Understanding Addiction Treatment
A Framework for Informed Decisions
The decision to enter addiction treatment — or to help a family member enter treatment — is among the most consequential decisions a person will make. It is also a decision made under extraordinary pressure: emotional distress, time urgency, and a landscape of options that can seem both overwhelming and opaque. This article provides a framework for understanding what effective treatment looks like, what the evidence supports, and what questions to ask when evaluating options.
What the Science Actually Says
Addiction — clinically termed substance use disorder — is a chronic medical condition with well-characterized neurobiological underpinnings. The National Institute on Drug Abuse (NIDA) defines it as "a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain." This definition is important because it frames the condition correctly: addiction is not a moral failure, a lack of willpower, or a character deficiency. It is a medical condition that responds to medical treatment.
The evidence base for addiction treatment has grown substantially over the past three decades. NIDA's Principles of Effective Treatment, first published in 1999 and updated regularly, synthesizes the research into thirteen principles that should guide treatment selection. Among the most relevant for families evaluating programs: no single treatment is appropriate for everyone; treatment needs to be readily available; effective treatment attends to multiple needs of the individual, not just substance use; an individual's treatment plan must be assessed continually and modified as necessary; treatment does not need to be voluntary to be effective; and medications are an important element of treatment for many patients, especially when combined with counseling and behavioral therapies.
The Levels of Care
The American Society of Addiction Medicine (ASAM) defines a continuum of care with multiple levels, each appropriate for different clinical presentations. Understanding these levels helps families evaluate whether a recommended level of care is clinically appropriate or whether it reflects the provider's business model rather than the patient's clinical needs.
Level 0.5 encompasses early intervention services — screening, brief intervention, and referral. Level 1 is outpatient treatment, typically involving individual therapy, group therapy, and psychiatric management on a scheduled basis while the patient lives independently. Level 2 encompasses intensive outpatient (IOP) and partial hospitalization programs (PHP), which provide more structured programming — typically nine or more hours per week — while the patient lives outside the treatment facility. Level 3 is residential treatment, in which the patient lives at the treatment facility and receives 24-hour clinical care. Within Level 3, there are subcategories ranging from clinically managed low-intensity residential to medically monitored intensive inpatient. Level 4 is medically managed intensive inpatient treatment, appropriate for patients with severe medical or psychiatric complications.
The ASAM Criteria provides a structured assessment tool for determining the appropriate level of care based on six dimensions: acute intoxication and withdrawal potential, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse potential, and recovery environment. A program that recommends a level of care without conducting this assessment — or that recommends the same level of care for every patient — should prompt questions.
What to Look For
Clinical Leadership
The medical director should hold board certification in addiction medicine (through the American Board of Preventive Medicine) or addiction psychiatry (through the American Board of Psychiatry and Neurology). The clinical team should include licensed therapists with addiction-specific training, psychiatric providers for medication management, and medical staff appropriate to the patient population's needs.
Evidence-Based Modalities
The treatment program should employ therapeutic approaches with demonstrated efficacy. These include cognitive-behavioral therapy (CBT), which helps patients identify and modify the thought patterns and behaviors associated with substance use; motivational interviewing and motivational enhancement therapy, which help patients develop intrinsic motivation for change; contingency management, which uses systematic reinforcement of positive behaviors; and medication-assisted treatment (MAT) — including buprenorphine, naltrexone, and methadone for opioid use disorders, and naltrexone, acamprosate, and disulfiram for alcohol use disorders.
Individualized Treatment Planning
Effective treatment is individualized. A program that applies the same protocol to every patient — the same schedule, the same therapeutic modalities, the same length of stay — is not practicing individualized medicine. The treatment plan should be based on a comprehensive assessment, updated regularly based on the patient's progress, and responsive to the specific clinical, psychological, and practical needs of the individual.
The Premium Treatment Landscape
For families with the resources to access the full spectrum of treatment options, the landscape includes several categories. Domestic residential programs at the premium tier include The Guest House Ocala in Florida, which operates a trauma-informed model on a 52-acre private estate; The Meadows in Wickenburg, Arizona, which has developed a proprietary model focused on resolving underlying trauma; Caron Treatment Centers in Pennsylvania, which operates one of the largest nonprofit treatment programs in the country; and Sierra Tucson in Arizona, which offers an integrative approach combining evidence-based therapies with complementary modalities.
International programs offer additional options for families seeking geographic distance or specific clinical approaches. Paracelsus Recovery in Zurich operates a one-client-at-a-time model, providing an entirely private treatment experience with a dedicated clinical team. The Kusnacht Practice, also in Zurich, offers a biochemical restoration approach alongside traditional therapeutic modalities. In the UK, The Priory Group operates the largest network of independent mental health facilities, with flagship programs in London and Surrey.
In-home treatment models represent an emerging alternative for patients who cannot or prefer not to leave their environment. For a comprehensive comparison of international in-home treatment programs, several independent reviews are available. These models bring the clinical team to the patient, delivering individual therapy, psychiatric management, and recovery support in the patient's residence. The clinical rigor of in-home models varies significantly; families should evaluate them with the same criteria applied to residential programs — clinical leadership, evidence-based modalities, individualized planning, and outcome tracking.
Questions to Ask
What is the medical director's board certification? What therapeutic modalities does the program use, and what is the evidence base for each? What is the patient-to-therapist ratio for individual therapy? How many hours per week of individual therapy will the patient receive? Does the program offer medication-assisted treatment when clinically indicated? How does the program determine the appropriate length of stay? Does the program track post-discharge outcomes, and what methodology does it use? What is the aftercare planning process? How does the program communicate with the patient's existing medical providers? What confidentiality protections are in place, and how does the program handle inquiries from third parties?
These questions are not adversarial — they are the questions that any informed consumer of healthcare services should ask. A program that responds to them with transparency and specificity is more likely to provide the quality of care that the patient deserves.