10 Questions to Ask Alcohol Treatment Programs
Before you decide on a treatment program, it’s important to verify any information you find on the Internet. Set aside some time to call each program on your list, and ask questions to learn more about their approach to alcohol treatment. Use the Navigator Toolkit worksheets to capture the answers.
In this section, you’ll find 10 recommended questions to ask – and the answers to listen for. Use this information to help find a program that has five signs of higher-quality treatment, and that is a good fit for your situation.
Treat this process just like you would approach any other health care decision—do your research, ask questions, and use your best judgment.
Information to gather before making the call
Treatment program staff will want to know a little bit about the person needing treatment. You might be asked to share the following kinds of information:
- Basics: Age, gender, marital and family status, job status?
- Payment options: Health insurance or other ways to pay for treatment?
- Alcohol and other drug use: The nature of the drinking problem? Other drug use? Any previous counseling or treatment (if so, how did it go)?
- Other health matters: Any other medical or mental health issues?
- Living and social situation: Stable living situation? Access to transportation? Social support network?
- Legal system involvement: Any DUIs, probation, other matters?
- Specialized needs and preferences: Non-English-speaking? Pregnant? Safety-sensitive job?
Donʹt feel as though you need to have detailed answers to all of these questions—you will do just fine using the information you already know, even if some of your answers are ʺIʹm not sure.ʺ Still, you may want to use the Navigator Toolkit Notes page [PDF - 105 KB] to help jog your memory.
What number to call
When contacting a specialty treatment program, you should call the ʺintakeʺ number. This is the unit that screens and interviews new patients. This number will usually connect you with an intake staff member who can help answer questions about the program. The intake person may also ask you a few questions about your loved one to get a better idea of what kind of treatment services may be involved.
Q1: Can you tell me about your treatment approach? What levels of care and other services do you offer?
Why you should ask: Treatment programs can vary widely in the services they offer. You want to learn about the intensity of treatment, the structure of the treatment program, and the content of the clinical services.
Intensity: Treatment programs may offer a variety of ʺlevels of careʺ—each is a different intensity of treatment. These levels can range from one-hour weekly sessions (outpatient), to medically managed hospital stays (inpatient), and various levels in between. Learn about the many routes to recovery [PDF - 1.35 MB] for alcohol treatment. While your loved one may not need to use multiple levels of care, it is helpful to know what options are available.
Structure: Youʹll want to get a sense of how much time a patient generally spends in group therapy sessions with other patients and in one-on-one sessions with their primary counselor.
Content: In group or individual counseling, youʹll want to hear more about the specific behavioral counseling techniques the program most often uses.
What to listen for: Try to get a sense of the programʹs overall philosophy about addiction and its approach to treatment of alcohol use disorder. Determine whether the program offers only residential care, only outpatient treatment, or both—and think about whether this will work for your loved one. Youʹll want to be reassured that the program does not offer a ʺone-size-fits-allʺ approach where every patient has the same experience.
When talking about counseling sessions:
- Most programs use some form of group counseling—what size are the groups? (Eight to 10 patients per group is ideal.)
- What happens in group sessions? Youʹll want a program where most group sessions are educational lectures or behavioral counseling, led by a trained professional. Itʹs not unusual to find peer-led 12-step groups, but these should not be the primary or only purpose of group sessions.
- Each patient should also have a primary counselor—how often will they meet one-on-one with that person? (At least weekly—but more is better.)
Q2: How do you decide what a personʹs treatment plan will include? Do you start with a complete assessment and diagnosis?
Why you should ask: Itʹs important that the patient be matched to treatment services that address their specific needs. This can only happen if the program conducts a comprehensive assessment of the patient that includes more than just questions about their drinking.
What you should listen for: A comprehensive assessment is a lengthy, structured interview, done by a trained clinician. The program should use an assessment process that would give them information about the patientʹs drinking, other substance use, mental health, physical health, family dynamics, employment, criminal justice involvement, and need for social services or other kinds of support. Youʹll also want to hear how the program will use the results of this assessment to develop a customized treatment plan that addresses those needs. Finally, you will want to hear that the patient will be involved in the development of their own treatment plan.
A good treatment program should be prepared to assist with the various alcohol, drug, mental health, medical, family, social, and other issues that a patient could need help with. The program may not have all of these resources onsite, but a good program will be able to refer a patient to other qualified providers—whether these are counselors, medical doctors, social service agencies, or other resources—and to coordinate a comprehensive treatment plan. You should listen for their ability and willingness to help the patient address all of their needs—even if that means coordinating with other providers.
Q3: What arrangements do you have to address other medical or mental health issues while someone is in treatment?
Why you should ask: As many as half of all people with alcohol use disorder also have a mental health issue, such as anxiety or depression. Itʹs important that these patients receive treatment for both conditions—preferably at the same time. Programs that have ʺintegratedʺ mental health services will have the skill and ability to identify and treat both conditions side-by-side. They will include a comprehensive mental health assessment at intake, and will employ clinical staff who are specifically trained in the treatment of mental health and addiction (often called ʺco-occurring disordersʺ).
