How To Select a Good Treatment Provider

by A. Thomas McLellan, Ph.D.

Providers of addiction treatment span a particularly wide range of backgrounds, approaches and methods. Consider the different types of care providers in relation to your problems.

Physicians

There are many types of physicians but only a few are likely to have training or experience in addiction. A greater proportion of psychiatrists than other physicians have received specialty training in addiction.

Is a Physician Right for Me?

If you have an opiate use (heroin, OxyContin or other pain reliever) or alcohol disorder, medications are likely to be an important part of your addiction treatment. In addition, if physical problems such as pain or psychiatric problems such as depression or anxiety are complicating your addiction problem, your treatment will very likely benefit from appropriate medications. In these cases, a trained and experienced physician can be helpful. You can find listings of physicians with this type of training in most state medical directories, from your insurance program or from the American Society of Addiction Medicine.

Therapists

Therapists use the power of clinical discussion to help addicted individuals get insight into the causes of their addiction, recognize and prepare for the situations that may trigger relapse, and develop a lifestyle that will be rewarding without alcohol and other drugs. Good therapy is not simply interested listening - it requires sophisticated techniques that can be very effective.

Counseling vs. Therapy

Counseling and therapy are different. In general, counseling focuses upon the here and now and offers advice and direction in solving daily problems. Counselors may come from many professional backgrounds, but good counselors have received formal training in counseling, particularly group counseling.

Therapy is generally more sophisticated than counseling and it focuses upon issues involving personal development and relationship formation and maintenance. A background in psychiatry, psychology, clinical social work or family systems is usually a prerequisite for training as a therapist. Regardless of background, the particular therapy always requires formal instruction and training in techniques.

Is a Therapist Right for Me?

The more severe your substance use and the more complex your additional social and relationship problems, the greater is the likelihood that you will need a professional therapist. The only way to find out if a therapist or counselor is right for you is to have a few sessions - at least three. By that point you should feel a bond with the therapist, feel that your problems are being heard and understood, and feel that the therapist has the interest and ability to help you figure things out. If you do not feel this way, you should find another therapist.

Programs

Most rehabilitative care for addiction occurs in "programs" that are dedicated to this specialty. Residential programs of about 21-30 days are most appropriate for patients whose substance use or life situation has gotten really out of control. Outpatient programs typically lasting 30-90 days and requiring participation from 2-8 hours per day for 2-5 days per week are suitable for individuals who have a reasonably supportive living situation.

All programs – whether residential or outpatient – have group and individual counseling. Many programs now offer medications for addiction and psychiatric problems. Some of the better programs offer social services to help gain better employment, deal with pending legal problems, improve parenting and marital relationships and even obtain drug-free housing. Better programs have more structure in their curriculum, better trained and supervised therapists and counselors, individualized treatment planning, monitoring of alcohol and drug use during treatment, and some programs offer follow-up continuing care after discharge.

Is a Program Right for Me?

If you have not had success in your efforts to control your substance use on your own, or through help from others, it is likely that a program will be more appropriate. Virtually all programs work to bring about total abstinence from alcohol and all other drugs - so if this is not what you want, a program may not suit you. On the other hand, if you have tried and failed at many ways to control your substance use without quitting, abstinence may be the most appropriate treatment goal for you.


Professionals trained in addiction psychiatry are experts in recognizing and treating substance use disorders, knowledge especially critical for people who have more than one mental health problem.

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