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Frequently Asked Questions: Searching for Alcohol Treatment

What is alcohol use disorder (AUD)? What are the symptoms?

what-is-alcohol-use-disorder-and-its-symptoms

Alcohol use disorder (AUD) is a condition that health care professionals diagnose when a patient’s drinking pattern causes significant distress or harm. Previously known as alcohol abuse or alcoholism, AUD can be mild, moderate, or severe. AUD can cause lasting changes in the brain that make patients vulnerable to relapse. The good news is that no matter how severe the problem may seem, most people with AUD can benefit from treatment with behavioral therapies, medications, or both.

AUD is diagnosed when a person answers “yes” to two or more of the questions below.

In the past year, have you:

  • Had times when you ended up drinking more, or longer, than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects?
  • Experienced craving—a strong need, or urge, to drink?
  • Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout (i.e., forgetting, after drinking, where you were or what you did while drinking)?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, dysphoria, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Any of these symptoms may be cause for concern. The more symptoms, the more urgent the need for change. A health professional can look at the number, pattern, and severity of symptoms to see whether AUD is present and help set a good course of action back to health.

Learn about the importance of a complete assessment in Why do different people need different options?

How common is a "dual diagnosis"—such as AUD plus anxiety or depression—and how is this treated?

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National data indicate that at least one-third of all persons enrolled in addiction treatment programs for alcohol use disorder (AUD) have a co-occurring mental health disorder—most often anxiety or depression. Likewise, about one out of every four people treated in mental health programs have a co-occurring substance use disorder—most commonly, AUD.

The co-occurrence of alcohol and mental health problems is challenging for treatment providers because each issue can complicate the other. It’s important that treatment providers be able to identify and address both issues at the same time. Treatment that focuses on one issue at a time (for example, treating the AUD before addressing a patient’s anxiety disorder) is less effective than a comprehensive, integrated approach to dual diagnoses.

Within the NIAAA Alcohol Treatment Navigator’s directories, there are three ways to identify providers who are most likely to be able to address co-occurring conditions.

  • Board-certified addiction psychiatrists will have the highest level of training in both addiction and mental health services.
  • Among therapists, licensed clinical psychologists with special training in addiction treatment would be well suited to address co-occurring disorders.
  • Treatment programs that meet the American Society of Addiction Medicine’s definition of “Dual Diagnosis Capable” or “Dual Diagnosis Enhanced” are best able to treat people with an addiction who have co-occurring mental health conditions.

If you are seeking treatment on behalf of someone with a known mental health issue, be sure to ask about the provider’s expertise in treating co-occurring disorders.

In addition to alcohol, my loved one is also addicted to opioids (pain medications). Can the Navigator help me?

can-the-navigator-help-someone-addicted-to-pain-medications

Individuals with opioid addiction should seek help from a medical professional who is specially qualified to treat this condition.  The medications, providers, qualifications, and regulations for opioid addiction treatment are different from those for alcohol use disorder treatment. 

A doctor who is board-certified in addiction medicine will be best able to treat opioid use disorder or make a knowledgeable referral to a provider who can.  (Even board-certified addiction doctors need additional certifications in order to prescribe medications that treat opioid addiction.) 

One option is to use the Navigator to Search for an Addiction Doctor. If you find one in your area, call and ask specifically whether they also treat opioid addiction.

The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains two online directories that may also be of help.  Their Buprenorphine Treatment Practitioner Locator will help you search for physicians or programs that treat opioid addiction by prescribing buprenorphine, an FDA-approved, evidence-based medication.  SAMHSA’s Opioid Treatment Program Directory will help you search for community-based programs that specialize in opioid addiction treatment.

ABOUT… Alcohol Treatment

What is meant by "evidence-based care"?

what-is-evidence-based-care

Evidence-based care is treatment that is grounded in the best available scientific research, showing a clear link between improved patient outcomes and the use of medications, behavioral therapies, or other treatment components.

NIAAA is the world’s leader in research on alcohol and health. For more than 45 years, NIAAA has sponsored hundreds of carefully designed alcohol treatment studies, involving thousands of people with alcohol problems. The NIAAA Alcohol Treatment Navigator is grounded in the findings from these years of scientific research.

