Q&As FOR ALCOHOL TREATMENT PROGRAMS

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.

Tip: If you cannot find a program that meets your needs, look for other types of providers. The Navigator can help you find therapists and doctors with addiction specialties. Learn how these healthcare professionals can provide “lower intensity” outpatient care.

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. As with other health care, both providers and patients need be clear about costs and payments.

Confirm whether the program and all its providers accept the person’s insurance. Then ask what other charges you should expect. This may include copayments, medications, specialized tests, or added counseling such as family therapy.

If the program is not covered by the person’s insurance, ask for a cost estimate for a typical treatment episode. If affording treatment is a concern, ask if there is a payment plan or a sliding fee scale.

Tip: Donʹt be discouraged or embarrassed if a program or provider is more expensive than you can afford. Remember, the most expensive treatment program is not always the best one.

Why you should ask: Online directories can be out of date and incomplete. So make sure that the programʹs license is 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, that’s step one. Also 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.

Tip: If you are interested in a licensed program that is not accredited, see how they respond to all the other questions here. Make sure they meet the signs of quality care.

It’s possible to find a non–accredited program that offers higher quality treatment. That’s because 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 the programʹs minimum standards for counselors and the credentials most of them have. Virtually all counselors need to be licensed or certified to practice in their state.

Look for programs that go “above and beyond” the minimum requirements. Look for programs in which most of the counselors are licensed clinical professionals. They should have formal education and training in alcohol and drug counseling.

Tip: You might also ask: “Does your program have on staff a primary care doctor or psychiatrist who is board certified in addiction medicine? If so, what is his or her role?” While rare, it would be a good sign if the program had guidance from someone with the highest available credentials in addiction treatment.

Why you should ask: Itʹs important that the patient be matched to treatment services that address his or her specific needs. This fit can only happen if the program does a full assessment that includes more than questions about their drinking.

What you should listen for: A comprehensive assessment is a lengthy, structured interview, done by a professional clinician. The program should use an assessment process that covers the personʹs drinking, other substance use, mental health, physical health, family dynamics, employment, criminal justice involvement, and need for social services or other kinds of support.

Note: Only a medical doctor can fully assess a personʹs physical health and any medical conditions.

You might also ask: How will the results of the assessment be used to develop a personalized treatment plan? How do you involve your patients in developing a treatment plan?

Tip: A program may not have all the resources a patient needs onsite. But good treatment program should be able refer a patient to other qualified providers as needed and coordinate a full treatment plan. This can include coordinating with therapists, medical doctors, social service agencies, and other resources. Listen for their ability and willingness to help the patient address all the needs identified in the assessment.

Why you should ask: Treatment programs can vary widely in the services they offer. You want to learn about the intensity of treatment offerings, the structure of the counseling program, and the content of the services. Learn about the many routes to recovery for alcohol treatment.

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. Youʹll want to be reassured that the program does not offer a “one-size-fits-all” approach where every patient has the same experience.

About intensity: Find out about the levels of care offered—residential, outpatient, or both. While your loved one may not need to use multiple levels of care, it is helpful to know what options are available. A complete assessment (see Question 4) will help determine the appropriate level of care.

About the structure of counseling:

• Most programs use some form of group counseling. Ask about the size of the groups. Eight to 10 patients per group is ideal, but groups can be effective with slightly smaller or larger sizes. You should also ask what formal training in group therapy the clinicians have.

• Each patient should also have a primary counselor. Ask how often they will meet one-on-one with that person. You’ll want at least weekly—but more is better.

About the content of sessions:

• Youʹll want to hear about the specific behavioral counseling techniques the program most often uses in group or individual counseling. Listen for mention of evidence-based behavioral treatment approaches—see examples here.

• For group sessions, youʹll want a program where most group sessions are 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.

Tip: Listen to the way the program staff member describes alcohol use disorder. Remember, addiction is a medical condition. It is not just a sign that someone is “weak” or needs to “straighten up.”

Watch out for programs that uses language that stigmatizes patients, such as calling them drunks or addicts or worse. And avoid programs that suggests that patients need a confrontational or “tough love” approach.

Youʹll want to find a caring, supportive environment. Language that shows moral judgment, stigma, or punitive approaches reflects thinking that is inconsistent with the current science of addiction.

