Finding Substance Use Treatment: What Published Guidance Supports

Key takeaways

• SAMHSA National Helpline: 1-800-662-HELP (1-800-662-4357), free and confidential, 24 hours a day, every day
• Languages: the helpline offers service in English and Spanish
• Most useful single change: Start with your primary care provider, who can assess and refer you.
• Commonest mistake: Programs that promise a quick cure or guaranteed results.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

How to find help for a drug or alcohol problem, from your doctor and the SAMHSA National Helpline to treatment programs. It sits within Substance Use. The figures come from the bodies named at the foot of this page.

The numbers, in one place

What helps

These are worth doing. None of them needs to happen all at once.

• Start with your primary care provider, who can assess and refer you
• Ask programs whether they offer medicines for opioid or alcohol use disorder
• Check what your insurance or Medicaid covers before choosing a program
• Ask about support for co-occurring mental health conditions

What to avoid

The usual wrong turns. Some are more tempting than others.

• Programs that promise a quick cure or guaranteed results
• Waiting until things get worse before reaching out
• Detoxing alone from alcohol, benzodiazepines or opioids without medical advice

In depth

Treatment for substance use is not one thing. It ranges from brief counseling in a doctor's office to outpatient programs, intensive outpatient and partial hospital programs, residential care and hospital-based withdrawal management. The right level depends on your substance, health, safety, home situation and goals, and it can change over time as you progress.

Good treatment is based on evidence. That means medicines for opioid and alcohol use disorder where appropriate, behavioral therapies with proven benefits, attention to mental health, and a plan for ongoing support after an intensive phase ends. Treatment centers vary widely in quality, so it helps to know what to ask before choosing one.

Many people delay seeking help because of stigma, cost, fear of losing a job or not knowing where to start. Federal and state laws protect the privacy of substance use treatment records, and most insurance must cover substance use care. Your primary care provider, the SAMHSA National Helpline and FindTreatment.gov are all good places to begin.

Signs and symptoms

• Using more than intended or being unable to cut down
• Problems at work, school or home because of substance use
• Health problems linked to drinking or drug use
• Withdrawal symptoms when you stop
• Family or friends expressing concern
• An overdose, accident or legal problem related to use

Causes and risk factors

• Not knowing where to look or what options exist
• Worry about cost or insurance coverage
• Fear of stigma or of others finding out
• Waiting lists or a lack of local programs
• Mixed feelings about stopping
• Untreated mental health conditions that make change harder

How it is checked

A clinician or treatment program will usually start with an assessment covering what you use and how often, your physical and mental health, past treatment, home life and goals. Many programs use a standard framework to match people to the right level of care, considering factors such as withdrawal risk, medical needs and support at home.

The assessment helps decide whether outpatient care is enough or whether you need a more intensive setting. It may include lab tests and screening for conditions such as depression or hepatitis. Ask to see your treatment plan and to be involved in decisions about it.

Treatment and support options

Outpatient treatment

Outpatient programs offer counseling, therapy and medicines while you live at home and keep working or studying. Intensive outpatient and partial hospital programs provide more hours of treatment each week. These suit many people, especially those with stable housing and support.

Residential treatment

Residential programs provide 24-hour structured care in a non-hospital setting. They can help people with severe substance use, unstable housing or repeated relapse. Ask how long stays usually last, what the program offers after discharge, and whether it continues medicines such as buprenorphine.

Withdrawal management

Some people need medical help to stop safely, especially from alcohol, benzodiazepines or opioids. Withdrawal management, sometimes called detox, can take place in a hospital, residential unit or outpatient setting. Detox alone is not treatment; it should lead to ongoing care.

Peer and mutual support

Peer recovery specialists, recovery community organizations and groups such as AA, NA and SMART Recovery offer ongoing support from people with lived experience. They can complement formal treatment and help sustain recovery long after a program ends.

