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How to write a treatment plan for substance use disorder

Familiarize yourself with the diagnostic criteria for SUD and the basics of creating a treatment plan for substance use disorder.

Substance use is common in the U.S. About half of U.S. adults and teens regularly drink alcohol, nearly 20 percent use tobacco or cannabis, and still more use illicit drugs. It can be tricky to tell when these common habits meet the bar for a diagnosis of substance use disorder (SUD), and how to proceed as a therapist if they do.

While diagnoses and treatment decisions must be made on a case-by-case basis, you can start by familiarizing yourself with the diagnostic criteria for SUD and the basics of creating a treatment plan for substance use disorder.

DSM-5-TR diagnostic criteria for substance use disorder

The DSM-5-TR includes information on diagnosing problematic use of 10 substance classes: alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco; and other/unknown substances. With the exception of caffeine, diagnostic criteria are similar across substance classes. 

The DSM-5-TR criteria for alcohol use disorder are provided below as an example of how to diagnose SUD. Generally, people who display two or three symptoms are thought to have “mild” SUD, those who display four to five have “moderate” SUD, and those who display six or more have “severe” SUD.

A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:


1. Alcohol is often taken in larger amounts or over a longer period than was intended.


2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.


3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.


4. Craving, or a strong desire or urge to use alcohol.


5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.


6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.


7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.


8. Recurrent alcohol use in situations in which it is physically hazardous.


9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.


10. Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

b. A markedly diminished effect with continued use of the same amount of alcohol.


11. Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal).

b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.


Specify if:

In early remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use alcohol,” may be met).

In sustained remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use alcohol,” may be met).

Specify if:

In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted.


American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing

What to include in a treatment plan for substance use disorder

Treatment of SUD should be highly individualized, shaped by factors including the substance in question and the duration and severity of use. Therapeutic modalities including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) may be effective in SUD treatment, but therapy may not be the only piece of the puzzle. Some people may also benefit from medication and/or inpatient treatment.

While a care strategy should always be personalized to address your client’s specific symptoms, circumstances, and hopes, below are sample goals, objectives, and interventions that — along with your clinical analysis and knowledge of the psychological literature — can help inform your treatment plan for substance use disorder.

Support sobriety

Getting and staying sober is at the core of any SUD treatment plan. Identifying patterns of and triggers for substance use is often a good place to start.

Develop coping strategies 

Therapeutic techniques such as CBT and DBT may help your client cope with and manage substance cravings. Support groups, such as Alcoholics Anonymous or Narcotics Anonymous, may also be beneficial for some people. 

Improve mental and emotional well-being

Many people with SUD also have other mental-health concerns, such as depression or anxiety. Working on these issues in therapy can enhance overall treatment and recovery.

Strengthen relationships 

People with SUD often experience interpersonal issues as a result of their substance use. Interventions such as family therapy or couples counseling may help mend some of that damage where necessary, while proactive strategies — like creating a fulfilling sober social life — can build a strong foundation for the future.

Create a healthy lifestyle plan 

Many people with SUD struggle to maintain their personal and professional obligations. Creating a structured schedule that includes work, social support, physical activity, hobbies, and self-care may help your client move forward successfully.

Substance use disorder treatment plan example

You’ll need to draw on your clinical skills and training to design a treatment plan that fits your client’s specific symptoms and needs, but this sample treatment plan for substance use disorder can serve as a guide.

Case example:

John is a 32-year-old sales representative who has consumed alcohol since he was 17. He reports drinking excessively for the past eight years, with increasing frequency and quantity over the last three years. He now consumes about eight to 10 drinks per day and experiences withdrawal symptoms including sweating, tremors, and anxiety when he tries to cut back. He states that his alcohol use has negatively affected his work performance, relationships, and overall health. His wife recently threatened to leave him if he did not seek help.

Goal 1: Achieve and maintain abstinence from substance use

  • Objective 1.1: Identify personal triggers and high-risk situations.
  • Intervention 1.1: Complete a substance use assessment and develop a relapse prevention plan by the end of the month.


  • Objective 1.2: Develop alternative coping mechanisms for managing cravings.
  • Intervention 1.2: Attend support groups (e.g., AA, NA, SMART Recovery) for peer support 1x per week.


Goal 2: Develop coping strategies to manage cravings and triggers

  • Objective 2.1: Learn and practice mindfulness and stress-reduction techniques.
  • Intervention 2.1: Engage in mindfulness-based therapy or meditation exercises 3x per week.
  • Intervention 2.1: Use journaling or mood tracking to recognize emotional triggers.


Goal 3: Improve mental and emotional well-being

  • Objective 3.1: Address co-occurring mental health conditions.
  • Intervention 3.1: Participate in psychiatric evaluation, trauma-informed therapy, and medication management if needed.

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