Resources

Addiction Types and Approaches — Full Guide

Comprehensive guide covering major substance and behavioral addictions, the evidence-informed approaches that help, what the group can and cannot do, and when professional treatment is needed. Pair with the Empowerment Template for issuing member-specific guidance.

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How to get this resource

This is the full addiction guide. Download the PDF for the complete document (21 pages); the summary is below.

The guide is written for peer support, NOT clinical treatment. The group supports, encourages, holds accountable, and points toward real help — it does not treat addiction.

It covers:

SUBSTANCE ADDICTIONS (Section 1):
- Alcohol Use Disorder — abstinence or reduced-use goal, trigger identification, replace the ritual, CBT-based coping, MAT (naltrexone / acamprosate / disulfiram), mutual-help (AA / SMART / Refuge), treatment programs. WARNING: alcohol withdrawal can be medically dangerous (seizures, delirium tremens) — medical detox may be needed. Do not encourage cold-turkey without medical input for dependent drinkers.
- Opioid Use Disorder — MAT (buprenorphine, methadone, naltrexone) is the gold standard and should be actively supported, not treated as optional. Naloxone must be on hand. Fentanyl test strips for harm reduction. Overdose response plan. Do NOT discourage MAT.
- Stimulant Use Disorder (cocaine, meth) — behavioral treatment (CBT, contingency management), structure / routine rebuilding, sleep recovery, nutrition, treat co-occurring conditions. Meth-induced psychosis needs medical evaluation. No FDA-approved medication for meth / cocaine.
- Cannabis Use Disorder — often underestimated. Clear goal, identify the function cannabis serves, replace the function, withdrawal support (1-2 weeks of irritability / sleep disruption).
- Nicotine / Tobacco — NRT / varenicline / bupropion significantly increase success. Quit plan. Multiple attempts are normal — a failed attempt is data, not a verdict.
- Benzodiazepine Dependence — WARNING: withdrawal can be fatal. Never cold-turkey. Medical taper under supervision is the only safe way. Treat the underlying anxiety with professional help.
- Polydrug Use — prioritize by medical danger (opioids first via MAT, alcohol / benzos via medical withdrawal management). Comprehensive treatment. Harm reduction if not ready for abstinence.

BEHAVIORAL ADDICTIONS (Section 2):
- Gambling Disorder — barriers / self-exclusion, financial accountability structures (the group's accountability can be genuinely protective here), CBT, financial counseling, treatment. Do NOT lend money without a plan — enables the problem.
- Gaming Disorder / Problematic Gaming — define the specific damage, boundaries vs. abstinence, replace the functions (escape, achievement, social, challenge), structure / routine, treat underlying issues.
- Internet / Social Media / Compulsive Phone Use — define the actual behavior, barriers / friction (app blockers, screen limits, grayscale, no-phone times), replace the function, scheduled use vs. compulsive use.
- Compulsive Buying / Shopping — financial barriers (remove saved payment methods, cash-only), wait rule, replace the function, treat underlying issues. Do not shame — shame fuels the cycle.
- Compulsive Sexual Behavior / Problematic Pornography — clear problem definition, barriers, trigger / emotion identification, shame reduction (critical — shame fuels this cycle), treat underlying issues. Non-shaming environment matters.
- Binge / Compulsive Eating — break the restriction-binge cycle, trigger identification, emotion regulation alternatives, treat underlying issues. NOTE: anorexia / bulimia / OSFED are serious conditions requiring professional treatment — not peer territory.
- Workaholism — define the damage clearly, boundaries, identity outside work, treat underlying issues. Hard to see from inside because it looks like success.

CROSS-CUTTING APPROACHES (Section 3): trigger management, urge surfing, function-replacement, structure rebuilding, harm reduction vs. abstinence, mutual-help, when professional treatment is needed.

WHAT THE GROUP CAN AND CANNOT DO (Section 4): the group CAN listen without judgment, issue empowerments, help identify triggers, set up barriers, attend mutual-help together, reduce shame, support access to treatment, stay connected, harm reduction. The group CANNOT provide medical treatment, manage dangerous withdrawal, fix finances / legal problems, enable, shame, pretend the group is enough when it is not, write someone off after a slip.

ESCALATION TRIGGERS (Section 6): overdose (911 plus naloxone), withdrawal risk (alcohol / benzos), suicidal thoughts / self-harm (988), psychosis / severe mental symptoms (medical eval), eating disorder beyond binge eating (professional eval), active addiction with no other help (treatment), acute crisis (legal / housing / financial emergency), addiction getting worse despite support.

US CRISIS RESOURCES: 988 Suicide and Crisis Lifeline (call or text), 911 for medical emergencies / overdose, SAMHSA National Helpline 1-800-662-4357, 1-800-QUIT-NOW for smoking cessation, findtreatment.gov for treatment locator, naloxone available at many pharmacies without prescription in many states.

