Expert Q+A: The New Solutions for Alcohol and Substance Use Disorders

Your ideas about substance use disorders may have been powerfully shaped by the movies or TV. It’s a familiar narrative: A character uses huge quantities of drugs or alcohol until they hit “rock bottom” and wind up in a rehab facility and sip coffee in a series of 12-step meetings, where they come to understand the roots of their substance dependence and slowly rebuild their lives. While that story may reflect the experience of many people, there are many other stories of how substance use disorder can look, and how it can be successfully treated.

This National Substance Abuse Prevention Month, Talkspace wants to spread the word that we’ve entered a new era in the diagnosis and treatment of substance use. We turned to experts at the forefront of addressing substance use disorders through telehealth to get their insights on how to prevent substance misuse and help people access the right treatments. As you may have noticed, we avoid the words “addict” and “alcoholic” both because these terms are stigmatizing and because substance use disorders occur along a spectrum—meaning there is no clear line one crosses from being a heavy drinker to an “alcoholic” and you don’t need to fit a label in order to seek treatment. 

To fill you in on the latest developments in treatment, and share advice on how you can help yourself, a loved one, or a colleague struggling with substance use, we turned to Aimee Peters LCSW, Chief Clinical Officer at Ria Health, an online program that empowers individuals to reduce or stop alcohol consumption, under the medical supervision of addiction experts, Brian Clear, MD, FASAM, Chief Medical Officer of Bicycle Health, an online program offering effective medical care for those with opioid use disorder, and our own Erica Patton Simpson, LCSW, Head of Clinical Operations and Erin Mack, LCSW, Clinical Quality, Risk Manager of Talkspace.

Why is it essential to reduce stigma around substance use disorders (SUDs), and how can we do that?  

“We need to dispel the myths that SUDs are due to poor moral character, and that sheer willpower is all that is needed to change behavior,” says Aimee Peters of Ria Health. “These are brain health diseases that are not so different from any other disease, and there are effective treatments.” Those outdated ideas that SUDs are an individual failing or a sign of weakness lead to shame and suffering, preventing people from seeking needed treatments. 

“It’s a challenge to acknowledge and accept treatment for any chronic illness, whether we’re talking about diabetes, depression, hypertension, or obesity,” adds Dr. Clear of Bicycle Health. “Now imagine how much more challenging that becomes when the illness you’re facing is associated in popular culture with being immoral, even criminal. It’s normal to resist that stigmatized label, and that’s one reason people struggling with addiction are reluctant to raise their hand and say, ‘I have a problem, please help,’ before it’s progressed to extremes.”

To reduce stigma and encourage people to seek help, the experts say we must educate society as a whole that SUDs are a disease with evidence-based treatments including medication and therapy. “We need to discard the false depiction of the “junkie,” or “addict,” and break down that stigma through understanding that members of our communities, our workplaces, our families, are often affected by substance use disorders but not defined by them,” says Dr. Clear. “They’re people, and they’re struggling with a problem that tends to be highly treatable especially if it’s identified and addressed before it escalates.”

We also must stop waiting for individuals to ask for help. “Proactive screening by healthcare providers is essential,” says Talkspace’s Erica Patton Simpson. “Rather than waiting for individuals to come forward, we should implement routine checks for substance use disorders. By framing SUDs as chronic health conditions—similar to diabetes or hypertension—we can foster a more compassionate understanding. This shift in perspective is crucial for encouraging those in need to receive treatment.”

Ultimately, creating an environment where seeking help is viewed as a strength, rather than a weakness, is key to reducing stigma and improving outcomes for those affected by substance use disorders. 

What are some early warning signs of substance abuse that friends and family should be aware of?

“Recognizing the signs of a substance use disorder (SUD) can be challenging, especially since the early indicators often look like symptoms of other chronic health issues like depression and anxiety,” says Erin Mack of Talkspace. “Changes in behavior, such as social withdrawal, erratic moods, or a decline in work or academic performance, can easily go unnoticed or be misattributed to stress or life changes.”  

