Quick Summary
“Evidence-based” gets used a lot in addiction treatment, and it does not always mean much. In plain terms, it means a treatment has been tested in research and shown to help people with a specific problem. This guide explains what that looks like for substance use disorders: the behavioral therapies with research behind them, the medications approved for opioid, alcohol and nicotine use disorders, why integrated care for mental health matters, and why the length of treatment matters. It also covers where the evidence is thin, such as medications for stimulant use disorders, so you know what to ask any program.
Key Takeaways
- Evidence-based means tested in research for a specific condition. It is not a guarantee of results for any one person.
- Behavioral therapies such as cognitive behavioral therapy and contingency management are core parts of treatment, alone or with medication.
- The FDA has approved medications for opioid, alcohol and nicotine use disorders. As of the NIH’s 2021 report, none had been approved for methamphetamine use disorder.
- Treating co-occurring mental health conditions at the same time as substance use is part of good care.
- Detox is the first step, not the whole treatment, and longer engagement in care is linked to better outcomes.
What “Evidence-Based” Actually Means
A treatment is evidence-based when researchers have studied it in groups of people, compared it with something else (often no treatment, usual care or a placebo), and found that it helps with a defined problem. That is a higher bar than a treatment sounding reasonable or having a good story behind it.
Two cautions go with the label. First, it is specific: a therapy can have strong evidence for one condition and little for another. Second, it describes groups, not individuals. A treatment that helps many people in a study may not help you, and one with modest results may be exactly right for you. That is why the National Institute on Drug Abuse (NIDA) states in its Principles of Drug Addiction Treatment that no single treatment is appropriate for everyone and that care should be matched to the person. That guide is the 2012 third edition, so some details may have changed, but the core principles still guide how treatment is described.
Behavioral Therapies With Research Behind Them
NIDA describes behavioral therapies as a central part of treatment, used on their own or alongside medication. Three come up most often.
Cognitive behavioral therapy (CBT)
CBT helps a person notice the thoughts, feelings and situations that lead to use, and build specific skills for handling them. It is a skills-based approach, which is part of why it has been studied so widely. Our overview of cognitive behavioral therapy for substance use recovery walks through how sessions typically work.
Contingency management
Contingency management gives small, planned rewards for positive steps such as attending sessions or providing negative drug tests. The National Institutes of Health (NIH) 2021 report described it as the most effective behavioral therapy for stimulant use disorders, while noting that access is limited, partly because of limits on the value of incentives programs are allowed to offer.
Motivational approaches
Motivational enhancement and similar approaches focus on strengthening a person’s own reasons to change rather than arguing them into it. NIDA lists motivational enhancement therapy and motivational incentives among the behavioral approaches used in treatment.
Other approaches, such as dialectical behavior therapy, are also used in practice, especially when emotion regulation is a major challenge. The strength of evidence differs from one therapy and one condition to the next, which is a fair question to put to any provider.
Medications by Condition
Medication works best when it is matched to the substance and the person. The table below summarizes what is approved or studied. It describes the research, not what any particular program offers.
| Approach | Used for | What the research shows |
|---|---|---|
| Methadone, buprenorphine, extended-release naltrexone | Opioid use disorder | FDA-approved. Studies link methadone and buprenorphine to lower risk of death. |
| Naltrexone, acamprosate, disulfiram | Alcohol use disorder | FDA-approved, not habit-forming. Few people with AUD receive medication. |
| Cognitive behavioral therapy | Many substance use disorders | Widely studied skills-based therapy, used alone or with medication. |
| Contingency management | Stimulant use disorders and others | Described in NIH’s 2021 report as the most effective behavioral therapy for stimulant use disorders, with limited access. |
| Naltrexone plus bupropion | Methamphetamine use disorder (under study) | Promising results in a 2021 trial, but not approved by the FDA for this use at the time of the NIH report. |
Opioid use disorder
The FDA lists methadone, buprenorphine and naltrexone as approved medications for opioid use disorder. A large analysis in the BMJ looked at mortality during and after opioid substitution treatment and found lower death rates during treatment with methadone and buprenorphine. An NIH-reported study of people who survived an overdose found that methadone and buprenorphine were linked to a reduced risk of death afterward. A head-to-head trial of extended-release naltrexone and buprenorphine-naloxone found them similarly effective once a person had started on the medication, though starting naltrexone can be harder because it requires being off opioids first. For more, see our guides on Suboxone and methadone and the Vivitrol shot.
Alcohol use disorder
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes three FDA-approved medications for alcohol use disorder: naltrexone, acamprosate and disulfiram. NIAAA describes these three FDA-approved medications as nonaddictive. Only a small share of people with alcohol use disorder receive medication, so asking about it is reasonable. Our alcohol rehab page gives an overview of care.
Stimulant use disorders
This is where the evidence is thinnest. In a January 2021 report, the NIH noted that no medication had been approved by the FDA for methamphetamine use disorder. The same report described a trial of extended-release naltrexone plus bupropion, published in the New England Journal of Medicine. In that trial of adults with methamphetamine use disorder, the study’s response measure was met by 16.5% of people taking the combination versus 3.4% taking placebo in weeks 5 and 6, and by 11.4% versus 1.8% in weeks 11 and 12. Those are encouraging differences, and they also show that most participants did not respond, so behavioral therapy remains the foundation. Regulatory status can change, so check the FDA for current information. See our pages on methamphetamine and cocaine treatment for general information.