How did NIAAA choose these five signs of higher-quality care?

how-did-niaaa-chose-quality-care-signs

The NIAAA Alcohol Treatment Navigator recommends that people seeking alcohol treatment look for providers with five signs of higher-quality care: credentials, comprehensive assessment, customized treatment plan, evidence-based treatments, and continuing recovery support. These signs are based on a review of the addiction health services research literature and the consensus of health professionals who are experts in alcohol treatment. These factors are strongly correlated with treatment quality or outcomes. While there are other indicators of quality, NIAAA chose these five signs because they are broadly applicable to both individual therapists and treatment programs; they reflect the entire treatment continuum (intake, treatment, and long-term recovery); and they address both the characteristics of treatment providers and the content of the treatment they deliver.

These five signs are intended to help consumers learn about and compare different treatment providers. Although there are no guarantees, providers with more of these signs are likely to offer higher-quality treatment, which should increase the likelihood of success.

What evidence-based behavioral treatments are available for treating AUD?

what-behavior-treatments-for-available-for-aud

Also known as counseling or “talk therapy,” behavioral treatments involve working with a health professional to identify and help change the behaviors that lead to alcohol use disorder (AUD). Behavioral treatments are offered by trained health professionals in a variety of settings, and may be provided in combination with prescribed medications.

Evidence-based behavioral treatments share certain features, which can include:

  • Developing the skills needed to stop or reduce drinking.

  • Bolstering the ability to manage emotions and stress.

  • Helping to build a strong social support system.

  • Working to set reachable goals.

  • Coping with or avoiding the triggers that might cause relapse.

Types of evidence-based behavioral treatment include the following:

  • Cognitive-behavioral therapy (CBT) can take place one-on-one with a therapist or in small groups. This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking, and managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger problem drinking. Health care providers can also offer their patients web-based cognitive-behavioral training that has been shown to reduce alcohol use beyond standard care.

  • Motivational enhancement therapy is conducted over a short period of time to build and strengthen motivation to change drinking behavior. The therapy focuses on helping the patient identify the pros and cons of seeking treatment, form a plan for making changes in drinking behavior, build confidence, and develop the skills needed to stick to the plan.

  • Contingency management approaches incorporate tangible rewards that are given to patients who achieve specific, measurable treatment goals. This approach is used to reinforce positive behaviors such as abstinence or regular attendance.

  • Behavioral couples and family counseling involve partners and other family members in the treatment process and can play an important role in repairing and improving family relationships. The approaches incorporate positive activities, communication skills training, and identifying relapse triggers.  Studies show that family support strengthened through family therapy increases the chances of maintaining abstinence (stopping drinking), compared with individual counseling alone.

  • Brief interventions are usually delivered in a few short, one-on-one counseling sessions. The physician or counselor provides information about the individual’s drinking pattern and potential risks, and then works with him or her to set goals and provide ideas for helping to make a change.

  • 12-Step Facilitation Therapy is an engagement strategy used in counseling sessions to increase a patient’s active involvement in 12-step-based mutual help groups (such as AA), in addition to professionally-led outpatient treatment.  The counselor works with the patient to encourage, review, and reinforce their participation in AA, in a structured process that may include reading assignments, journaling, and setting AA participation goals for the week. 

  • Mindfulness-based relapse prevention (MBRP) combines CBT skill building approaches with mindfulness practices, which promote flexible rather than “autopilot” responses to physical and emotional triggers to drink.

Ultimately, choosing to get treatment may be more important than the specific approach used, as long as the approach incorporates empathy, motivational support, and a focus on changing drinking behavior, and avoids confrontation.

What medications are available for treating AUD?

what-medications-treat-aud

Three medications have been approved by the US Food and Drug Administration to help people with alcohol use disorder (AUD) stop or reduce their drinking and avoid relapse:  

  • Naltrexone works by blocking the receptors in the brain that are involved in craving alcohol or the rewarding effects of drinking. It comes either as a pill that is taken daily, or as an injection that can be given once per month.

