hand).
• Self-help groups are based on the principles of
empowerment, shared experience, and a
collective goal of personal growth or recovery.
Characteristics of Self-help Groups

Peer led Shared goal of

Empathy
structure recovery
• Groups are led • Gather people • Unique level of
by people who who share a empathy
are common goal • Understanding
experienced • Unites and acceptance
• Fosters a sense members, allows
of equality makes them members to
feel part of a open up
community
Characteristics of Self-help Groups

Emphasis on
Non-hierarchical Community and
personal
environment belongingness
responsibility
Taking
Operate on equal Foster a sense of
responsibility for
footing belonging
one's actions

Easy for Recognize their

Members create
members to roles in
strong
freely share their managing their
connections
thoughts challenges
Alcoholics
Anonymous (AA)
• Alcoholics Anonymous (AA) is one of the
most widely known self-help groups,
specifically dedicated to helping individuals
struggling with alcohol addiction.
• Founded in 1935 by Bill Wilson and Dr. Bob
Smith in Akron, Ohio, AA has grown into a
global organization with millions of
members worldwide.
• Its primary goal is to help people achieve
and maintain sobriety by providing a
supportive, peer-led community where
individuals can share their experiences,
challenges, and successes.
• AA is structured around a 12-step program
that guides members through the recovery
process.
• These steps include acknowledging the
problem, seeking help, making amends, and
engaging in a process of continuous
personal reflection and improvement.
• The steps are spiritually oriented,
encouraging members to believe in a
“higher power,” which can be interpreted in
a way that suits each individual, whether
religious, spiritual, or simply a sense of
community.
• One of the most valuable aspects of AA is
the sense of fellowship.
• Members gather to share their experiences
and challenges in a safe, confidential space
where they know others will understand
what they’re going through.
• The shared sense of struggle and goal of
sobriety creates a strong bond among
members, who support each other both in
AA meetings are typically held in person but are also available
online.

In meetings, members openly discuss their journey with alcohol,

including their past struggles and current progress.

Some meetings are "closed," meaning they are only open to people
who wish to stop drinking, while "open" meetings allow family,
friends, and other supporters to attend.

This openness helps members feel less isolated in their journey.

Sponsorship is a unique element of AA, where a more experienced

member (a "sponsor") helps guide a newer member through the
program and its 12 steps.

Sponsors provide one-on-one support, offer insights based on their

own experiences, and help members stay accountable.

This relationship is often highly beneficial, as sponsors provide

encouragement and advice during challenging times.
 This respect for privacy helps
AA’s principle of anonymity is
members feel safe in being
foundational to the group,
open about their struggles
emphasizing that “what is
without fear of judgment or
said here, stays here.”
social stigma.

AA encourages continuous
Members typically only use
personal growth through daily
first names in meetings,
practices, self-reflection, and
which reinforces this sense of
engagement with the 12
confidentiality.
steps.

Members often use tools such

as the “Big Book” (the main
text of AA, written by the This ongoing commitment to
organization’s founders) and sobriety is often described as
daily meditation or reflection “one day at a time.”
to reinforce their sobriety
goals.
 • Admitting powerlessness over alcohol and recognizing
that life has become unmanageable.
• Believing in a power greater than oneself that can restore
sanity.
• Deciding to turn one’s will and life over to that higher
power, as understood individually.
• Conducting a fearless moral inventory of oneself.
• Admitting the nature of one’s wrongs to oneself, others,

The 12 Steps and a higher power.

• Becoming ready to have these defects removed by the

of Alcoholics higher power.

