Substance Use Care Pathway

Substance use disorder (SUD) is a medical condition defined by a pattern of using alcohol or drugs that causes significant impairment or distress. The DSM-5-TR diagnoses SUD on a spectrum from mild (2–3 criteria) to moderate (4–5) to severe (6 or more) across 11 criteria that include loss of control, cravings, tolerance, withdrawal, and continued use despite negative consequences. It is not a moral failing — it is a chronic, treatable health condition with known biological, psychological, and social drivers.

New Hampshire has been hit particularly hard by the opioid crisis: the state consistently ranks among the highest per-capita rates of drug overdose deaths in the country. But substance use disorders extend well beyond opioids — alcohol use disorder is the most prevalent SUD nationally, and stimulant use is rising. Co-occurring mental health conditions (depression, anxiety, PTSD) are the norm rather than the exception.

Recovery is possible, and multiple evidence-based pathways exist. Medications for opioid use disorder (buprenorphine, methadone, naltrexone) dramatically reduce overdose death and support sustained recovery. Behavioral therapies — CBT, motivational interviewing, contingency management — are effective across substance types. Mutual-aid groups (AA, NA, SMART Recovery) provide ongoing community support. New Hampshire has a robust network of treatment providers, recovery centers, and harm-reduction services.