Q&As FOR DOCTORS 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. Specialist doctors 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 doctor is not accepting new patients, ask for a referral to someone they recommend, and call and interview that person. See also “What if I can’t find a nearby board-certified addiction doctor?” 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 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 doctor accepts the person’s insurance. Then ask what other charges you should expect.

If the doctor does not accept 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.

Why you should ask: Online directories can be out of date. So make sure that the physician’s credentials are current.

What to listen for: Listen for confirmation that the doctor is board certified in addiction medicine or addiction psychiatry. This is a sign of quality, evidence-based care.

Specialists who are board certified have thousands of hours of training and practice. They have passed a long and difficult exam. And they must continue to take training courses to keep their certification.

Why you should ask: Board certified addiction physicians are well-trained in evaluating patients, so all you may need is a quick confirmation and a sense of how this particular doctor does the assessment.

What to listen for: Be aware that a comprehensive assessment is a lengthy, structured interview that may take more than one session. It 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.

Note: 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 board-certified addiction physician should be able to refer a patient to other qualified providers and to coordinate a full treatment plan. This can include coordinating with therapists, 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: You’ll want a clear picture of the services offered. There are two types of addiction doctors: Addiction medicine physicians and addiction psychiatrists. Both can do independent assessments and help set up complete treatment plans. Both can also prescribe medications for alcohol use disorder.

Here is how they differ:

Addiction medicine physicians are often primary care doctors. They can provide a complete medical exam to assess all health issues, related or not to alcohol. They can also offer brief counseling to help motivate patients to make a change.

Addiction psychiatrists are experts in mental health. They are well prepared to care for patients with more than one mental health issue. Some provide both medications and talk therapy while others focus mainly on medications.

If the doctor provides medications but not behavioral treatment for AUD, ask if they can refer you to a licensed therapist for that part of the treatment. And check how often they communicate with these providers.

What to listen for: You can be assured that a board-certified addition doctor has had up to date training in managing the care of a patient with AUD. You’ll just need to get a sense of whether to choose an addiction medicine physician or an addiction psychiatrist based on the individual’s needs.

If you hire an addiction psychiatrist who will provide behavioral treatment, see the Q&As for therapists. And listen for mention of evidence-based behavioral treatment approaches.

You also want to listen for a doctor who works closely with other healthcare providers as needed to provide optimal care for each patient.

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: Board certified addiction physicians are trained in prescribing medications for AUD, so all you may need is a quick confirmation.

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 their ability and willingness to coordinate with therapists, 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 physicians may expect patients 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 providers will have different expectations.

Youʹll also want to know how family members might be involved in a patientʹs treatment, and whether the doctor can recommend a family therapist. The primary focus of treatment will be on the patient, of course. But itʹs important to seek some sort of family counseling or program as well, if they are open to it.

Why you should ask: Like other substance use disorders, alcohol use disorder can become a chronic condition, with periods of recovery and relapse (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: Board-certified addiction physicians are trained to see relapse as a normal part of recovery and to help patients manage it. All you may need is a quick confirmation of this and an idea of how the doctor manages relapse. This may involve adjustments to goals, counseling, medications, or a combination.

Why you should ask: Addiction doctors will vary in how long they think a patient should continue to take a given medication. Ask up front how long patients are typically maintained on a given medication. Also ask what signs the doctor would look for to reduce the dosage or stop the medication.

If you hire an addiction psychiatrist who provides behavioral therapy, ask about continuing recovery support after the initial course of therapy has stopped. (See also the Q&As for therapists.)

What you should listen for: When a person completes the initial course of treatment, the doctor should help develop a plan with recommendations for ongoing recovery support services. This might include preventive “booster” or refresher sessions, telephone “check-ins,” 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 the receptionists’ time on the phone is limited, you will learn a lot by focusing on answers to the first five questions. Some may ask you to make an appointment with the doctor to discuss your situation—that’s perfectly reasonable.

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.