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Identifying substance use disorders can be confusing. We have developed these FAQs to assist you as you try to find appropriate answers to your questions regarding treatment and payment for services.

The Basics
Opioid Risks and Alternatives
Identifying a Substance Use Problem and Treatment Options
Treatment Cost and Insurance Questions
Family and Community Support


What is substance use disorder?

Substance use disorder involves excessive and compulsive use of alcohol or drugs. It causes health problems or disability. It limits your ability to meet responsibilities at work, school or home.1 Substance use disorder is a disease, not a failure of will or weakness of character. It can be serious and life-threatening. It is also treatable and many people can recover if they seek the proper care. Help is nearby. Call the Substance Use Disorder Helpline at 1-855-780-5955 to speak with a licensed clinician.

What if I have more questions?We are available 24/7 to answer your questions. These may include your personal health, care for a family member, coverage, cost of care, and more. We are committed to making it as easy as possible for you to access the services you or your loved one may need. Simply call the Substance Use Disorder Helpline today at 1-855-780-5955.

What are Opioids?

Opioids are prescription-only narcotic pain medications. They treat and manage moderate to severe pain by blocking pain signals in the brain. The most common opioid medications include:

  • hydrocodone — common brands include Vicodin®, Lorcet® and Lortab®
  • oxycodone — common brands include Percocet®, OxyContin®, Roxicodone® and Xtampza ER®
  • morphine — common brands include MS Contin®, Kadian® and Avinza®
  • fentanyl — common brands include Duragesic® and Fentora®

Why has opioid use become an epidemic?

Doctors have prescribed opioid medications to treat pain for several years. They were thought to be safe and not addictive. This has proven wrong, however. Opioids are very addictive. This has caused millions of people around the country to become dependent on these medications. If they’re unable to obtain more prescription medication, people often turn to heroin and other illegal drugs. Heroin addiction affects more than half a million people. Every day, 16 people die from an overdose of opioids.

How do I safely take prescribed opioid medications and why is this important?

Prescription opioid abuse is a serious public health issue. Understanding the potential risks and how to take, store and dispose of these powerful medications properly can help avoid serious risks.

Do not take your medication more frequently than prescribed, and never take extra doses without consulting your doctor or pharmacist. To avoid dangerous interactions, talk with your doctor or pharmacist about all medications you take. Never mix alcohol or other sedating drugs, such as sleeping pills (zolpidem, Ambien®) or anxiety medications (diazepam, Valium®, alprazolam, Xanax®, lorazepam, Ativan®). Opioids are designed to be taken as needed. Once pain is under control, it is acceptable to take them less frequently or change to alternative options. Never share your medications with others.

What alternative pain medication options should I consider?

Pain relief options come in many forms — many with fewer risks and side effects than opioids. These include:

  • Over-the-counter medications, such as ibuprofen (Motrin®), acetaminophen (Tylenol®) or naproxen (Aleve®)
  • Prescription strength anti-inflammatory drugs such as celecoxib (Celebrex®), diclofenac (Voltaren®)and etodolac (Lodine®)
  • Select prescription non-opioid medicines which target the nerves that produce pain, such as gabapentin (Neurontin®) and pregabalin (Lyrica®)
  • Injectable and topical non-opioid therapies
  • Chiropractic services, physical and massage therapy, exercise and cognitive behavioral therapy

What risks are associated with taking opioids?

  • Tolerance — needing higher and higher doses to achieve the same effect
  • Dependence — having symptoms of withdrawal when the medication is stopped
  • Addiction — uncontrollable cravings and an inability to control drug use
  • Overdose or even death

How do I know it is time to seek care for me or a loved one?

There are many signs that tell it’s time to seek help. Here are just a few:

  • Mood swings or mysterious change in personality
  • Neglecting responsibilities or abrupt change in friends
  • Weight loss or decline of appearance.

What types of treatment programs are available?

When it comes to treatment, there is no "one-size-fits-all" solution because everyone's situation is unique. An individualized treatment strategy begins with an assessment by a licensed clinician. In general, treatment options may include one or more of the following:

  • Detoxification
  • Local, short-term, intensive residential treatment
  • Medication-assisted treatment
  • Intensive outpatient treatment
  • Individual substance use disorder counseling
  • Group therapy

You can speak to a licensed clinician right now. They can evaluate your situation and arrange for an almost immediate face-to-face evaluation with one of our trusted network experts who can create a unique care strategy that’s right for you — usually within 24 hours.

Why is Medication-assisted Treatment (MAT) the best treatment for opioid use?