Dr. Clear from Bicycle Health agrees that it’s hard to detect “early” warning signs, but over time you may be able to detect that a loved one is struggling: “A silently progressing substance use disorder can look a great deal like other chronic health conditions such as depression—it can manifest as uncharacteristic changes in mood or disengagement from usual social activities and obligations,” he says. “Recurrent withdrawal from a substance will impair sleep quality and may present as fatigue and tiredness. Maintaining regular illicit substance use can be expensive, so if you have visibility into their financial situation and can’t explain a new financial hardship, then combined with other signs this can suggest substance use. These signs along with poor self care, absenteeism from responsibilities, and social isolation are not early warning signs, but indications of a severe, decompensated substance use disorder.”

The experts agree that you’ll be best prepared to help a friend or family with substance use if you create space for conversations that feel safe for them. “If your loved one is able to talk to you about their drinking and other drug use before it becomes problematic, then they’ll more likely talk to you about it as it’s developing into a problem,” says Dr. Clear. “Hearing it from them is incomparably more reliable than looking for hidden warning signs.” 

Mack agrees, “Creating space for open communication and understanding to recognize signs of SUD can empower us to support our loved ones more effectively, ultimately giving us the ability to guide them toward the help they may need.”

Can you share any evidence-based strategies or programs that have been particularly successful in preventing substance abuse in your community?

“Substance use disorders (SUDs) develop everywhere that people have access to substances that overwhelm our brain reward pathways” says Dr. Clear “Approaches that effectively reduce the rate of SUD development will either limit access, or improve awareness of safe use practices.” Age limits and other restrictions are effective prevention strategies. “For instance, we know that communities with higher legal drinking and smoking ages see lower rates of adolescent alcohol and tobacco use disorder,” he says. “In communities where we find kratom and tianeptine commonly available in stores, we find higher rates of associated harms.”

When it comes to improving awareness, we have evidence that educational campaigns are effective, as long as they give accurate information about health impacts and promote stigma-free conversation about substance use. As examples of campaigns with demonstrated success. Dr. Clear cites “Truth,” for adolescent smoking prevention and “Talk. They Hear You,” to inform parents about how to have effective conversations with their children about alcohol and drug use.

What advice would you give to individuals struggling with substance use issues who are hesitant to seek help?

When it comes to alcohol use disorder, Peters of Ria says, “First, know that you are not alone, because one in 10 suffer from alcohol use disorder. Second, understand that there are safe and effective treatments that you can engage in virtually from the comfort of your own home or other private space on a schedule that you choose.” These proven virtual treatments typically include a combination of medication assisted treatment with counseling or therapy, and objective progress tracking via breathalyzer data. “When treatment is delivered virtually through telehealth it increases engagement and outcomes,” says Peters. “By bringing expert care and support directly to you, it saves you from the discomfort of searching, traveling, and taking time away from your life.”

About drug use and addiction generally, Dr. Clear says “Your life can be better, now. Don’t believe that you have to hit ‘rock bottom,’ or lose everything before beginning care. Effective medical care isn’t something you have to earn or be ‘ready,’ for; it’s available to you right now.”

You don’t have to wait for care to be offered to you—go ahead and seek it out for yourself. If you have a primary care provider, tell them you would like treatment for your substance use disorder, and they’ll either offer it themselves or will refer you. If the referral takes too long (for opioid use disorder, more than 3-4 days is too long), then go directly to findtreatment.gov to find a program to start sooner. You can also work with a Talkspace therapist, or sign up for comprehensive care including medication at Ria or Bicycle Health, both Talkspace partners.

“Remember that your life can improve, and you don’t need to wait to start your journey toward recovery,” says Patton-Simpson. “Effective treatment is available now, and you deserve access to it without any judgment. Seeking help is a sign of strength, and there are resources available to support you every step of the way.”

What preventive measures do you think are most effective for youth in reducing the risk of substance abuse?

When it comes to alcohol use, it can be effective to have honest, science-backed conversations with youth about how alcohol affects the developing brain, how males and females metabolize alcohol differently, and the physical and emotional health risks of excessive and binge drinking, according to Peters. 