  • Acamprosate is prescribed to help people with AUD maintain abstinence from alcohol by alleviating some negative symptoms of prolonged abstinence. It is a pill that is taken three times per day.

  • Disulfiram is a pill that causes unpleasant symptoms such as nausea and flushing of the skin when a person drinks. Wanting to avoid those unpleasant effects can help some people refrain from drinking.

All of these medications are non-addictive. They are designed to help manage a chronic disease, just as someone might take medications to keep their asthma or diabetes in check.

Not all people will respond to medications, but for some individuals, they can be an important tool in overcoming alcohol use disorder.

Scientists are working to develop a larger menu of pharmaceutical treatments that could be tailored to individual needs. As more medications become available, people may be able to try multiple medications to find which they respond to best.

How do people know if a medication for AUD may be worth a try?

how-does-one-know-if-medication-for-aud-is-worth-a-try

Used in the context of a comprehensive treatment plan, medications for alcohol use disorder (AUD) can provide an opportunity for behavioral therapies (counseling) to be helpful by reducing craving or helping to maintain abstinence from alcohol. In that way, medications can give people with an alcohol problem some traction in the recovery process.

It’s important to consult a doctor who understands which people are good candidates for AUD medications. Some studies suggest that people with a family history of AUD may be likely to benefit from naltrexone, for example. But those who have a liver condition or use opioid medications (such as those prescribed for pain) should not take naltrexone. A doctor can assess these and other conditions and match an appropriate medication with the patient.

As with any other medication, patients should communicate with their doctor about how the medication is working, and the doctor may be able to adjust the dose if needed.

Medications for AUD can be prescribed not only by specialists in addiction treatment, but also by primary care physicians. To find a specialist in addiction treatment, see the Search for Addiction Doctors section of the NIAAA Alcohol Treatment Navigator. More detailed information about prescribing AUD medications is provided in NIAAA’s publication, Helping Patients Who Drink Too Much: A Clinician’s Guide.

What outcome should a person aim for following treatment? Is abstinence from alcohol the only goal, or is it possible to simply cut back on drinking?

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For persons with alcohol use disorder (AUD), abstaining from drinking (stopping altogether) is generally recommended, and provides the greatest chance of long-term success. Abstaining is especially important when the individual is pregnant or is trying to become pregnant; is taking medications that negatively interact with alcohol; or has a medical or psychiatric disorder that is made worse by drinking. However, decisions about the ultimate goal of AUD treatment should be determined in a dialogue between the patient and a credentialed treatment provider. Some people with an alcohol problem may wish to moderate their drinking, but they ultimately find that it is easier to stop drinking entirely. Others may aim for abstinence but find that, with the skills learned in counseling, they are able to manage occasional drinking without returning to problematic use. If the initial goal is to cut back on drinking, but the person finds that they cannot stay within the recommended daily/weekly drinking limits, then abstinence is strongly advised.

Detox—what is it? Why isn't it "enough" to help a person stop drinking?

what-is-detox

Medical detoxification (or “detox”) is the process of getting alcohol or drugs out of a person’s system. When someone who has been drinking heavily for a prolonged period of time suddenly stops drinking, the body can go into a painful or even dangerous process of withdrawal. Symptoms can include nausea, rapid heart rate, seizures, or other problems. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing.

Detox alone is not the same as treatment. While detox helps to stabilize a person with an alcohol problem, it does not teach important skills such as how to identify and address situations that may lead to heavy alcohol use; how to refuse alcohol in social situations; or how to cope with stress in a way that does not involve drinking. All of these are the kinds of skills people learn in treatment that is delivered by health care professionals.

Research shows that people who go through detox without additional treatment are far more likely to relapse. Detox alone is not a fast or effective way to achieve long-term recovery from alcohol use disorder.

I have always heard that treatment happens in residential rehab programs. Isn't that the best option?

why-is-rehab-not-always-the-best-option

Based on what you might see on TV or in the movies, it would seem like most treatment happens in residential rehab programs. But most people do not use—and do not need—a residential program. Here’s why.