While much of treatment will involve group and individual counseling and behavioral therapy, alcohol use disorder is a medical condition, and a patientʹs long-term drinking patterns can have an impact on their physical health, or make other medical conditions worse. Itʹs important that a treatment program have staff who are trained to identify and address these issues.
What to listen for—mental health issues: In general, you might expect programs to fall into one of three groups: (1) those that offer addiction treatment services for patients who have little to no co-occurring mental health problems; (2) addiction treatment programs that are able to treat patients with mild to moderate mental health problems (like anxiety and depression); and (3) programs that can treat the full array of mental health conditions that may co-occur with addiction, including severe psychiatric disorders. Research suggests that the majority of programs likely fall into the second group. If your loved one has a known history of mental health problems, you should consider those needs when interviewing treatment programs.
What to listen for—medical issues: Availability of medical doctors will depend on the level of care offered in the program. Outpatient programs—which typically treat people with mild to moderate alcohol use disorder—are not required to have medical doctors on staff, but they should be able to refer patients to local doctors if needed. Hospital-based inpatient programs will be staffed by a medical team. Residential rehab programs (those based outside of hospitals) should have a medical doctor who is present on certain days or is ʺon call.ʺ Find out how often the physician is onsite at the program, and how often a patient would see that person. Especially when talking to residential programs, youʹll want to know that a physician is a real part of the personʹs treatment team.
Q4: Are you able to arrange for someone to prescribe a medication to treat alcohol use disorder if it is appropriate?
Why you should ask: Medications can be helpful for some people as part of their treatment plan. Currently, there are three U.S. Food and Drug Administration (FDA)-approved medications for the treatment of alcohol use disorder. Naltrexone comes in two forms: a pill that is taken daily (ReVia® or Depade®), or a long-acting injection (called Vivitrol®) that is given once a month. Other medications are acamprosate (Campral®) and disulfiram (Antabuse®).
What to listen for: While medications are not a good fit for every person, the option should at least be on the table. Steer clear of programs that reject the use of medications (ʺWe donʹt believe in medicationsʺ) or who argue that these medications ʺjust substitute one addiction for another.ʺ FDA-approved alcohol medications are not addictive; they can be critically important in giving the brain a chance to heal while counseling and other recovery supports gain traction. If a program refuses to even consider the use of a medication, their approach is not in line with current scientific evidence.
Learn more about alcohol use disorder treatment medications.
Q5: Is the treatment program licensed and accredited? Can you tell me about the qualifications of your counseling staff?
Why you should ask: You should always verify information you find on the Internet. Online directories can be out of date and incomplete, so you want to make sure that the programʹs license is current and valid, and, in general, that they are also accredited (more on this below). You also want to learn about the training that the programʹs counselors have received.
What to listen for—program accreditation: If a program tells you they are licensed, ask whether they are also accredited—they are not the same thing. All treatment programs are required to be licensed by the state in which they operate; states vary in how rigorous their licensing requirements are. For that reason, we recommend that in general, you look for a treatment program that is also accredited. Accredited programs have undergone a rigorous review by an independent review board—this signals that the program meets widely accepted standards of clinical quality. About half of all treatment programs in the United States are accredited. The two most common types of accreditation for addiction treatment programs are those issued by The Joint Commission and by CARF. Of note: If you are interested in a licensed program that is not accredited, see how they respond to all the other questions here and make sure they meet the signs of quality care. It’s possible to find a non-accredited program that offers higher quality treatment -- some states have licensing standards that are comparable to accreditation, and some smaller, quality programs forego accreditation because of costs.
What to listen for—counseling staff credentials: Programs use different standards for hiring counseling staff. Most programs will have a variety of people on staff, and their credentials will vary. You want to get a sense of what the programʹs minimum standards are for counselors and what credentials most of them have. Virtually all counselors need to be licensed or certified to practice in their state. You want to look for programs that go ʺabove and beyondʺ the minimum requirements. Look for programs in which most of the counselors are licensed clinical professionals who have received formal education and training in alcohol and drug counseling.
You might also want to ask: ʺAre the counselors supervised by a primary care doctor or psychiatrist who is board certified in addiction medicine?ʺ While rare, this would mean the clinical program is overseen by someone with the highest available credentials in addiction treatment.
Q6: What do you expect of your patients and their families during treatment?
Why you should ask: This question will help set your expectations about the treatment process and give you a sense of the commitment involved on all sides.