• Humbly asking to remove these shortcomings.
Anonymous • Making a list of people harmed and becoming willing to
make amends to them.
• Making amends wherever possible, except when doing so
would cause harm.
• Continuing personal inventory and promptly admitting
when wrong.
• Seeking to improve one’s relationship with the higher
power through prayer and meditation.
• Carrying the message of recovery to others in need and
practicing these principles daily.
 • Speaker Meetings: A member
shares their story of addiction and
recovery, often followed by group
discussion.
• Discussion Meetings: Members
discuss specific topics related to
addiction and recovery, sharing
insights and advice.
• Step Meetings: Meetings focused
Types of AA on one of the 12 steps, allowing
Meetings members to go deeper into each
step’s meaning and application.
• Closed Meetings: For individuals
who identify as alcoholics and are
actively seeking recovery.
• Open Meetings: Open to anyone
interested in learning about AA,
including family, friends, and
supporters.
Criticisms of AA Meetings
• Spiritual and Religious Orientation
• AA’s 12-step program emphasizes spirituality and the concept
of a “higher power” as central to recovery. While AA allows
individuals to define their higher power as they see fit, the
program’s spiritual language can be a barrier for those who
prefer a secular approach or do not relate to religious or
spiritual beliefs.
• One-Size-Fits-All Approach
• The AA model is based on the 12-step process, which is
applied similarly across all members. This structure may not
suit everyone, as addiction and recovery are highly
individualized.
• Lack of Professional Guidance
• AA meetings are peer-led, meaning they lack the oversight of
mental health professionals or addiction specialists. While this
peer-driven approach can foster openness and relatability,
some individuals may need guidance that only professionals
can provide
• Mixed Evidence for Effectiveness
• While AA has been effective for many, scientific evidence on its success rate is mixed.
Studies show that AA can help those who regularly attend meetings and actively
participate, but for some individuals, other treatment methods may be more effective.
• Emphasis on Lifetime Identity as an “Alcoholic”
• AA encourages members to identify as “alcoholics,” even if they have been sober for
years. For some, this label helps maintain vigilance against relapse, but others may feel
that it reinforces a negative identity
• Variable Meeting Quality
• AA meetings can vary widely in quality and atmosphere, as they are facilitated by
volunteers rather than professionals. Some meetings may be very supportive, structured,
and helpful, while others may be less organized or feel less welcoming
• Potential for Negative Peer Influence
• In some cases, members may encounter people who are not fully committed to sobriety
or who exhibit negative attitudes.
• Limited Focus on Underlying Mental Health Issues
• AA’s focus is primarily on achieving sobriety, but it does not specifically address co-
occurring mental health disorders such as depression, anxiety, or PTSD, which often
accompany addiction.
 SYSTEMIC
INTERVENTION
What is it?
• Systemic intervention SUDs focus on a
holistic, multi-layered approach to
treatment, addressing the interconnected
influences of individual, family,
community, and societal factors that
contribute to substance abuse.
• Rather than focusing solely on the
individual’s behavior, systemic
intervention takes into account the
broader context in which the individual
lives, recognizing that SUDs are often
influenced by and, in turn, impact
multiple domains.
• This approach integrates social,
psychological, environmental, and
biological factors, making it a
comprehensive framework for addressing
SUDs.
 The Recovery-Oriented Systems of Care
(ROSC) Model
• ROSC is a framework that emphasizes a
person-centered, self-directed approach to
recovery, where the system adapts to the
individual’s evolving needs rather than
expecting individuals to adapt to a rigid
system. It includes:
Models of • Continuum of Care: Services are
available at each stage of recovery,
Systemic from prevention to long-term
management, and focus on

Intervention maintaining wellness over a lifetime.

• Holistic and Integrated Services:
Treatment is linked to resources for
mental health, physical health,
housing, and employment.
• Community and Peer
Involvement: Involves the broader
community in supporting recovery,
including family, peers, and
community organizations.
 • Based on Urie Bronfenbrenner’s ecological
systems theory, this approach considers
the multiple layers of an individual’s
environment that impact substance use:
• Microsystem: Individual’s close
relationships, such as family and friends.
The • Mesosystem: Connections between
different microsystems, like family and
Ecological work or school.
Systems • Exosystem: External environments, such
as government policies or community
Theory resources, that influence the individual
indirectly.
Approach • Macrosystem: Cultural, societal, and
economic factors that shape attitudes and
behaviors toward substance use.
• This approach considers how
interventions can be applied across these
layers to address the broad factors
contributing to substance use.
Key Aspects

