Once justice professionals understand what science tells us about substance use disorders (SUDs), the next question is practical: Can people with SUDs be successfully treated?

Courts, prosecutors, law enforcement officers, community supervision professionals, and treatment court teams regularly encounter individuals whose substance use has been a significant factor in repeated arrests, violations, family disruption, unemployment, and other serious consequences. After seeing the same individuals return again and again, it can be easy to conclude that treatment has failed or that some people simply will not change.

The evidence, however, tells a different story. SUDs are treatable conditions, and recovery is possible.^[1] That conclusion has significant implications for the criminal justice system. 

The American Society of Addiction Medicine describes addiction as a “treatable, chronic medical disease” involving interactions among brain circuits, genetics, the environment, and individual life experiences.^[2] Research also demonstrates that substance use disorders can be managed using approaches similar to those used for other chronic conditions.^[3]

For justice professionals, that changes the starting point. Repeated substance use should not automatically be viewed as evidence that an individual is unwilling or unable to change. Like other chronic conditions, SUD may involve periods of recurrence that require treatment to be continued or adjusted.^[4] Recognizing that SUD is treatable does not mean that every person will respond to every intervention. Recovery may take time, and the appropriate treatment may change along the way. 

What matters is that effective interventions exist. Justice-system decisions can help create the conditions in which appropriate treatment has an opportunity to work, or create barriers that make recovery more difficult.

Treatment Is Not One Thing

One of the persistent misconceptions about SUD treatment is the idea that there is a single treatment that either “works” or “doesn’t work.” ^[5]

As with other chronic conditions, effective treatment for SUD must be individualized. 

SUDs vary in severity.^[6] The substances involved differ.^[7] Individuals have different medical conditions, mental health needs, family circumstances, housing situations, employment histories, risks, strengths, and sources of support.

The Substance Abuse and Mental Health Services Administration (SAMHSA) emphasizes that treatment should be based on an individual’s needs and may need to change over time as the person responds to care.^[8] Depending upon those needs, treatment may include behavioral therapies, medications, counseling, recovery supports, or combinations of these approaches.^[9]

The need to individualize treatment is particularly important in the justice system.

When an individual struggles in a particular program, the appropriate conclusion is not necessarily that treatment does not work or that the individual is incapable of recovery. The better question may be whether the program was appropriate for that individual or whether the treatment plan needs to be modified.

Justice professionals do not need to become treatment professionals to understand this distinction. Judges, prosecutors, law enforcement officers, probation and parole officers, and treatment court team members do, however, make decisions that can affect access to and continuation in treatment. Recognizing that treatment often requires ongoing assessment and adjustment provides important context for justice system decision-making.

Recovery from Substance Use Disorders Is a Process

The chronic nature of SUD should also change how success is understood.

For some individuals, treatment results in sustained improvement.^[10] Others experience periods of stability followed by renewed substance use and require additional or different treatment.^[11] Still others may need continuing services and support over an extended period.^[12]

SAMHSA describes SUDs as often long-term health conditions with a risk of recurrence even after years of recovery.^[13]Yet millions of Americans live healthy, productive lives in recovery.^[14]

Those two facts are not contradictory. The possibility that symptoms may recur does not mean recovery is impossible. Rather, managing a chronic condition requires a different perspective than treating an acute illness

This distinction has immediate consequences for justice-system decision making.

Consider a positive drug test. A positive result is important information. It may establish a violation of a court order or supervision condition and may require an immediate response. But a positive test does not, standing alone, establish that treatment has failed or that the individual is incapable of recovery.

Instead, renewed substance use may indicate that the treatment plan, level of care, supervision strategy, or other supports should be reassessed.

That does not mean ignoring the behavior. It means understanding what the behavior tells us and responding in a way most likely to promote future compliance, recovery, and public safety.

Medications Are Treatment

The principle that SUD is treatable also requires recognizing the full range of evidence-based treatment options. Nowhere is this more important than in the treatment of opioid use disorder (OUD).

Medications for opioid use disorder (MOUD) are not an exception to treatment.^[15] They are part of treatment.^[16]

Methadone, buprenorphine, and naltrexone are FDA-approved medications for treating OUD.^[17] Research has demonstrated that these medications can improve treatment retention, reduce illicit opioid use, and reduce the risk of overdose.^[18]

Yet, mistaken beliefs about these medications continue to influence justice-system practices.  The belief that taking methadone or buprenorphine merely substitutes one drug for another, for example, misunderstands the clinical role of these medications.^[19]

That misconception matters for judges, prosecutors, law enforcement officers, community supervision professionals, and treatment court teams because their decisions may affect whether an individual can begin or continue receiving medication. None of those roles requires justice professionals to determine which medication is clinically appropriate. Treatment decisions should be individualized and made by qualified treatment professionals. But justice-system decisions should begin with an accurate understanding that an FDA-approved medication can be a legitimate component of treatment rather than evidence that an individual is not truly in recovery.