Generally, it is recommended that people with alcohol use disorder (AUD) seek the least intensive type of care first, and then move to a more intensive level only if they need it. Most people who get treatment for AUD start with outpatient counseling, either at a treatment program or in one-on-one sessions with a therapist or doctor. Outpatient treatment gives people the flexibility to continue living at home, and even to continue going to work. It’s also much less expensive than residential or hospital treatment.

Some people will find that outpatient treatment isn’t a good fit for them. This is especially likely for someone who does not have stable or secure housing, or does not have family or friends who are supportive of recovery. Residential programs can help provide stability, support, and a structured daily routine for people who need it. Hospital inpatient programs are best for people who have other health conditions that require medical attention.

In short, residential programs can be very helpful for some people with an alcohol problem but are not necessary for most. It’s important to find options that are the best match for a person’s particular situation. (See the section on Why Do Different People Need Different Options?.)

Are treatment records confidential?

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Health care providers are required to comply with federal and state laws, as well as their professional code of ethics, regarding patient privacy and the confidentiality of treatment records. There are extra laws in place that specifically protect patients and their records when it comes to addiction treatment. A patient must be asked, and explicitly agree, before their treatment records can be shared with anyone else.

While these laws are well intended, they can sometimes create hurdles that you may not expect. For example, a patient would have to give explicit permission for a treatment program to share their records with the patient’s own primary care doctor. Also, these confidentiality protections may limit how much information a treatment provider can share with a patient’s family members.

ABOUT… Helping Someone with an Alcohol Problem

When a person has an alcohol problem, his or her willingness to recognize it, seek help, and follow a treatment plan can be significant issues. How can concerned families help?

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NIAAA’s website, Rethinking Drinking, can help people who drink and concerned others assess their level of drinking and the risks it poses. The site also offers practical tips for reducing risk and for getting help.

To help a person with an alcohol problem accept treatment, an approach called the Community Reinforcement and Family Training (CRAFT) method has been shown to be more effective than confronting the person in an “intervention.” CRAFT teaches concerned friends and family members ways to encourage positive behaviors. For more information, see the NIAAA Alcohol Treatment Navigator's Support Through the Process as well as the Helpful Links section for family and friends. 

Once a person is in treatment, families can help by getting involved to the extent possible. Many treatment providers offer family counseling or a formal family program. These offer opportunities to support the patient and strengthen the family environment to promote recovery. In addition, families often get involved in mutual help groups, where they get support from other families in similar circumstances. Two examples are Al-Anon and SMART Recovery.

What if I'm seeking treatment for an adolescent?

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The NIAAA Alcohol Treatment Navigator is designed to find help for adults with alcohol problems. Adolescents have many different issues that need to be addressed in different ways, and the treatments themselves are often different. For example, there are no alcohol treatment medications that have been approved for use by adolescents. Counseling for adolescents may use different techniques and often places much greater emphasis on family therapy. And teens need to build different skills and coping strategies than adults. All of these factors make it important to find treatment providers that have special expertise in treating adolescents.

In the future, we hope to expand the Navigator to include adolescent treatment services. In the meantime, if you need to find treatment for an adolescent, we refer you to the excellent resources available from The Partnership for Drug-Free Kids, as well as from the Family Resource Center (http://www.familyresourcectr.org/).

ABOUT… Searching for Treatment Providers

How did NIAAA choose which provider directories to use in the Navigator?

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Each of the directories in the NIAAA Alcohol Treatment Navigator'sSM “How to search—And what to ask” section covers the entire United States and includes professional medical and behavioral health care providers—that is, providers with advanced education, training, and credentials appropriate for treating addiction. Within each directory, the user can identify providers with the recommended credentials by using our step-by-step guidance. While more directories are available, we aimed to simplify the search process by suggesting that you start with the directories with the greatest coverage.

If you are unable to find a provider using the directories in the NIAAA Alcohol Treatment Navigator, we offer some other suggestions in separate FAQs about therapists, programs , and physicians.

