Q&As FOR THERAPISTS WITH ADDICTION SPECIALTIES

Why you should ask: You want them to know you’re actively searching for a treatment provider and that you’ll probably want to start as soon as possible. Therapists may have limited availability, or they may schedule their intake and assessment appointments on certain days and times. Find out now whether there might be any delays in getting started. 

Tip: If the therapist is not accepting new patients, donʹt take it personally—they have only so much time available for appointments. Ask for a referral to someone they recommend, and call and interview that person.  See also “What if I can’t find a nearby therapist with a specialty in addiction?” in the Navigator FAQs. 

Why you should ask: The costs of treatment can vary from one provider to the next, sometimes by a lot. Insurance may cover some, but not all, of these costs. Before committing to a specific treatment provider, 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 one of the first questions the therapist (or receptionist) asks you is how you plan to pay for treatment. As with other health care, both providers and patients need be clear about costs and payments.

Confirm whether the therapist accepts the person’s insurance. Then ask what other charges you should expect. This may include copayments for visits or charges for missed sessions.

If the therapist does not accept the personʹs insurance, ask for a cost estimate for a typical treatment episode. If affording treatment is a concern, ask if there is a a payment plan or a sliding fee scale.

Why you should ask: Online directories can be out of date. So make sure that the therapistʹs credentials (license/certification) are current and valid. Youʹre looking for someone with formal training, credentials, and experience in treating alcohol use disorders.

What to listen for: Therapists—clinical psychologists, licensed professional counselors, and social workers—should be licensed to practice independently in your state. But having a license is not enough to ensure quality.

It’s best to find a therapist who holds at least a Masterʹs degree and has special training in treating addiction. The specific type of training and credentials will vary, so ask them to tell you more about their experience.

You might also ask: How long have you been treating patients with alcohol problems? How much of your practice deals with addiction versus other conditions? What other mental health conditions do you have expertise in treating?

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

What to listen for: A comprehensive assessment is a lengthy, structured interview. Be aware that this interview may take more than one session. The assessment should cover a personʹs drinking, other substance use, mental health, family dynamics, employment, criminal justice involvement, and need for social services or other kinds of support.

The therapist should also recommend a history and physical from a medical doctor, if one has not been conducted recently. Only a medical doctor can fully assess a personʹs physical health and any medical conditions.

You might also ask: How many visits will it take to complete this assessment? 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 therapist with expertise in treating addiction should be able to refer a patient to other qualified providers as needed and coordinate a full treatment plan. This can include coordinating with medical doctors, social service agencies, or other resources. Listen for their ability and willingness to help the patient address all the needs identified in the assessment.

Why you should ask: It’s important to hear how a therapist approaches the treatment of alcohol use disorder. It will be helpful to hear different perspectives from different therapists.

What to listen for: The therapist should describe a process that has at least some structure to it, indicating that they have a plan. But it should not have so much structure that it sounds inflexible or is the same for every patient. It’s okay if the answer begins with them saying, “It depends on the patient, but generally I will do ____.”

Listen for mention of evidence-based behavioral treatment approaches.

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

Watch out for anyone who uses language that stigmatizes patients, such as calling them drunks or addicts or worse. And avoid anyone who 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: Most psychologists, licensed counselors, and social workers will not be able to write prescriptions themselves. But they should be willing to coordinate with a medical doctor who can.

While medications may not be needed, the option should at least be on the table. Steer clear of providers who reject the use of medications or who argue that these medications “just substitute one addiction for another.” As noted above, FDA-approved medications for alcohol use disorder are not addictive.

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 both conditions—preferably at the same time.

Also, a person’s long-term drinking patterns can have an impact on their physical health or make other medical conditions worse. It will be very helpful if the person you select is able to offer support and direction with other issues if and when they come up.

What to listen for: Itʹs unlikely that any single provider would be able to address all the issues that a patient could need help with. These can include other drug, mental health, medical, family, and social problems.

But a good provider will be able to refer a patient to other qualified providers and coordinate a full treatment plan. Listen for a willingness to coordinate with medical doctors, social service agencies, or other resources as needed.

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 therapists may expect clients 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. Different therapists will have different expectations.

Youʹll also want to know how family members might be involved in a patientʹs treatment, and whether the therapist offers family therapy or can recommend a family therapist. The primary focus of treatment will be on the patient, of course. But itʹs important to seek that some sort of family counseling or program 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 stop treating clients who have a relapse.

Why you should ask: This question will give you a sense of how the therapist 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: Youʹll want to hear that the therapist recognizes that relapse is a likely part of the recovery process. Learn whether they would respond by making appropriate changes to the patientʹs treatment plan.

In some cases, the patient may need more intensive treatment. This could be more frequent or different behavioral counseling. Or it could be the addition of a prescribed medication or treatment in a residential setting.

Why you should ask: The length of treatment from a therapist varies. Sometimes, the therapist and patient will agree at the start on a specific number of sessions. But after this set treatment period, the recovery stage still requires continuing support.

A good provider will help the person “step down” in treatment intensity when the initial course of treatment is done. It’s always a good idea to ask about ongoing support services once regular therapy sessions have stopped.

What to listen for: When a person completes the initial course of treatment, the therapist should help develop a plan with recommendations for ongoing recovery support services. This might include preventive “booster” or refresher sessions, telephone ʺcheck-ins,ʺ and plans for what to do in the case of relapse.

Tip: While it may seem early to 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: If you leave a message and donʹt hear back within 2 days, call again. If you donʹt hear back at all within a week, cross them off your list.

Tip: It could take 20 minutes or longer to ask and answer all 10 of the recommended questions. Some therapists will be able to spend this much time with you. Others may ask you to make an appointment, a reasonable and common practice. It’s preferable to go through all 10 questions, but if time is limited, you will learn a lot by focusing on the first five questions.

Tip: Pay attention to the way the therapists interact with you, and how you feel when you are talking to them. If they provide complete answers to your questions, take time to understand your situation, and show 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, 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. 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.