“There have been many examples of successful safe use, or harm reduction, campaigns targeting opioid overdose prevention, and these safety measures are just as important for young people,” says Dr. Clear. “Widespread education around fentanyl testing and Narcan distribution, combined with access to these resources, seems to have finally halted the trend toward increasing opioid overdose deaths each year. Medical care is also well established to be effective and appropriate for 16 and 17 year-olds with opioid use disorder.”

But substance education that starts and ends with “just say no” isn’t likely to be effective. To reach those most at risk, educational campaigns aimed at youth must also consider those who have or will choose to use drugs despite being advised against it. “Accurate, effective content will only be received by this audience if it addresses them with respect and dignity. We want young people to feel able to talk about their drug use and obtain the information and help they need to improve safety, and to reduce or stop use when desired,” says Dr. Clear. 

Adds Mack: “Risk and Protective Factor models have been shown to assist with identifying factors for youth at risk of substance use. The goal of these models is to involve parents, schools, and local communities that can help create supportive environments leading to a reduction in substance use and the development of substance use disorders. An example of an effective strategy is the proactive approach of the New York City Department of Health and Mental Hygiene in offering free mental health care to youth ages 13-17 through the NYC Teenspace program, where we have seen a significant reduction in mental health related disorders such as SUDs, as a result of early intervention.” 

What recent trends in substance use have you observed, and how should prevention strategies adapt to these changes?

“Overall there has been an increase in excessive drinking, especially in women, resulting in alcohol-related health complications at younger ages—for example women in their 30s with cirrhosis,” says Peters of Ria. 

“Recent trends in substance use are increasingly concerning, particularly the rise in potency of various drugs. We’re witnessing a significant shift, with substances like fentanyl being used with devastating consequences. This trend toward higher potency means that individuals can achieve the same effects with smaller quantities, which not only increases the risk of overdose but also complicates prevention efforts,” adds Patton-Simpson. 

Dr. Clear agrees: “The trend toward higher potency drugs means the same effect from a smaller quantity, and this is visible in the way fentanyl now dominates illicit opioid use and deaths. It’s also seen in very high potency cannabinoids and increased rates of associated adverse effects. This is particularly dangerous when the user doesn’t fully understand the potency and takes more than intended. In commercially available drugs, very clear dosing information and portion-control packaging help reduce accidental overdose or accidental ingestion. For illicit drugs, harm reduction education around contaminant and potency testing as well as Narcan availability are beneficial.”

The Bottom Line

Overall, a comprehensive approach that combines education, harm reduction, and accessible resources will be crucial in addressing the evolving landscape of substance use and ensuring that individuals have the knowledge and tools they need to make safer choices. On the positive side, advances in telehealth delivery of medical and therapeutic treatment for substance use disorders mean that science-based, stigma-free solutions are more accessible than ever. Anyone who is struggling with substance use can reach out privately and conveniently, at any time, to get started on the road back to health.

About Ria Health

Ria Health empowers individuals to take control of their journey to reduce or stop alcohol consumption, under the medical supervision of some of the top experts in the addiction field. Our nationwide program combines cutting-edge medical care, 1:1 coaching, and group support, all accessible from the comfort of your home. Whether you’re aiming for sobriety or moderation, Ria Health provides the personalized tools and support you need. With FDA-approved medications, guidance from certified addiction specialists, and real-time progress tracking via our Bluetooth breathalyzer, our comprehensive approach ensures you’re in expert hands throughout your journey. We also work with most major insurance plans to make treatment accessible for everyone.

About Bicycle Health

Bicycle Health is an online program offering effective medical care for those with opioid use disorder across most of the United States. We deliver evidence based specialist care in a stigma-free environment with an emphasis on quality outcomes and patient experience.  

About Talkspace 

Talkspace is an online mental health platform with 5000+ licensed therapists and psychiatric providers who possess an average of a decade of experience, and expertise in more than 150 mental health conditions and treatment approaches. Our mission is to break down barriers to mental health care, so it’s more accessible, affordable, and convenient for everyone.