Alcohol Use Disorder — What Helps

Alcohol is the most common recreational substance in many cultures and one of the most embedded. For established alcohol use disorder, abstinence is the more common treatment goal. Withdrawal can be medically dangerous for dependent drinkers.

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What it is: a pattern of alcohol use with loss of control, craving, continued use despite negative consequences, tolerance, and/or withdrawal. Spectrum from heavy drinking causing problems to physical dependence.

Why it is hard: socially embedded, physically addictive (withdrawal can be dangerous — seizures, delirium tremens), self-reinforcing (drink to cope with stress, then stress gets worse from drinking).

Common approaches:
- Abstinence or reduced-use goal. Abstinence is the more common goal in treatment for established disorder. Help the person define their goal; support the one they commit to.
- Identify triggers — people, places, times, emotions, situations that cue drinking. Common: stress, social gatherings, boredom, certain friends, end-of-day wind-down.
- Replace the ritual — alcohol often fills a function (wind-down, social lubricant, celebration, numbing). Replacing the function matters more than replacing the substance.
- CBT-based coping — urge surfing: the urge peaks and passes if you do not act on it. Practice together.
- Medication-assisted treatment (MAT) — naltrexone, acamprosate, disulfiram. Prescribed by a doctor. Support the person in accessing and staying on it. Remove stigma: MAT is treatment, not replacing one drug with another.
- Mutual-help — AA, SMART Recovery, Refuge Recovery, Moderation Management (for non-dependent heavy drinking). Different philosophies; people try more than one. Offer to attend together.
- Treatment programs — outpatient, intensive outpatient, residential.

MEDICAL NOTE — withdrawal can be dangerous: if someone who drinks heavily daily stops abruptly, withdrawal can cause seizures and delirium tremens. Medical detox may be needed. Do not encourage cold-turkey without medical input if they are physically dependent.

What NOT to do: hide / dispose of their alcohol without agreement, assume one approach fits all, shame after a slip (shame fuels relapse — a slip is data, not a verdict).

Escalate when: signs of physical dependence with planned cessation (medical detox needed), inability to stop despite serious consequences, co-occurring conditions, crisis.

US resources: SAMHSA 1-800-662-4357, findtreatment.gov.

Opioid Use Disorder — MAT Is the Standard

Opioid use disorder (heroin, fentanyl, prescription opioids) carries high overdose risk and high dependence. Medication-assisted treatment (MAT) — buprenorphine, methadone — is the most effective treatment and saves lives. Do not discourage it.

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What it is: problematic use of opioids — heroin, fentanyl (often in counterfeit pills or illicit supply), prescription painkillers (oxycodone, hydrocodone, etc.). High addiction potential, high overdose risk, especially with fentanyl in the supply.

Why it is hard: powerful physical dependence, fentanyl in the supply makes overdose risk unpredictable, stigma prevents people from seeking MAT (the most effective treatment), often tied to pain (physical or emotional) that opioids were masking.

Common approaches:
- Medication-assisted treatment (MAT) — buprenorphine (Suboxone), methadone, naltrexone. THIS IS THE GOLD STANDARD. Reduces craving, reduces overdose risk, lets people stabilize. The group actively supports access: help find a provider, insurance, appointments. Remove stigma. MAT is treatment.
- Naloxone (Narcan) — reverses opioid overdose. Should be on hand for anyone using opioids or in contact with someone who does. Make sure the person AND close contacts have it and know how to use it.
- Fentanyl test strips — detect fentanyl in substances. Harm reduction, available through many harm reduction organizations.
- Overdose response plan — know the signs (unresponsive, slow or no breathing, blue / gray lips), call 911, give naloxone, rescue breathing. Make sure people around them know the plan. Do not let fear of legal issues stop calling 911 — many states have Good Samaritan overdose laws.
- Trigger and craving management — identify triggers, urge-surf, have a plan for high-risk moments.
- Pain management alternative — if opioids were prescribed for pain, find non-opioid pain management with a doctor (physical therapy, non-opioid medications, procedures).
- Mutual-help — NA, SMART Recovery, recovery community centers. Offer to attend together.

MEDICAL NOTE: opioid withdrawal is not typically life-threatening by itself, but the risk of return to use — and overdose, especially with reduced tolerance after a break — is the real danger. MAT dramatically reduces that risk.

What NOT to do: discourage MAT or frame it negatively (biggest harm the group can do here — MAT saves lives), assume someone on MAT is not really in recovery (harmful myth), keep naloxone secret or unavailable, let stigma keep someone from calling 911 in an overdose.

Escalate when: overdose (911 plus naloxone immediately), signs of dependence with planned cessation (MAT access needed), co-occurring conditions, anyone not accessing MAT who should be.