We’re here to make treatment as accessible and affordable as possible — and are in network with many insurance providers. Not sure about your coverage? We can help.
Treating Mental Health and Substance Use Together
Substance use disorders and mental health conditions often occur together. The National Institute of Mental Health describes substance use and mental health conditions as commonly co-occurring, and the Substance Abuse and Mental Health Services Administration (SAMHSA) has published guidance on treating co-occurring disorders. The practical takeaway is that both conditions should be assessed and addressed, ideally in a coordinated way, rather than one after the other. Our page on co-occurring mental health conditions and our blog on co-occurring disorders explain this in more detail.
Why Length and Continuity of Care Matter
NIDA’s principles state that treatment lasting less than about 90 days is of limited effectiveness, and that better outcomes come with longer treatment. They present this as a general finding, not a rule for every person. They also state that medical detoxification is only the first stage of treatment and by itself does little to change long-term use. This does not mean everyone needs a 90-day residential stay. Care can step down to outpatient and aftercare, and the right pace depends on the person. Our guides on how long rehab takes and why detox is not enough cover how levels of care fit together.
Peer support also plays a role. NIAAA notes that mutual-support groups can provide ongoing peer support alongside professional care. See our SMART Recovery page and aftercare support page.
How to Use This When Choosing a Program
Use the evidence as a set of questions, not a checklist of buzzwords. Ask which therapies a program uses and how often. Ask how medication is handled, including whether you can continue medication you already take. Ask how mental health is assessed and treated, and what happens after a higher level of care ends. We put these together in our guide to 10 questions to ask a rehab center before you enroll.
Be careful with any program that promises a cure, relies on a single method for everyone, or cannot explain the research behind what it does.
When to Reach Out for Help
If you or someone you care about is struggling with substance use, you do not need to wait for a crisis. If an opioid overdose is possible, call 911, give naloxone if you have it, and stay with the person until emergency help arrives. If you or someone you know is in emotional crisis, call or text 988. If anyone is in immediate danger or cannot stay safe, call 911 or go to an emergency department. If you drink heavily every day or take sedatives, get medical advice before stopping, because withdrawal can be dangerous.
Talking With a Professional
A good first conversation covers what you are using, your health and your mental health, and what you want from treatment. Bring a list of medications and your insurance information. The admissions team can explain what an assessment involves. Ask which services are currently available and whether outside care is needed.
FAQ
Does evidence-based treatment guarantee recovery?
No. It means a treatment has research support for a specific condition. Individual results vary, and recovery often involves setbacks and adjustments to the plan.
Is medication just replacing one drug with another?
Approved medications for opioid and alcohol use disorders are used to reduce cravings, withdrawal and risk, under medical supervision. The FDA and NIAAA describe them as treatments for a medical condition. Talk with a prescriber about which options fit your situation.
Is there a medication for methamphetamine addiction?
As of the NIH’s 2021 report, none had been approved by the FDA. Behavioral therapies such as contingency management and CBT are the main tools, and research on medications is ongoing.
Is 30 days enough?
It depends on the person. NIDA’s 2012 principles report limited effectiveness for treatment under about 90 days and better outcomes with longer engagement, but the right length and setting must be individualized, and that can include step-down levels of care and not only residential stays. A clinician can recommend a plan after an assessment.
What if I also have anxiety or depression?
Tell the program at the start. Both conditions should be assessed and treated together when possible.
References
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition. Accessed October 2026. nida.nih.gov
- National Institutes of Health. Combination treatment for methamphetamine use disorder shows promise in NIH study. Accessed October 2026. nih.gov
- Trivedi MH, et al. Bupropion and Naltrexone in Methamphetamine Use Disorder. N Engl J Med. 2021. Accessed October 2026. pubmed.ncbi.nlm.nih.gov
- U.S. Food and Drug Administration. Information about Medications for Opioid Use Disorder (MOUD). Accessed October 2026. fda.gov
- Sordo L, et al. Mortality risk during and after opioid substitution treatment. BMJ. 2017. Accessed October 2026. pmc.ncbi.nlm.nih.gov
- National Institutes of Health. Methadone and buprenorphine reduce risk of death after opioid overdose. Accessed October 2026. nih.gov
- Lee JD, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). Lancet. 2018. Accessed October 2026. pubmed.ncbi.nlm.nih.gov
- National Institute on Alcohol Abuse and Alcoholism. Understanding Alcohol Use Disorder. Accessed October 2026. niaaa.nih.gov
- National Institute of Mental Health. Substance Use and Co-Occurring Mental Disorders. Accessed October 2026. nimh.nih.gov
- Substance Abuse and Mental Health Services Administration. TIP 42: Substance Use Treatment for Persons With Co-Occurring Disorders. Accessed October 2026. library.samhsa.gov
Related Reading
- Medically Assisted Treatment Program
- Why MAT Improves Your Chances of Recovery
- 10 Questions to Ask a Rehab Center Before You Enroll
- Co-Occurring Mental Health and Substance Use Disorders
Resources
- 988 Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential support 24/7.
- SAMHSA National Helpline. Call 1-800-662-HELP (4357) or visit the SAMHSA National Helpline page for free, confidential referrals to local treatment.
- 911. For any medical emergency, including a suspected overdose, call 911 immediately.
This article is general education and is not medical advice.
If you have questions about treatment options, call Discovery Point Retreat at (855) 245-7133 to talk with our admissions team.
