Substance use disorder (SUD) treatment is different today than it was even just a few years ago. The traditional way of thinking about SUD, in which relapse was often perceived as failure and rehab was the default path, has since been replaced with a more compassionate, evidence-based approach. For health plans, this shift has implications for member outcomes, engagement and costs.
Rethinking relapse
Until recently, relapse, or return to use, was treated as a setback steeped in stigma and shame. That kind of mindset turned out to be counterproductive, as research shows that shame is linked to depression and return to use in people recovering from addiction. The fact is, recovery isn’t linear and return to use is common. According to the National Institute on Drug Abuse, 40-60% of people in recovery from substance use disorder (SUD) return to use at some point, a rate similar to other chronic illnesses like diabetes and hypertension.
When members view return to use as a stepping stone instead of a moral failing, they’re more likely to remain engaged in care. They can instead use return to use as an opportunity to recalibrate, strengthen coping strategies and build resilience. This perspective shift is essential for lasting recovery, and health plans can play a role in shaping it.
“When members view relapse as a stepping stone instead of a moral failing, they’re more likely to remain engaged in care.”
Adam Ligas, MD – Medical Director
The role of social support
People navigating SUD need connections with supportive friends, family and communities who understand their journey, and those connections don’t always need to be sober themselves. What matters is having people who can support recovery, not sabotage it. People with strong social networks are more likely to stay in treatment longer and have better recovery outcomes. Peer programs, family counseling and recovery coaching build a foundation of accountability and encouragement that lasts long after formal treatment ends. Health plans can help members by prioritizing these supports.
Expanding treatment options
Another significant shift in recovery is that it has broadened beyond just inpatient rehab. Medication for addiction treatment (MAT) has become a lifeline for many, with medications like buprenorphine, methadone and naltrexone helping to reduce cravings, limit overdose deaths and keep people in treatment longer. In fact, studies show that patients engaged in MAT programs are more likely to remain in recovery compared to those relying solely on behavioral interventions.
At the same time, some members do better with outpatient therapy, digital support tools or community programs. For health plans, this means that offering a spectrum of evidence-based options, rather than a one-size-fits-all SUD solution, is the key to keeping members healthy.
Health plans can align their benefits with today’s best practices for SUD treatment by:
- Reframing relapse as part of recovery, not the end of it.
- Prioritizing social support through peer networks and family engagement.
- Expanding access to evidence-based care, including MAT, outpatient programs and digital supports.
By evolving their strategies to meet the realities of recovery today, plans can achieve better member engagement, lower costs and build stronger community trust.
Adam Ligas, MD is a medical director at Lucet.