US resources: SAMHSA 1-800-662-4357, findtreatment.gov. Naloxone available at many pharmacies without prescription in many states.

Stimulant Use Disorder (Meth / Cocaine) — What Helps

Stimulant use disorder (methamphetamine, cocaine, prescription stimulants used non-medically) is driven by intense craving and binge cycles. There is no FDA-approved medication for meth / cocaine — treatment is primarily behavioral. Meth can cause psychosis and cognitive effects that need medical evaluation.

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What it is: problematic use of stimulants — cocaine, methamphetamine (meth), prescription stimulants (Adderall, Ritalin, etc.) used non-medically. Meth in particular can cause significant neurological and psychological effects with heavy / long-term use.

Why it is hard: intense craving and binge cycles, meth specifically can cause psychosis / paranoia / cognitive effects with heavy use (recovery from those takes time and sometimes does not fully reverse), no FDA-approved medication (treatment is primarily behavioral), often tied to energy / productivity / social confidence people miss when stopping.

Common approaches:
- Behavioral treatment — CBT, contingency management (reward-based — small rewards for negative drug screens, one of the more effective tools for stimulant use), motivational interviewing. Help the person find programs that offer contingency management.
- Structure and routine — stimulant use destroys structure (binge / crash cycles). Rebuilding a predictable routine is often core to early recovery.
- Sleep recovery — heavy stimulant use wrecks sleep. Sleep recovery is significant in early abstinence and can take weeks to normalize. Do not let the person interpret poor sleep as failing recovery — it is expected.
- Nutrition and physical care — stimulant use suppresses appetite and dehydrates. Rebuilding eating and hydration is often necessary. Practical help (meals, reminders) can matter more than advice.
- Craving and trigger management — same urge-surfing / trigger-identification framework. Practice together.
- Mental health treatment — heavy stimulant use often co-occurs with depression, anxiety, trauma. Treating the co-occurring condition matters. Support the person in getting evaluated.
- Peer support — MAS (Methamphetamine Anonymous), CA (Cocaine Anonymous), SMART Recovery.

MEDICAL NOTE: meth-induced psychosis (paranoia, hallucinations, delusions) can occur with heavy use and can persist into early recovery. If someone is experiencing this, they need medical evaluation — not something the group handles alone.

What NOT to do: assume behavioral approaches alone are always enough (some people need more intensive treatment — not a failure), interpret ongoing cognitive / mood issues in early recovery as the person not trying (some of this is residual effects that take time).

Escalate when: psychosis or severe mental symptoms (medical evaluation), inability to stop despite serious consequences, co-occurring conditions.

US resources: SAMHSA 1-800-662-4357, findtreatment.gov.

Gambling Disorder — Financial Accountability Matters

Gambling disorder is one of the most financially destructive behavioral addictions. For most people with it, cutting down does not work — abstinence from gambling is the goal. Barriers (self-exclusion, blocking sites, financial controls) matter, and the group can help set them up. Do not lend money without a plan.

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What it is: problematic gambling — loss of control, chasing losses, gambling despite serious negative consequences (financial ruin, relationship damage, legal issues). One of the most destructive behavioral addictions because of the financial damage.

Why it is hard: near-misses and intermittent reinforcement are designed to keep people gambling (the brain treats near-misses like wins), easy access (online gambling, casinos, sports betting apps), often tied to financial desperation ("one win will fix it" is a false belief that drives escalation), can be hard to see from the outside until significant damage is done.

Common approaches:
- Complete barrier to gambling — for most people with gambling disorder, cutting down does not work. Abstinence from gambling is the goal. Barriers: self-exclusion from casinos, blocking gambling sites / apps, closing accounts, giving control of finances to someone else temporarily.
- Financial accountability — the group can help set up financial barriers and accountability structures. This is one case where the group's accountability can be genuinely protective.
- CBT and trigger management — identify gambling triggers, challenge the cognitive distortions ("I am due for a win," "I can control it"), build alternatives. Help call out distortions when you hear them — gently.
- Financial counseling / debt management — if significant debt is present, professional financial help may be needed. Point toward resources; do not try to fix their finances yourself.
- Mutual-help — Gamblers Anonymous, SMART Recovery. Offer to attend together where possible.
- Treatment — therapy (CBT), sometimes medication (naltrexone has some evidence for gambling). Support access.

What NOT to do: lend money to someone in active gambling disorder without a clear plan (usually enables the problem), pretend financial damage is not happening because it is uncomfortable, assume "I will just gamble less" is viable for someone with established gambling disorder.

Escalate when: acute financial / legal crisis (eviction, legal action, utility cutoff — help navigate real resources), signs of active gambling despite serious consequences, co-occurring conditions.

US resources: SAMHSA 1-800-662-4357, findtreatment.gov.