The NIAAA Alcohol Treatment Navigator aims to teach you what you need to know to be an informed consumer of alcohol treatment services, and to help you find high-quality treatment no matter what source you search. Always ask the 10 recommended questions  when interviewing therapists and treatment programs, and use the answers to check for five signs of higher-quality treatment.

Why doesn't the NIAAA Alcohol Treatment Navigator just include a list of providers who meet the "five signs" and have all the preferred credentials? Why do I need to search these directories myself?

why-does-niaaa-not-provide-lists-of-alcohol-providers

As a government agency, NIAAA cannot endorse or promote any particular provider, service, or organization. In addition, credentials such as licenses and accreditations can lapse over time, meaning directories need to be constantly refreshed. This makes it difficult for us to create and maintain a curated list of treatment providers that will always be current and accurate.

Unfortunately, there is no one single database listing all of the addiction treatment providers in the United States. We’ve tried to identify directories that cover the whole country, are relatively easy to use, and can lead you to good results if you know what to look for. These are the directories our own staff members use when they need to search for treatment service providers. These directories are maintained by organizations outside of NIAAA.

What's the difference between the terms "licensed," "certified," and "accredited"?

what-is-the-difference-between-licensed-certified-and-accredited-therapists

These terms apply somewhat differently depending on whether you are talking about a physician, therapist, or treatment program.

A license grants permission to practice as a health care provider or organization. It is issued by the state in which that provider is based. Each state has its own criteria for someone to receive a license, and how frequently that license needs to be renewed. States will have different criteria for physicians, therapists, and treatment programs.

Certification is a sign of professional specialization that often requires completion of advanced coursework and a comprehensive exam. It is usually awarded by an independent educational board. Primary care physicians, for example, can choose to become “board certified” in addiction medicine. Likewise, psychiatrists can choose to become board certified in addiction psychiatry. Providers with board certification have achieved the highest level of training in the treatment of addiction. Therapists can also receive certification in addiction treatment—for example, they can become a National Certified Addictions Counselor or a Master Addictions Counselor.

Accreditation is a sign that health care facilities, including addiction treatment programs, have passed a thorough, independent review of their program’s procedures, records, staff, and facilities. Accreditation is usually awarded for a period of three to five years, after which the program must repeat the review process. The independent agencies that most commonly review and accredit treatment programs are The Joint Commission, CARF, and the National Committee for Quality Assurance (NCQA).

What credentials should I look for when seeking an alcohol treatment provider?

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This table describes the major types of providers that offer addiction treatment services. For each, you can see the minimum credentials that the provider should have. These basic requirements should be considered the bare minimum. For example, nearly all treatment providers will have a license, but that does not necessarily mean they have the expertise you need.

Ideally, you will want to find a provider that goes above and beyond those minimum credentials. These “above and beyond” credentials, shown in the right-hand column, indicate that the provider has obtained a professional specialty through additional formal training and has passed a rigorous independent review of their expertise. If you’re choosing among several providers, try to choose one with these “above and beyond” credentials.

 

Provider type

Minimum credentials to look for
GOOD!

“Above and beyond” the minimum:
Additional specialized credentials
BETTER!

Clinical psychologists

  • Doctoral-level degree (PhD, PsyD)

  • Current license

  • Continuing education programs and experience in addiction treatment

  • (Less common) Certification of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders

Licensed Professional Counselors (LPCs; may also be called Licensed Clinical Professional Counselors (LCPCs) or Licensed Mental Health Counselors (LMHCs)) and Licensed Marriage and Family Therapists

  • Master’s degree in counseling

  • Current general practice license (such as LPC, LCPC, LMHC, LMFT)

  • Continuing education programs and experience in addiction counseling

  • License in alcohol and drug counseling

  • (Less common) Certification as a Master Addiction Counselor (MAC)

Licensed Clinical Social Workers

  • Master’s degree in clinical social work (MSW)

  • Current general practice license (LCSW)

  • Continuing education programs and experience in addiction counseling

  • (Less common) Certified Clinical Alcohol, Tobacco, and Other Drugs Social Worker (C-CATODSW)

Treatment programs

  • Current license (usually from the state agency overseeing addiction or mental health services)

  • Accreditation from The Joint Commission, CARF, the Council on Accreditation (COA), or NCQA

  • Counselors are licensed and trained in the treatment of addiction.