Why you should ask: Medications can be helpful for many people as part of a treatment plan. They can give the brain a chance to heal while counseling and other recovery supports gain traction.

Three non-addicting medications are approved by the U.S. Food and Drug Administration (FDA) to treat 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 may not be needed, the option should at least be on the table. Steer clear of programs that reject the use of medications. They may say “We donʹt believe in medications” or argue that these medications “just substitute one addiction for another.” As noted above, FDA-approved medications for alcohol use disorder are not addictive.

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 medications.

Why you should ask: As many as half of all people with alcohol use disorder also have another mental health issue, such as anxiety or depression. Itʹs important to treat all mental health conditions—preferably at the same time.

Programs with “integrated” or “dual diagnosis” mental health services can treat multiple conditions. These programs will include a full mental health assessment at intake. And they will have clinical staff trained to treat “co-occurring disorders.”

Also, a person’s 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 medical issues if and when they come up.

What to listen for—mental health issues: In general, you might expect programs to fall into one of three groups, treating patients with (1) little to no co-occurring mental health problems; (2) mild to moderate mental health problems like anxiety and depression; and (3) any mental health conditions that may co-occur with addiction, including severe psychiatric disorders.

Research suggests that most programs likely fall into the second group. If your loved one has a history of mental health problems, 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 are not required to have medical doctors on staff. They should, however, be able to refer patients to local doctors if needed.

Hospital-based inpatient programs will be staffed by a medical team.

Residential (rehab) programs based outside of hospitals should have a medical doctor present on certain days or “on call.” 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.

Why you should ask: This question will help set your expectations about the treatment process. It will also give you a sense of the commitment involved on all sides.

What to listen for: Youʹll want to hear the “nuts and bolts” of treatment attendance. This includes the number of sessions and their length (minutes/hours), schedule (days per week), and duration (number of weeks or months).

Then listen for other expectations. For example, some programs may expect participants to get involved in a mutual-help group. Some may ask them to sign an agreement that they will take their medication. Others may ask them to use a recovery support app on their smartphone. 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. The primary focus of treatment will be on the person with the alcohol use disorder, of course. But itʹs important that some sort of counseling or program be available for the family as well, if they are open to it.

Tip: Be wary of “all or nothing” expectations and inflexible rules. An example would be a policy to discharge patients who have a relapse or forget to take a prescribed medication.

Why you should ask: This question will give you a sense of how the program views addiction and its treatment. Like other substance use disorders, alcohol use disorder can become a chronic condition. People can have periods of recovery and relapse, or a return to heavy drinking.

Relapse is not a failure. It indicates the need for additional recovery support and behavior change strategies. These can be gained from adjustments to goals, counseling, medications, or a combination.

Often, a relapse may turn out to be a valuable learning experience for the patient that can help them recognize changes they need to make.

What to listen for: Relapse may indicate that the person requires more intensive treatment. This could be a different type of behavioral counseling or more frequent counseling sessions. Or it could be the addition of a prescribed medication, or treatment in a residential setting.

Youʹll want a program that recognizes relapse as a likely part of the recovery process. And you’ll want to hear that they would respond by offering more intensive care or other additional support.

Tip: Steer clear of any program that views relapse as a violation of program rules. Avoid programs that discharge people who relapse instead of offering additional help.

Why you should ask: Initial treatment lasts for a fixed time, but recovery is an ongoing process that will require continuing support. A good program will help the person transition to the next level of care (such as from inpatient to outpatient) and to life after treatment. These are often called “continuing care” or “aftercare” plans.

A treatment program may offer recovery support services connect patients with community services. Itʹs helpful to learn what you should expect.

What you should listen for: When a person completes the treatment program, the program should work with them to develop a “discharge plan.” This should include recommendations for ongoing recovery support services. Some programs may do periodic telephone “check-ins” to see how patients are doing. They may link patients with additional services if needed. Find out how the program helps their patients transition from treatment to their long-term recovery process. And learn what they will do if a patient has a relapse.

Tip: While it may seem early think 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 you’ll be more prepared about additional help you may need to find.

Tip: 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. But if they are rushed, or make you feel like your questions are “dumb” or not important, or just refer you to their website, thatʹs also useful information. Would you want to be their patient?

Tip: After each call, make some notes. Besides their answers to your questions, also write down your overall impression. (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 include details 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.