Treatment Extends Beyond Medication

Focusing exclusively on MOUD, however, would make the same mistake in the opposite direction.

SUDs include far more than opioid use disorder, and effective treatment encompasses far more than medication.^[20]

Behavioral therapies can help individuals recognize triggers, develop coping strategies, change patterns of thinking and behavior, improve decision-making, and strengthen skills necessary for recovery.^[21] Depending on individual needs, effective care may also involve mental health services, family involvement, peer recovery support, housing assistance, employment services, and other resources.^[22]

What Treatment Means for Justice Professionals

Recognizing that SUD is treatable does not require justice professionals to become clinicians. It requires them to understand enough about treatment and recovery to make informed decisions within their own roles.

That includes distinguishing treatment failure and the need to adjust care. Renewed substance use may require a justice-system response, but it does not necessarily mean that recovery has failed. Medications should be recognized as legitimate treatment when clinically appropriate, and treatment decisions should be guided by qualified treatment professionals. 

Justice professionals should also recognize that their decisions can affect an individual’s opportunity to engage in and benefit from treatment.

Care must still be appropriate. Individuals must engage in the recovery process. Justice professionals must continue to perform their responsibilities. Public safety remains essential.

Recovery Is Possible

People often enter the justice system at the lowest points in their lives. A person standing before a judge, meeting with a probation officer, entering a treatment court, or interacting with a police officer may have experienced years of substance use and repeated consequences. It is understandable that repeated setbacks can create skepticism in both the justice professional and the individual. But the evidence provides reason for a different perspective: people with SUDs can and do recover. 

That fact changes the question facing the justice system. Rather than asking only what consequence should follow the behavior, justice professionals can also ask what response is most likely to reduce future substance use, encourage lasting behavior change, and improve public safety.

Recognizing that recovery is possible does not eliminate personal responsibility. Instead, it raises the next question: how can the justice system create guardrails that hold individuals accountable while supporting treatment and behavior change that reduce future justice involvement and protect the public?

That question will be the focus of the third principle in JSI’s framework: Accountability: Recovery and Public Safety Can Coexist.

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^[1] Treatment of Substance Use Disorders, Ctrs. for Disease Control & Prevention (Apr. 25, 2024).

^[2] Definition of Addiction, Am. Soc’y of Addiction Med. (Sept. 15, 2019), https://www.asam.org/quality-care/definition-of-addiction.

^[3] A. Thomas McLellan et al., Can Substance Use Disorders Be Managed Using the Chronic Care Model? Review and Recommendations from a NIDA Consensus Group, 35 Pub. Health Revs. 1, 1–14 (2014).

^[4] Nat’l Inst. on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide 3 (3d ed. 2018).

^[5] Demystifying Myths About Addiction Treatment: Separating Fact from Fiction, Porch Light Health.

^[6] Nora D. Volkow & Carlos Blanco, Substance Use Disorders: A Comprehensive Update of Classification, Epidemiology, Neurobiology, Clinical Aspects, Treatment and Prevention, 22 World Psychiatry 203, 203–29 (2023).

^[7] Id.

^[8] Substance Abuse & Mental Health Servs. Admin., Substance Use Disorders Treatment Options, SAMHSA.

^[9] Id.

^[10] Principles of Drug Addiction Treatment, supra note 4.

^[11] Id.

^[12] Id.

^[13] Substance Abuse & Mental Health Servs. Admin., Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (2025), SAMHSA 2024 NSDUH report.

^[14]Id.

^[15] Nat’l Inst. on Drug Abuse, Medications for Opioid Use Disorder, Nat’l Insts. of Health.

^[16] Id.

^[17] Id.

^[18] Id.

^[19] Treatment Options for Substance Use Disorder, Substance Abuse & Mental Health Servs. Admin., (last visited Aug. 12, 2026).

^[20] Nora D. Volkow & Carlos Blanco, Substance Use Disorders: A Comprehensive Update of Classification, Epidemiology, Neurobiology, Clinical Aspects, Treatment and Prevention, 22 World Psychiatry 203, 203–29 (2023),

^[21] Id.

^[22] Id.