Doctors, including primary care physicians as well as psychiatrists

  • Medical degree (MD, DO)

  • Current license

  • Board certified in addiction medicine (issued by the American Board of Addiction Medicine (ABAM)) or

  • Board certified in addiction psychiatry (issued by the American Board of Psychiatry and Neurology (ABPN))

 

 

Someone has suggested the name of a treatment provider to me. How can I find out if they offer higher-quality treatment?

how-can-i-tell-if-a-treatment-provider-referral-meets-quality-signs

You may already know the name of an addiction treatment provider, perhaps from one of these sources:

  • A recommendation from a doctor or another health professional.

  • A list of “in network” providers from your insurance plan.

  • A recommendation from a friend or family member.

  • An advertisement you saw on television or online.

Even if you’ve been referred by a trusted source, it’s still important to check a provider’s credentials—education, experience, license, and certifications. Just like hiring any other business, you’ll want to do a little homework to be sure you’re working with a provider who has the right expertise for the job. Call and ask the 10 recommended questions for therapists or treatment programs, and use the answers to check for five signs of higher-quality treatment.

I am searching for treatment for someone who is a US veteran. Can the NIAAA Alcohol Treatment Navigator help me find addiction treatment offered by the VA?

can-i-find-addiction-treatment-providers-for-veterans

The NIAAA Alcohol Treatment Navigator focuses on treatment providers that are available to the general public. The best resource to find treatment in the Veterans Health Administration is the VA’s online treatment locator.

The NIAAA Alcohol Treatment Navigator shows you how to search selected directories of professional addiction therapists, specialty alcohol treatment programs, and addiction doctors. Be sure to start by visiting How to Search—And What to Ask. Depending on where you live, you may need more options and strategies—if so, see below.

What if I can't find a nearby addiction therapist?

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If you want to work with an addiction therapist but cannot find one using the directory listed in Search for Addiction Therapists, here are some additional suggestions:

  • The American Psychological Association maintains a database of clinical psychologists throughout the United States. These are usually PhD-level psychologists with a variety of specialties. Go to their website (locator.apa.org/), enter your zip code, and select “Addictions/Substance” from the drop-down list labeled “Area of Specialization.” If you find one near you, remember to call and ask the 10 Questions before scheduling an appointment.
  • The National Association of Social Workers maintains a directory of licensed clinical social workers throughout the United States. These are master’s-level professionals who can provide counseling as well as linkages to other important services in the community. Go to the HelpPro Social Worker Finder, enter your zip code, and select “Addictions/Substance” in the field labeled “Specializes in this concern:” If you find one near you, remember to call and ask the 10 Questions before scheduling an appointment.
  • If necessary, you might consider traveling to a distant addiction therapist for a consultation that includes a comprehensive assessment and treatment plan that could be carried out in collaboration with providers closer to your home. Call ahead to explain your situation and arrange a visit.
  • In many states, insurance companies and Medicaid have begun to cover “telehealth” services. This can include telephone or video sessions with professional health care providers, including licensed therapists. You might ask a therapist whether this option is available. Check with your insurance company about coverage.

What if I can't find a nearby board-certified addiction doctor?

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If you want to work with a physician but cannot find one in the Navigator’s current  "Search for Addiction Doctors" directories, here are some more options.

  • Search the Physician Lookup provided by the American Board of Preventive Medicine (select “Addiction Medicine” as the Specialty area).  ABPM began certifying physicians in addiction medicine in 2017.  This database will grow over time as more physicians complete the credentialing requirements.

  • Check with the American Society of Addiction Medicine (ASAM), which is the professional organization for physicians who have an interest in treating addiction. Some physicians may be interested in (and good at) treating people with alcohol and drug problems, but they may not have completed the board certification process. You can find out if there is one near you by contacting the chapter president for the ASAM chapter in your state. Find that person’s contact information at the ASAM State Chapters page.