Demand Supply Reduction Harm Reduction

Reduction
 • Demand reduction is a key aspect of
systemic intervention for SUDs,
focusing on decreasing the desire,
interest, and motivation for substance
use within a population.
• This approach aims to reduce the

Demand prevalence and impact of substance

use by targeting factors that drive
Reduction individuals to start or continue using
substances.
• Demand reduction involves a multi-
layered approach encompassing
prevention, education, treatment, and
policies to reduce the attractiveness,
accessibility, and perceived necessity
of substances.
 Prevention and Early Intervention
Programs
Preventative programs aim to reduce the initial uptake of substance use, especially among youth, by building
awareness of the risks and by fostering resilience and healthy behaviors.

School-Based Programs: Education programs in schools focus on teaching children and adolescents about
the risks associated with drugs, alcohol, and tobacco. Programs like Life Skills Training and Project ALERT aim
to build self-confidence, coping skills, and decision-making abilities that help students resist peer pressure and
avoid substance use.

Community Outreach: Public awareness campaigns and educational workshops provide information on the
dangers of substance use, reaching a broad audience within the community and increasing awareness of
healthier alternatives.

Parent and Family Education: Programs that support families in developing effective communication and
parental monitoring can reduce risk factors for substance use within the home environment. Educating parents
on signs of substance use and how to address them encourages earlier intervention and support.
Public Health Campaigns and Social Marketing

Risk Awareness Campaigns: Campaigns

Social marketing campaigns raise can focus on raising awareness about the
awareness of the risks of substance use health risks, addiction potential, and legal
and promote healthier lifestyles, often with consequences of using substances. For
a focus on harm reduction and reducing example, anti-tobacco campaigns that
the social desirability of substance use. depict the harmful effects of smoking have
shown success in reducing smoking rates.

Stigma Reduction: Reducing the stigma

associated with seeking help for substance Healthy Lifestyle Promotion:
use disorders encourages more individuals Encouraging healthy alternatives, such as
to seek treatment without fear of judgment sports, arts, and community activities, can
or discrimination. Public campaigns provide positive outlets that fulfill the
highlighting that substance use disorders social or emotional needs that substance
are medical conditions can foster empathy use might otherwise address.
and reduce barriers to treatment.
 These programs focus on developing life skills and emotional
resilience, especially in high-risk populations, to reduce
Education vulnerability to substance use.

and Skill-
Building Life Skills Training: Programs that teach stress management,
communication skills, emotional regulation, and decision-

Programs making can be powerful tools in preventing substance use. By

equipping individuals with the skills to handle stress and peer
pressure, these programs can decrease demand for
substances.

Employment and Vocational Training: Providing people,

particularly those in vulnerable communities, with access to job
skills training and employment opportunities can reduce
socioeconomic factors that may lead to substance use.

Mental Health Education: Teaching people to recognize and

address mental health challenges early on can prevent self-
medication with substances. Addressing mental health issues
through proper channels reduces the likelihood of substance
use as a coping mechanism.
Policy and Legal Measures

Regulation of Substances:
Limiting access to legal substances Prescription Drug Monitoring
Policies can play a critical role in
(e.g., alcohol, tobacco) through Programs (PDMPs): Monitoring the
reducing demand by controlling
policies like age restrictions, high prescription of potentially addictive
access to substances, discouraging
taxation, and licensing restrictions substances helps to prevent misuse
misuse, and incentivizing healthy
decreases availability and increases and reduce the demand for opioids
choices.
the cost, thereby reducing and other prescription drugs.
consumption rates.

Zero-Tolerance Policies in
Drug Courts: For individuals
Schools and Workplaces: Policies
charged with substance-related
that enforce consequences for
offenses, drug courts offer a
substance use in educational and
treatment-focused alternative to
professional settings can deter
incarceration. By addressing
usage. Coupled with education and
underlying addiction issues, drug
treatment resources, these policies
courts can reduce the likelihood of
provide a framework for reducing
reoffending and the demand for illicit
substance use without punitive
substances.
measures alone.
Supply Reduction

Supply reduction in systemic intervention focuses on limiting the

availability, distribution, and production of substances, thereby reducing
access and making substance use more challenging and less appealing.