In MAT, medications are given under strict supervision from a doctor. These medications safely control withdrawal symptoms and cravings. This gives the patient time to recover and reduces the risk of relapse. Research shows that medication-assisted treatment (MAT) is the most promising treatment. When combined with counseling and other support, MAT is extremely effective.6

Without MAT, 90% of individuals with Opioid Use Disorder (OUD) will relapse within one year. With MAT, the relapse rate for those with OUD decreases to 50% at one year.

What is methadone and how does it help people overcome their dependence?

According to the U.S. Office of National Drug Control Policy, methadone is “a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.” Pharmacologically, methadone is a man-made opioid. It is known chemically as a “full agonist.” In other words, it completely binds to the opioid receptors in the brain like all other prescription pain medications, including heroin. Methadone is available in the form of a pill or oral solution, and has been available in the US for more than 65 years.

Methadone is prescribed under strict state and federal guidelines only by providers with the appropriate training, certification and credentials. When utilized to treat chronic pain, methadone can be prescribed by a physician and filled in a pharmacy. When used to treat OUD, methadone can only be provided in a licensed, regulated methadone treatment program or Opioid Treatment Program (OTP).

Methadone is long-acting and does not generate the euphoric feeling like that of a short-acting opiate, such as heroin. When provided at the correct dose, methadone does not cause impairment to mental function or daily activities. Instead, methadone eliminates acute symptoms of opioid withdrawal and relieves craving.

What is buprenorphine?

Buprenorphine has been available since 2002 for the treatment of OUD. It can be prescribed by a qualified medical provider and filled in a pharmacy. Unlike prescription pain medications, medical professionals must have a special license through the Food and Drug Administration (FDA) to prescribe buprenorphine.

Like all other opioids, buprenorphine acts on the opioid receptors in the brain. Unlike methadone, prescription pain medications, and heroin, buprenorphine does not completely bind to opioid receptors. As such, it is chemically known as a “partial agonist” and only binds to parts of the opioid receptor resulting in relief from symptoms of withdrawal and decreased cravings.

Buprenorphine does not require increasing dosage with long-term use to achieve its effects, which is different from full agonists. And, even in high doses, buprenorphine does not cause the respiratory depression.

Since 2002 buprenorphine has been FDA-approved in many different forms and routes of administration including a pill, dissolvable tablet, buccal film, 6-month implantable rods, and most recently a 30-day IM injection. As a result, buprenorphine can be tailored to the needs of individuals within a comprehensive, long-term treatment plan.

What is naltrexone and what is the difference between agonist and antagonist MAT?

FDA approval of MAT, in all its forms, allows individuals to seek treatment without the preoccupation of physical cravings or the anxiety of impending withdrawal. MAT can be tailored to individual needs, and can be provided in multiple settings. A simple way to remember the different forms of MAT is to understand how they work on the opioid receptors to achieve the same result of long-term recovery and prevention of fatal overdoses.

Three different classes:

  • Full agonist (methadone)
    • An opioid that binds completely to the opioid receptor in the brain
    • May only be dispensed in a federally regulated methadone clinic for the treatment of OUD
    • Must be taken on a daily basis
    • Eliminates withdrawal symptoms and relieves drug cravings
    • Does not require increased dosing to achieve the same therapeutic effect
  • Partial agonist (buprenorphine)
    • Binds partially to the opioid receptor in the brain
    • May only be prescribed by a physician, nurse practitioner or physician assistant that has the appropriate FDA license/Data 2000 Waiver Certification
    • Can be filled by a community pharmacy
    • Must be taken as prescribed in a pill, dissolvable tablet, buccal film, 6-month implantable rods or 30-day IM injection
    • Eliminates withdrawal symptoms and relieves drug cravings
    • Does not require increased dosing to achieve the same therapeutic effect
    • Does not induce respiration depression resulting in fatal overdoes
  • Antagonist (naltrexone)
    • Inhibits opioids introduced into the system from binding to the opioid receptors in the brain that cause euphoria, dependency, respiratory depression and overdose
    • Does not require appropriate FDA-licensure and may be prescribed by a physician, nurse practitioner or physician assistant acting under the scope of their licensure
    • Can be filled by a community pharmacy
    • Does not require increasing dosing to achieve the same therapeutic effect
    • Must be taken as prescribed in a pill or 30-day IM injection

Isn’t Medication-assisted Treatment just exchanging one drug for another?