What to listen for: Youʹll want to hear the ʺnuts and boltsʺ of treatment attendance—how many sessions, lasting how long (minutes/hours), how frequently (days per week), for what duration (number of weeks or months). Then listen for other expectations—for example, perhaps the programʹs patients are also expected to get involved in a mutual-help group, or to sign an agreement about taking their alcohol medication (called a ʺmedication adherence contractʺ), or even expected to use a recovery support app on their smartphone. These expectations will vary by program.
Youʹll also want to know what type of family program is available, and in what ways family members are involved in treatment. While the primary focus of treatment will be on the person with the alcohol use disorder, itʹs important that some sort of counseling or program be available for the family too (if they are willing to be involved).
You should be wary of expectations that sound ʺall or nothingʺ and for rules that are completely inflexible—for example, that a person would be discharged for having a relapse or forgetting to take their prescribed medication.
Q7: What do you do if a patient has a relapse while in treatment?
Why you should ask: This question will give you a sense of how the program views addiction and its treatment. Alcohol use disorder, like other substance use disorders, is a chronic disease that can include periods of recovery and relapse (a return to drinking). Relapse is not a failure; it indicates the need for additional recovery support and behavior change strategies, which can be gained from counseling and (for some people) medications.
What to listen for: Relapse may indicate that the person requires more intensive treatment—either a different type of behavioral counseling, more frequent counseling sessions, the addition of a prescribed medication, or treatment in a residential setting. Youʹll want to hear that the program recognizes relapse as a likely part of the recovery process, and that they would respond by offering the person a more intensive level of care or other additional support.
Steer clear of any program that views relapse as a violation of program rules, especially if they would automatically discharge someone from treatment instead of offering additional help.
Q8: What about after treatment? Are there ongoing recovery support services available?
Why you should ask: While treatment lasts for a defined period of time, recovery is an ongoing process that will require continuing support. A good program will help the person transition to the next level of care (e.g., from inpatient to outpatient) and to life after treatment is completed. These are often called ʺcontinuing careʺ or ʺaftercareʺ plans. A treatment program may offer a set of recovery support services, or they will recommend or help link patients with recovery support services in the community. Itʹs helpful to learn what you should expect.
What you should listen for: When a person completes the treatment program (as indicated in their treatment plan), the program should work with them to develop a ʺdischarge plan.ʺ This should include recommendations for ongoing recovery support services. Some programs may do periodic telephone ʺcheck-insʺ with patients to see how they are doing and to link them with additional services if needed. Youʹll want to get a sense of whether and how the program helps their patients transition from the treatment setting to their long-term recovery process—and what they will do if a patient has a relapse.
While it may seem like itʹs too early to be thinking about what happens after treatment, itʹs important to ask these questions now. That way, when the person is ready to transition out of treatment, youʹll already have an idea of what to expect and what additional help you may need to be prepared to look for.
Q9: Can you help me estimate the cost of treatment? Will insurance cover these costs?
Why you should ask: The costs of treatment can vary from one program to the next, sometimes by a lot. Insurance may cover some, but not all, of these costs. Before committing to a specific treatment program, youʹll want to be sure that itʹs one you (or the patient) can afford. Learn more about treatment costs and insurance.
What to listen for: Do not be surprised or offended if the first question the intake person asks you is about how you will pay for treatment. Just like any other health care service, both providers and patients need to understand the costs involved and how the treatment will be paid for.
Youʹll want to confirm that the program accepts the personʹs insurance. Then ask what other charges you should anticipate—for example, copayments for outpatient sessions, the cost of prescription medications, any specialized tests, or additional counseling such as family therapy. If the program is not covered by insurance, ask them to help you estimate the cost of a typical treatment episode. If affording treatment is a concern, you can ask whether the program offers a payment plan or a sliding fee scale to help with these costs.
Donʹt be discouraged or embarrassed if a program is more expensive than you can afford. Remember, the most expensive treatment program is not always the best one.
Q10: If you turn out to be the best option, how soon could treatment begin?
Why you should ask: Youʹll probably want to start treatment as soon as possible. Programs may have limited availability, or they may schedule their intake/assessment appointments on certain days and times. Find out now whether there might be any delays in getting started.
Other questions to ask
If you have other questions, ask them! If you donʹt understand an answer, ask the person to explain what they mean. Donʹt worry about feeling ʺdumbʺ—get the answers you need to make an informed decision.
One last suggestion
Pay attention to the way the program staff interact with you and how you feel when you are talking to them.
If staff provide complete answers to your questions, take time to understand your situation, and demonstrate a concern for you, thatʹs a good sign! On the other hand, if they are rushed, or make you feel like your questions are ʺdumbʺ or not important, or if they just refer you to their website, thatʹs also useful information. Would you want to be their patient?
After each call, make some notes—not just about their answers to your specific questions, but also the overall impression you got from talking to them. (You might use some sort of symbol—like a checkmark or a star—to mark the program(s) that you felt the most positive about.) Try to write yourself a note to remind you what made you feel that way. Later on, when you are comparing options, these notes may help you and your loved one make a choice.