The evidence-based core is unremarkable, and that is deliberate. Cognitive behavioural therapy, dialectical behaviour therapy, motivational interviewing, EMDR where trauma is present, and medication where it is indicated. Anything unusual is added around that spine, never instead of it.
Medication is not a last resort
For opioid use disorder there are three FDA-approved medications, and the evidence on survival for two of them is stronger than for anything else in this field. Approved medications exist for alcohol use disorder too and are widely under-used. For stimulants and sedatives none exists — there the answer is behavioural work or a supervised taper, and we say which applies rather than implying a medication is being withheld.
What we treat underneath
Most people arrive with something the substance was solving: pain, insomnia, trauma, ADHD, depression. Treating the substance and none of the reasons is how a second attempt gets scheduled.
Integrative components, honestly labelled
Somatic work, mindfulness-based relapse prevention, nutrition psychiatry and structured physical work are offered where they suit the person. They are adjuncts with varying evidence, we describe them that way, and none of them substitutes for the clinical spine.