All disorders of addiction are chronic conditions with very real biochemical components. Research is conclusive that Substance Use Disorder is linked to specific receptors involved with the “reward system” in the brain. This is especially true for OUD, which also involves receptors that are responsible for pain relief and feeling pleasure. For the treatment of OUD, MAT works on these same receptors in varying ways. With the exception of methadone, MAT does not treat pain. When taken as prescribed and under appropriate supervision, MAT used in the treatment of OUD is not addictive. Unlike heroin, MAT prescriptions do not induce feelings of euphoria or cause habitual, unhealthy or compulsive use. When taken as directed, MAT does not cause either intoxication or withdrawal as seen with prescription pain medications and heroin.

More importantly, continual use of MAT enhances long-term recover by decreasing cravings. In fact, studies have shown that after short-term use of MAT for “detox” only, relapse is most likely to occur, and can result in a fatal overdose. Misguided beliefs about MAT and how they work only continue to stigmatize individuals suffering from Substance Use Disorder.

How safe is Medication-assisted Treatment?

The World Health Organization has placed methadone and buprenorphine for the treatment of OUD on their list of “essential medications.” The American Society of Addiction Medicine (ASAM), National Institute of Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMHSA) recognize MAT as the Standard of Care and Evidenced-Based Treatment for individuals suffering from Substance Use Disorder.

When used as prescribed under appropriate supervision, MAT can safely be taken without damaging side effects. But, as with any medication, there are potential side effects. When experienced, these side effects are known to be minor, with no long-term health risks, and most reduce over time, once a stable dose of medication is reached.

The decision about MAT should be made only after discussion with a medical professional about the potential side effects, as well as obtaining a clear understanding of the risks and benefits of incorporating---and not incorporating---MAT into a long-term treatment plan.

How long does Medication-assisted Treatment last?

Incorporating MAT into any treatment plan should be designed to address each individual’s unique situation. Duration of treatment varies and should take into consideration the individual’s treatment response, needs and circumstances. There is no FDA limit on how long an individual may utilize MAT in their treatment. The rule of thumb is that one should remain on MAT to achieve and maintain recovery goals.

What guidance does the FDA give regarding Medication-assisted Treatment during pregnancy?

Methadone has been used for pregnant women with OUD since the 1970’s and has been recognized as the gold standard of care since 1998.

In addition, The FDA issued safety labeling changes for buprenorphine products when prescribed for use during pregnancy. Research has demonstrated the following benefits from methadone and buprenorphine treatment during pregnancy:

  • Stabilizes fetal levels of opioids
  • Reduces repeated prenatal withdrawal
  • Improves neonatal outcomes
  • Increases maternal HIV treatment and reduces the fetal transmission
  • Promotes better prenatal care

Is there Medication-assisted Treatment for alcohol-use disorder?

There are several FDA-approved medication-assisted treatments for Alcohol Use Disorder, which include:

  • Medications used to reduce reward from alcohol intake:
    • Naltrexone, Revia® and VIVITROL® (naltrexone IM injection)
  • Medication used to reduce cravings
    • Campral EC (acamprosate)
  • Medication used to cause adverse effect of alcohol ingestion
    • Antabuse® (disulfiram)

What should I look for in a substance use disorder treatment program?

There are many factors that can help you achieve a successful recovery. Providers should use evidence-based practices, show a track record of positive results, and have the highest level of credentialing. You should have choices in treatment because there are many paths to recovery. A program should also include community services and participation of family and friends who can support your recovery process.

Call the Substance Use Disorder Helpline at 1-855-780-5955 for immediate access to a licensed clinician. They can guide you to a qualified practitioner. You can also visit Liveandworkwell.com for a list of trusted providers.

Why does the location of treatment matter?

The chances for recovery improve when a treatment and recovery plan is designed and conducted within the patient’s local community. This creates a strong, nearby, long-term support system. Local treatment enables rebuilding of relationships with family, friends and others to support a successful recovery.2

Substance use disorder can be a chronic condition. Relapse is possible during recovery. Your care team should be nearby and readily accessible. We can help you find trusted care providers in your area. Our experts at the Substance Use Disorder Helpline at 1-855-780-5955 can match you with a local provider.

Does my health insurance help pay for substance use treatment?

Yes, and we can help you understand what services are covered and provide options that may minimize your out-of-pocket expense. To learn more, call the Substance Use Disorder Helpline at 1-855-780-5955. Licensed clinicians can guide you to a treatment provider or treatment center in your covered network. Your benefit information is also available on Liveandworkwell.com under the "Claims and Coverage" section of the website.

Do some services require prior authorization?