Supply reduction complements demand reduction by creating a physical

and economic environment where substances are harder to obtain, more
expensive, and less socially accepted.

This approach involves enforcing regulations, monitoring supply chains,

reducing illegal production, and implementing policies to decrease the
circulation of both legal and illicit substances in communities.
 • Law enforcement efforts play a key role in disrupting the
supply chain of illegal substances, reducing availability
in the community.
• Drug Seizures and Raids: Targeting production sites,
trafficking routes, and distribution networks disrupts the
flow of illicit drugs and prevents them from reaching
Law users. Law enforcement agencies work both locally and
internationally to dismantle supply networks and
Enforcement apprehend key players.
• Targeting High-Risk Areas: Intensive surveillance and
and Criminal policing in high-traffic areas help prevent drugs from
circulating within vulnerable communities. Targeting
Justice hotspots for drug trafficking reduces access to
substances in those areas.

Initiatives • Drug Courts and Diversion Programs: While

traditional criminal justice measures aim to reduce
supply through enforcement, drug courts and diversion
programs address the underlying factors of addiction
and promote rehabilitation rather than simply punishing
users. This helps to address the demand for illicit drugs,
which in turn reduces the supply incentive.
 Regulation and
Monitoring of Prescription
Drugs
• Controlling the legal distribution of prescription
drugs, especially opioids, stimulants, and sedatives,
helps reduce misuse and diversion to illegal
markets.
• Prescription Drug Monitoring Programs
(PDMPs): PDMPs track prescribing and dispensing
of controlled substances, helping to detect
overprescribing, doctor shopping, and other red
flags associated with prescription drug misuse. By
tightening control over prescription practices, these
programs reduce the supply of potentially addictive
substances.
• Education for Healthcare Providers: Training
and guidelines for healthcare providers on safe
prescribing practices reduce the chance of
prescription drugs being diverted to the illicit
market. By prescribing only what’s necessary,
providers contribute to a controlled and reduced
supply.
• Electronic Prescribing Systems: E-prescribing
allows prescriptions to be tracked and monitored
more effectively, reducing the risk of fraudulent
 Border Control and International
Collaboration
Global Partnerships:
Customs and Border
Collaborative efforts with
Security: Strict screening
International collaboration and international law enforcement
processes at borders, ports, and
border security are essential to agencies (e.g., the Drug
airports prevent the import of
prevent illicit substances from Enforcement Administration in
illicit substances. This includes
entering the country and the U.S., Interpol, United Nations
the use of technologies like
disrupting cross-border Office on Drugs and Crime) help
drug-detection dogs, X-ray
trafficking. target and dismantle
machines, and chemical sensors
transnational drug trafficking
to intercept drugs.
networks.

Extradition Agreements and

Legal Collaboration:
Extradition agreements and
collaborative legal frameworks
among countries enable
prosecution of international
traffickers, which disrupts the
global drug supply chain.
 By controlling the production, distribution, and sale of legal
substances, policies can reduce accessibility and lower
consumption.

Age Restrictions and Licensing: Enforcing age restrictions

on the purchase of alcohol, tobacco, and cannabis, along with
regulating licenses for sellers, limits youth access to these
substances.
Policies
Regulating Taxation and Price Controls: Increasing taxes and
regulating prices on substances like alcohol and tobacco
Legal make them more expensive, which can reduce consumption.
Economic research shows that higher prices generally
Substances discourage use, particularly among youth and low-income
populations.

Advertising Restrictions: Limiting or banning advertising

for legal substances helps reduce demand and indirectly
affects supply by lowering overall consumption rates.
 Reducing the production of raw materials for drugs, such as opium poppies for heroin,
coca plants for cocaine, and cannabis plants for marijuana, directly limits supply.

Environmenta Crop Eradication Programs: Some governments engage in manual or aerial

eradication of illicit crops to reduce the supply of raw materials for drug production. This
l and approach is controversial, as it may negatively impact the livelihoods of local farmers,
but it can disrupt large-scale drug production efforts.

