I would argue that our actual treatment programming is also sorely lacking. The standard of treatment, often as good as it gets, is a combination of medical/pharmacological detox (as short as 3 days in patient to upwards of 2-3 weeks depending on a host of factors), followed by milieu therapy and groups in a residential setting for a short period (1-12 weeks depending on where you are), and subsequent recovery housing with drug testing, support group participation, and in-house group(s). This obviously varies widely depending on things like insurance status, location (in the US) and available/accessible treatment programs - I worked with a clinic in Kentucky once who was the sole outpatient addictions provider accessible to a patient within 50 miles, guy was traveling in weekly for buprenorphine and while this is outpatient, it shows the lack of access some people may face in treatment.
What most places do not offer is integrated vocational rehabilitation, legal assistance, family therapy (this may be accessible in private pay settings), and other life skills oriented treatment. When I got clean in 08, the hardest part was relearning how to be an adult. I had a college degree but I couldn't function in even the most basic ways after years of heroin addiction and homelessness. Since I had a degree and a relatively decent work history, I was able to re-enter the workforce. Because I didn't have a criminal record, I wasn't limited by background checks etc. Most of the folks I've worked with over the years have decompensated due to trauma related to substance use and the experience of being a substance user (two different things). Without incorporating skills based learning and assistance with addressing legal and/or family/community issues, the onus is on the individual to deal with these issues.
I've also become increasingly convinced that opioids (in particular) have an impact on aging in strange ways. Opioids suppress testosterone expression which has a variety of immediate effects such as impacting female menses, and diminishing libido/ejaculation etc. in men. I believe that for males who begin using in adolescence and into young adulthood, may experience hormonal-related disruptions which could have complex impacts over their lives, even in abstinence. This is hypothetical, but research has begun to explore the impact of opioids on things like pregnancy (moms on methadone being looked at currently in studies I mentioned in another post). I believe that the reality facing many opioid users who are seeking support is clouded by numerous factors which are not sufficiently addressed in the vast majority of our current treatment models.
When you're looking at outpatient treatment, maintenance therapy may be effective at preventing death, but they also may be effective at maintaining the identity of 'addict' while tethering people to power dynamics that rarely treat the patient as an equal participant in care. The long term impact of maintenance therapies is incredibly difficult to study, and it is my experience that they can stifle self-determination and serve as a consistent reminder of having "a problem".
I could go on about this, but just wanted to toss in some of my thoughts.