Yes, some services offered by your health plan may require prior authorization. This means that you or your treatment provider must seek a medical necessity approval prior to receiving services. Medical necessity criteria are defined by nationally recognized standards of care. Some out-of-network providers may not be aware of medical necessity criteria. They may recommend a higher level of care or more restrictive treatment. Or they may offer you treatment in the only setting that they have available.

We can also help you understand what kinds of treatment require authorization and walk you through the process. Simply call the Substance Use Disorder Helpline at 1-855-780-5955 today to get started.

Is there going to be any cost to me for treatment?

There may be a cost to you. This depends on two main factors:

  • a) Your treatment provider. In general, in-network providers offer lower out-of-pocket costs than out-of- network providers. In-network providers meet our strict quality standards of care to achieve better results and lower costs for you.
  • b) Level of care appropriate for you. Usually, the more intensive the setting, the higher the cost, but this may be dependent on your benefit plan.

Once you have a personal assessment from a licensed clinician, call the Substance Use Disorder Helpline to get an estimate of out-of-pocket costs.

Why are there cost differences between in-network and out-of-network providers?

In-network treatment typically means lower out-of-pocket costs. These providers and facilities are contracted with your health plan. They are familiar with medical necessity, coverage determination guidelines, and your plan's benefit design. In-network providers handle the insurance paperwork to obtain authorizations and submit claims for you. They usually do not bill you for any charges other than your copayments, deductibles or coinsurance.

If your insurance plan allows services through out-of-network providers, you will very likely pay more for using these services. Costs include a higher deductible and coinsurance, plus any amount over the allowed maximum set by your plan. Please note that some services from out-of-network facilities may not be covered by your plan at all. This can result in more unanticipated out-of-pocket costs. If you agree to see an out-of-network provider, you would be responsible for those costs.

How do out-of-network providers manage claims and payments?

You may have to personally guarantee payment with a credit card before treatment with an out-of-network provider. They are not limited in what they may charge. You may be billed for the remaining balance of provider charges after your health insurer pays its portion. These providers may not request pre-authorization for services or advocate on your behalf for payment of services. They generally do not submit claims for you. And they may not provide enough information for your health insurer to approve the care provided or pay the claim.

Can I get into treatment today? If not, when?

Call the Substance Use Disorder Helpline today at 1-855-780-5955. The team can schedule a professional assessment for you, usually within 24 hours. There are local in-network treatment options in all areas where we provide coverage.

Can my family be part of my treatment process?

Family involvement is recommended throughout the treatment and recovery process,3 unless there is a clinical reason to limit family participation.4 Your family may work with community resources to help them understand and support your recovery. A provider may offer family education and sessions with you as part of the treatment process. If you believe this is integral to your recovery, be sure that the treatment provider you choose offers this option.

Signing a release of confidential information allows family members to participate and receive treatment updates. A release may not be required if the person is under 18, but this may vary from state to state.

Once treatment is complete, is there a connection to community support systems or a transitional program?

Recovery is a life-long process. It is important that you remain engaged in outpatient treatment and aftercare programming after you complete formal treatment.5 Check with your treatment provider to determine which support services will work best for you. The Substance Use Disorder Helpline can offer guidance and resources for your important transition back into the community.

Is this treatment confidential?

Substance use treatment is always confidential and is protected by federal and state laws.

What if I have more questions?

We are available 24/7 to answer your questions. These may include your personal health, care for a family member, coverage, cost of care, and more. We are committed to making it as easy as possible for you to access the services you or your loved one may need. Simply call the Substance Use Disorder Helpline today at 1-855-780-5955.


1. "Substance Use Disorders." 27 October 2015. SAMHSA. Retrieved 31 March 2016.

2. "Recovery and Recovery Support." 5 October 2015. SAMHSA. Retrieved 31 March 2016.

3. "Substance Abuse Treatment and Family Therapy: A Treatment Improvement Protocol TIP 39," Chapter 1. 2015. SAMHSA. Retrieved 31 March 2016.

4. Gifford, Steven. "Family Involvement is Important in Substance Abuse Treatment." Retrieved 31 March 2016. http://psychcentral.com/lib/family-involvement-is-important-in-substance-abuse-treatment

5. "Recovery and Recovery Support." 5 October 2015. SAMHSA. Retrieved 31 March 2016.


Only a treating health care clinician or physician can endorse any treatment or medication, specific or otherwise. This service provides referrals to such a professional, as well as information to help you maintain and enhance your personal health management. This service and information is not meant to replace professional medical advice. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services.


*Resources and information available to you on liveandworkwell.com may vary depending on your benefit.