Agricultural
Controls on
Illicit Drug Alternative Livelihood Programs: In regions dependent on cultivating illegal crops,
governments and NGOs sometimes offer programs that provide farmers with alternative
income sources, such as growing legal crops. By reducing financial dependence on illicit
Production crop cultivation, these programs contribute to supply reduction sustainably.

Environmental Surveillance: Satellite imaging and drone technology are used to

monitor areas where illicit crops are cultivated, allowing authorities to target efforts to
limit production.
Harm Reduction

Harm reduction in systemic intervention for SUDs focuses on reducing the

negative health, social, and legal impacts associated with substance use
without necessarily requiring abstinence.

This approach prioritizes practical strategies to reduce harm to individuals

and communities, acknowledging that some individuals may continue to use
substances despite efforts to reduce demand and supply.

Harm reduction strategies aim to meet individuals “where they are” by

offering safer, non-judgmental options to manage and mitigate risks, and
they are increasingly recognized as essential in comprehensive SUD
interventions.
 Needle and Syringe Exchange Programs (NSPs)
• Needle exchange programs provide
access to sterile needles and syringes,
reducing the transmission of bloodborne
diseases such as HIV, hepatitis B, and
hepatitis C among individuals who inject
drugs.
• Disease Prevention: By providing sterile
equipment, NSPs reduce the risk of
infections and abscesses associated with
shared needles.
• Safe Disposal: NSPs also offer safe
disposal of used needles, protecting
communities from discarded syringes in
public spaces.
• Gateway to Additional Services: Many
needle exchange programs also provide
referrals to healthcare, counseling, and
treatment services, encouraging
• These facilities allow individuals to use
substances in a monitored, clean
environment with medical supervision.
• Overdose Prevention: Trained staff
can administer naloxone in cases of
opioid overdose, reducing fatalities and Supervised
providing immediate medical care.
Injection Sites
• Reduced Public Consumption: Safe (SIS) and Safe
consumption sites decrease public drug Consumption
use and associated issues, such as
Rooms
littering and public safety concerns.
• Harm Reduction Education: Staff at
these sites often educate individuals on
safer use practices and connect them to
services like detox programs or housing
support.
 Naloxone Distribution and Overdose
Prevention Programs

Widespread Distribution: Training for Use: Training Reduces Fear of

Naloxone is a medication Community programs and on naloxone use helps both Overdose: Access to
that can quickly reverse pharmacies often distribute individuals with SUDs and naloxone increases safety for
opioid overdoses, saving naloxone kits to individuals community members, users and may encourage
lives when administered in at risk of overdose, family making it easier to intervene individuals to seek treatment
time. members, and first during an overdose and knowing they have a lifeline
responders. prevent fatalities. in case of emergency.
 • Drug checking programs allow users to test
substances for dangerous additives like
fentanyl, reducing the risk of accidental
overdose or poisoning.
• Awareness of Substance Contents:
Drug Knowing the contents of substances

Checking allows individuals to make informed

decisions about dosage and timing.
and Safe • Safe Supply Initiatives: In some
regions, safe supply programs provide
Supply pharmaceutical-grade substances to
individuals, especially those with severe
Programs SUDs. This reduces reliance on potentially
dangerous street drugs and lowers
overdose risk.
• Behavioral Insights: Drug checking can
encourage people to seek treatment by
fostering trust and demonstrating the
community's commitment to their safety.
 • Education on safer substance use practices helps
individuals reduce health risks associated with
their behavior.
• Safer Use Techniques: Education on methods to
minimize harm (e.g., not using alone, spacing out
doses) helps reduce immediate health risks.
Harm • Community Outreach: Harm reduction workers
Reduction often connect with individuals in high-risk areas,
Education and offering education, naloxone, and resources for
safer substance use practices.
Outreach
• Connecting with Marginalized Populations:
Outreach programs often focus on vulnerable
groups like the homeless or those with limited
healthcare access, offering them judgment-free
support and pathways to services.