  • If there is not an ASAM-affiliated doctor near you, you might try working with your own or your loved one’s primary care doctor. We recommend this especially if the person has a medical condition that needs monitoring in addition to an alcohol use disorder. NIAAA has developed a Clinician’s Guide called Helping Patients Who Drink Too Much that is designed to help doctors and other health professionals feel more comfortable assessing and treating alcohol use disorder. You might share this link to the Clinician’s Guide with your doctor, or download it and bring it with you to an appointment.

  • If there are no nearby options, you might consider a single day of travel to a distant board-certified addiction medicine or psychiatry specialist for a consultation. A goal would be to have him or her conduct a comprehensive assessment and create a treatment plan that could be carried out closer to home in collaboration with your local primary care physician and a nearby therapist. Call ahead to explain your situation and arrange a visit. 

  • In many states, insurance companies have begun to cover “telehealth” services that link physicians or therapists to patients by phone or video conference that might be used for counseling and follow-up. Check with your insurance company about coverage.

ABOUT… Recovery and Continuing Care

What are some possible components of continuing care?

what-are-components-of-continuing-care

A variety of recovery support services are available. As with treatment services, continuing care services will vary from one person to the next depending on their specific needs.

  • The best-known type of continuing care is involvement in a mutual support group such as Alcoholics Anonymous (AA) or SMART Recovery, in which persons in recovery meet with peers to share their experience and support.

  • Professional counselors might provide telephone-based continuing care (sometimes called recovery management “checkups”), in which they call the patient periodically to check in and to provide or arrange for any additional needed support.

  • Recovery coaching involves one-on-one support from a peer recovery support specialist.

  • If needed, recovery housing (sometimes called “sober living” or a “halfway house”) is available for people who need the time and support to transition from a structured treatment setting back into their community.

  • For people requiring ongoing monitoring as part of a formal job-based or criminal justice program, continuing care might also include periodic alcohol and drug testing, with support available to prevent or interrupt a relapse.

What is relapse? Does it mean treatment didn’t work?

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Relapse is a return to drinking after a period of abstinence. Relapse is common among people in treatment for alcohol use disorder. People with an alcohol problem are most likely to relapse during periods of stress or when exposed to people or places associated with past drinking.

Just as some people with diabetes or asthma may have flare-ups of their disease, a relapse to drinking can be seen as a temporary setback to full recovery and not a complete failure. Relapse can present an opportunity to reevaluate the treatment plan and make adjustments.

Seeking professional help can prevent relapse. Behavioral therapies can help people develop skills to avoid and overcome triggers, such as stress, that might lead to drinking. Most people benefit from regular checkups with a treatment provider. Medications also can deter drinking during times when individuals may be at greater risk of relapse (e.g., divorce, death of a family member).

Visit NIAAA’s Rethinking Drinking website for tips on recovering from a drinking episode when your goal is to quit, as well as modules on drink refusal skills and handling urges to drink.

What about mutual help groups? How can they be helpful?

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Many individuals find that participation in mutual help groups helps to reinforce and extend the benefits of professional alcohol treatment services. These groups—including Alcoholics Anonymous (AA), SMART Recovery, Women for Sobriety, and others—provide a ready-made social network that is supportive of recovery and abstinence.

Group meetings are available in most communities, at low or no cost, at convenient times and locations—including an increasing presence online. This means they can be especially helpful to individuals at risk for relapse to drinking. For a listing of these groups and their contact information, see the Helpful Links section.

Most research on mutual help groups has been on AA and similar 12-step groups. Both the anonymous and voluntary nature of participation in these groups makes it difficult to conduct randomized controlled trials (the gold standard of scientific research) to directly study their effectiveness.

However, numerous studies have looked at the outcomes of participants over time, often comparing them to people who did or did not also receive some form of professional treatment. While this body of literature is complex and still growing, the evidence suggests that the free and flexible support provided by mutual help groups can help people make and sustain beneficial changes and thus promote recovery. The research indicates that groups may help by providing a social framework that improves coping, boosts self-confidence, and continually enhances motivation toward recovery.