People with co-existing diabetes and substance use issues are more likely to experience physical health issues, poor treatment outcomes, and other related conditions, compared to people with one or neither condition. Integrated care can help address these issues concurrently, although there is currently limited evidence around this type of treatment approach.
How substance use impacts diabetes management
In the United States, there are around 24 million adults with Type 2 diabetes. People with diabetes are more likely to experience health issues such as cardiovascular disease, kidney damage, and neurological conditions. [1][2]
Substance use is common among people with diabetes, including tobacco and alcohol use among 20% and 50-60%, respectively. Alcohol, cigarette, and drug use are linked to an increased likelihood of developing Type 2 diabetes and are associated with poorer health outcomes and a higher likelihood of diabetes-related complications such as amputations and neuropathy. [1][3]
Similarly, substance abuse and substance use disorders (SUDs) among those with diabetes can increase the risk of developing severe health consequences requiring hospital admission. [1][3]
Furthermore, people with SUD are less likely to seek, receive, and adhere to diabetes treatment and health recommendations than those without SUD. This could also contribute to poor health outcomes. [3]
What the systematic review found
A recent systematic review (Husain, Ray, & Tafuto, 2025) aimed to investigate the benefits of various treatment approaches available to individuals with co-occurring diabetes and SUD.
Of the retrieved studies, nine met the reviewers’ inclusion criteria, including eight US studies and one Canadian study, all published between 2015 and 2025. Each of the nine studies focused on Type 2 diabetes or did not specify the type of diabetes participants had. Substances included were tobacco (2 studies), alcohol (4), cannabis (1), opioids (4), and others (3). [4]
Interventions found to be beneficial for people with diabetes and SUD include: [4]
- Medications, such as semaglutide and buprenorphine
- Diligent treatment adherence
- Care management programs focused on comorbidities
- Reward and reinforcement for treatment adherence and substance abstinence
- Talk therapies, including Cognitive Behavioral Therapy and other behavior-focused therapies, and mindfulness strategies
This systematic review highlights limitations and gaps in current research. For instance, very few of the studies discussed the benefits of behavioral interventions, although these evidence-based approaches have proven beneficial in SUD treatment. [4]
Additionally, it highlights a need for treatment approaches and models (such as an integrated care program) that address symptoms of both diabetes and substance use issues concurrently. [4]
Core evidence-based treatment approaches
There are evidence-based treatment approaches for both SUD and diabetes that may be combined or utilized in parallel to manage symptoms of each condition.
Medications
SUD treatment can involve the use of pharmacological interventions to reduce substance use, manage withdrawal symptoms, and maintain recovery. For example, buprenorphine is an effective medication in opioid use disorder treatment.
Diabetes medications can also influence SUD treatment and recovery. For instance, when compared to other diabetes medications, semaglutide, a GLP-1 medication, has been found to help reduce the incidence and recurrence of SUD, particularly alcohol use disorder and cannabis use disorder. It is also found to help reduce the risk of opioid overdose. [4]
Care management programs
Individuals utilizing professional treatment can benefit from a comprehensive care management program. This might involve a multi-disciplinary team to address various aspects of well-being and a care coordinator to oversee and manage the individual’s treatment and progress. [3][4]
This type of approach can be crucial in SUD treatment and diabetes management. Professionals involved can help identify high-risk cases, ensuring the individual is able to access necessary services to provide comprehensive treatment, such as physical and mental health care, SUD treatment, and comorbidities. [3][4]
Reward and reinforcement
Interventions such as contingency management and motivational interviewing have been shown to be beneficial in SUD treatment. They provide rewards and motivation for individuals in recovery, helping to reduce substance use, improve treatment adherence, and improve treatment outcomes. [4][5]
Psychological interventions
Research indicates a significant benefit in SUD or diabetes outcomes with the use of interventions such as mindfulness-based therapies. However, there are no studies investigating the integrated use of these interventions to address coexisting symptoms. [4]
Mindfulness-based interventions can help people with diabetes improve stress and depression symptoms, glucose control, and self-management of symptoms. Similarly, mindfulness can be beneficial in SUD treatment to reduce cravings and substance use. [4]
Barriers to treatment
Less than a quarter of people who could benefit from substance use treatment utilize such interventions. [6] This is often due to the following factors: [6][7]
- Fear of stigma and judgment
- Belief that substance use issues can be managed without professional help
- Financial concerns
- Transportation or location challenges
- Childcare needs
- Limited service availability
These barriers can also apply to diabetes treatment, particularly cost-related issues, as people may be unable to afford the necessary medications.
Integrating SUD care into diabetes services
Integrating SUD treatment into diabetes care requires a multifaceted approach. This can include placing SUD specialists within diabetes clinics to help provide collaborative care.
Alternatively, physicians can offer SUD screening and advice at diabetes clinics, including assessment and screening, brief intervention, and referral to treatment. This could be routinely offered to people attending diabetes clinics to help identify at-risk individuals and provide or refer them to necessary specialist treatment services. [1][3]
People who are concerned about their substance use can also use these appointments as an opportunity to seek professional advice.
The path forward for managing coexisting conditions
Further research and treatment approach development are required to effectively manage both SUD and diabetes concurrently. There is a clear gap in the literature, highlighting the need for evidence-based integrated treatment approaches.
Despite this, studies show many treatments that provide overlapping benefits and positive impacts on each condition separately. This could be a path forward in developing integrated treatment that combines effective pharmacological and behavioral interventions.