Prevention

• Check that a program is licensed by your state
• Ask whether the program offers FDA-approved medicines
• Be wary of programs that offer free travel or housing to enroll
• Confirm what your insurance covers before admission
• Ask about aftercare and ongoing support

Day to day

Starting treatment is a big step, and it is normal to feel nervous. Bring a list of questions, your medicines, insurance information and someone you trust if that helps. Be honest about your use and your goals. Treatment works best when it fits your life and you feel heard.

After an intensive phase, ongoing support makes recovery more stable. This might mean outpatient counseling, medicine, peer support or recovery housing. Keep your follow-up appointments, and reach out quickly if you start to struggle. Recovery is a process, and many people need more than one try.

For specific groups

Teens

Teens need treatment designed for their age, involving family where appropriate. Look for adolescent programs, and ask your teen's doctor or school counselor for referrals. Early help can prevent problems from getting worse.

People with mental health conditions

Many people with substance use problems also have depression, anxiety, PTSD or other conditions. Integrated programs that treat both at the same time tend to work better than treating each separately. Ask whether a program has mental health staff.

Veterans

Veterans can get substance use treatment through the VA, including medicines, counseling and residential programs. The Veterans Crisis Line is available by calling 988 and pressing 1. Many community programs also have experience with military service members.

Questions to ask your doctor

• What level of care do you think I need?
• Can you start treatment with medicine today, or refer me to someone who can?
• Which local programs do you trust?
• Is withdrawal likely to be dangerous for me?
• How can I get help for my mental health at the same time?
• Who should I contact if I am struggling between appointments?

More questions, answered

Is substance use treatment confidential?

Federal law protects the privacy of substance use treatment records, with stronger protections than for many other health records. In most cases, programs cannot share your information without your consent. Ask a program how it protects privacy if you are worried.

Can I lose my job for seeking treatment?

Federal law may protect people in treatment or recovery from discrimination in some situations, and the Family and Medical Leave Act may let you take unpaid leave for treatment. Protections have limits. Your employer's employee assistance program may also offer confidential help.

How do I spot a bad treatment program?

Warning signs include promises of quick cures, guaranteed results, free travel or rent in exchange for enrolling, refusal to use FDA-approved medicines, and pressure to commit immediately. Check that a program is licensed and accredited, and ask about the staff's qualifications.

What if I cannot afford treatment?

Many programs accept Medicaid, and some offer sliding-scale fees or state-funded services. The SAMHSA National Helpline and FindTreatment.gov can help you find low-cost options. Community health centers may also offer substance use care.

How long does treatment take?

It varies. Some people need a few weeks of intensive care followed by months of outpatient support. Others take medicine for years. Research suggests staying in treatment for an adequate length of time improves results. Your plan should change as you progress.

Do I have to hit rock bottom before getting help?

No. Treatment can help at any stage, and getting help earlier usually leads to better results. You do not need to wait for a crisis. If you are worried about your use, that is enough reason to talk to someone.

Related topics

• The Evidence on Talk Therapy, Without the Hype (Mental Health)
• Sexual Health Services: What Published Guidance Supports (Sexual Health)
• Choosing the Right Care: What Published Guidance Supports (Preventive Care)
• Finding a Primary Care Doctor: What the Evidence Actually Says (Using Health Services)

Where to go next

• Finding Substance Use Treatment in Five Minutes
• Finding Substance Use Treatment, Explained Without the Jargon
• Finding Substance Use Treatment — the reference entry
• Substance Use: The Complete Guide
• Supporting a Family Member With Addiction: Sorting the Evidence From the Noise
• The Evidence on Safe Disposal of Medicines, Without the Hype

When to speak to a doctor

If you are thinking about suicide or are in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. Call 911 for an overdose, seizures or someone who cannot be woken.

Where this comes from

• SAMHSA — National Helpline
• SAMHSA — FindTreatment.gov
• 988 Suicide & Crisis Lifeline — Get Help

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.