My approach is to treat the patient as someone with a medical illness. It is very difficult for many to ask for help and I acknowledge that. Asking for help is actually a significant act of recovery.
Guilt and shame fuels the disease and is dealt with.
We start with a careful evaluation of the SUD, medical and psychiatric illnesses and standardized criteria are used to determine the appropriate level of care.
If office based treatment is indicated medications are used if they are indicated. I also do education, motivational interviewing, and coaching for recovery. I recommend seeing a counselor or IOP and peer support (12 step, Smart Recovery and others). Unfortunately, many patients do not have the resources to afford a counselor.
For Alcohol Use Disorder, naltrexone (oral or Vivitrol), acamprosate (Campral) and Antabuse are FDA approved and significantly improve recovery.
For Tobacco or nicotine (vaping) use disorder Chantix and buproproprion are used.
For amphetamine, methamphetamine use disorder there is some evidence naloxone and buproprion have some benefit.