Most families start with a sinking feeling that something is wrong and no idea what to do first. The work from there is fairly concrete: get a professional assessment, talk to your loved one about specific things you’ve seen, check any program’s license and insurance network yourself, and book aftercare before treatment ends.
Maybe you found pills in a drawer. Maybe your son has missed work again, or your partner’s drinking has stopped being something you can explain away. Maybe you’ve been through treatment once already and you’re scared it’s starting over.
Addiction is a treatable medical condition, and families have more influence than they tend to think. You can’t make someone recover, but what you say, the boundaries you hold and the program you pick all count.
Recovery Advocators is an independent education resource. We don’t own treatment centers or take payment for referrals.
Where should I start?
With whatever question you’re facing today. The sections below follow the order these questions usually come up, and each card opens the page that covers that step in full.
The questions families face
Is something seriously wrong?
Most families notice a pattern before they can name it. No single sign proves anything, but these are the ones worth paying attention to:
- Secrecy and lying about where they’ve been, who with, or how much they’re using
- Pulling away from family, old friends, hobbies, work or school
- Unexplained spending, borrowing, or missing cash, valuables or medications
- Changes in sleep, weight or hygiene, slurred speech, pinned or very large pupils, frequent “flu”
- Mood swings, and defensiveness whenever substances come up
- DUIs, arrests, lost jobs or failing grades that don’t change anything
- Shakes or sweats when they cut back, or drinking in the morning to feel normal
- Using more than they meant to, and broken promises to cut down
Clinicians call this a substance use disorder. For alcohol, doctors work from a list of 11 symptoms and rate the condition mild (2–3 in the past year), moderate (4–5) or severe (6 or more).3 “Addiction” isn’t a formal diagnosis; it usually describes the severe, compulsive end.3
You don’t need a diagnosis to act. “I’m worried about how much you’re drinking, and I want you to see someone” is enough. A primary care doctor, a licensed addiction counselor or a program’s intake team can do a screening. More on the warning signs and why someone can want to stop and still keep using.
Is it dangerous for them to stop?
For alcohol and benzodiazepines (Xanax, Klonopin, Ativan, Valium), it can be. A heavy daily drinker who quits cold turkey can have seizures or delirium tremens anywhere from the first day to about five days after the last drink,4 and stopping benzodiazepines too fast can cause seizures even in people who took them exactly as prescribed.5 Anyone in that situation should see a doctor before stopping; this page explains when withdrawal needs medical care. Opioid withdrawal is painful and hard to get through, so ask about buprenorphine or methadone. Stimulant withdrawal isn’t usually dangerous in the same way, but depression is common afterward.6
Detox gets someone through withdrawal so treatment can begin. On its own it does little to change long-term use,9 so a detox that doesn’t hand your loved one on to ongoing care hasn’t done its job. See what happens in a supervised detox.
How do I talk to them?
In the first conversation, say what you’ve seen, show you care, and offer one next step they can take now or later.
Pick a time when they’re sober, rested and not in a hurry, never in the middle of or right after an incident. Bring two or three specific things you’ve noticed and describe behavior rather than character: “Last Saturday you didn’t remember driving home” lands, “You’re a drunk” doesn’t. Say how it affects you (“I love you, and I’m scared”), then listen. Have one concrete option ready, like a doctor’s appointment, so a yes can turn into action the same day. Keep it to one or two people they trust, and only say what you’re prepared to follow through on.
Expect denial, anger or blame the first time. That’s normal, and it doesn’t mean you got it wrong. A calm message repeated over weeks tends to do more than one big talk. Our guide to starting the conversation has a seven-step plan and words to use when they get defensive.
What if they refuse help?
Plenty of people say no at first and agree later.
The family approach with the strongest evidence is CRAFT (Community Reinforcement and Family Training). In a randomized trial, 64% of family members trained in CRAFT got a resistant loved one with a drinking problem into treatment, compared with 30% using a confrontational “Johnson-style” intervention and 13% using a program focused on Al-Anon.11 It teaches you to reward sober time, step back when they’re using, let natural consequences land instead of rescuing them, and raise treatment again at the right moments, often just after a consequence. See how CRAFT works and where to find it.
While you wait, protect what you can. If opioids or pills from outside a pharmacy are in the picture, keep naloxone in the house; the nasal spray is sold without a prescription.12 Lock up or get rid of medications, especially opioids, sedatives and stimulants. Separate your accounts, change passwords, and pay bills directly instead of handing over cash. Children shouldn’t be left in the care of someone who’s intoxicated.
A boundary is about what you will do: “I won’t give you cash, but I’ll pay the treatment deposit.” “I won’t call your boss to cover for you.” State it calmly and keep it. More on boundaries versus enabling.
Some states let a court order evaluation or treatment, and the rules vary a lot.12 It’s usually a last resort. See involuntary treatment laws, whether an intervention makes sense and what to do when they say no.
What kind of treatment might they need?
“Rehab” isn’t one thing, which is why an assessment should come before anyone picks a program. Professionals use the ASAM Criteria (fourth edition, 2023), which look at six areas of life, from withdrawal risk and physical and mental health to living situation and the person’s own preferences.13 Ask any program how it applied them to your loved one. Our page on whether your loved one needs rehab explains how to get an assessment.
| Level of care | What it looks like | Often a fit when |
|---|---|---|
| Medically managed withdrawal (detox) | 24-hour medical monitoring for a short stay | Withdrawal could be dangerous or very hard to tolerate |
| Residential (inpatient) | Live on site, structured therapy every day | Home is unsafe or chaotic, repeated relapse, serious health needs |
| Partial hospitalization (PHP) | Treatment most days, often 20+ hours a week; sleep at home15 | Needs a lot of structure but not 24-hour care |
| Intensive outpatient (IOP) | Several sessions a week, often 9+ hours in total14 | Stable home, can keep working or studying |
| Outpatient | Counseling a few hours a week or less | Milder problems, or continuing care after a higher level |
Medication for addiction is treatment in its own right.8 Methadone and buprenorphine help prevent opioid overdose,7 and naltrexone, acamprosate and disulfiram are approved for alcohol use disorder.16 They can be used at any level of care, so be wary of a program that won’t allow them. Depression, anxiety, trauma and ADHD often come along with addiction, and a program that treats both together (dual diagnosis care) is worth looking for. See our guide to addiction medications and how PHP and IOP differ.
How do we find a legitimate program?
The treatment industry has excellent programs and some that put profit first, so search neutral sources and check everything yourself.
Good places to start are FindTreatment.gov, SAMHSA’s list of state-licensed providers,17 and the free SAMHSA National Helpline at 1-800-662-4357, which also refers uninsured callers to state-funded programs.18 Your insurer’s provider directory and your loved one’s doctor are useful too.
Once you have an assessment, shortlist two or three programs at the recommended level of care. Check each one’s license on your state licensing agency’s website (it should cover that level of care at that address), then look it up in The Joint Commission’s directory and CARF’s provider search.1920 Accreditation means outside review, not a guarantee. Then call admissions with the questions in the next section, and take notes. The Rehab Comparison Worksheet keeps the answers side by side.
Walk away from any program that offers free travel, free housing, gift cards or cash to enroll, pushes you to commit today, promises a success rate, won’t give you a written cost estimate, or recommends the same 30-day stay before anyone has assessed your loved one. Paying or taking kickbacks for treatment referrals can be a federal crime, with fines up to $200,000 and up to 10 years in prison per violation.21 The FTC also warns that some search ads use real treatment centers’ names but connect you to a different business.22 See how to spot paid referrals and patient brokering and how to check a license and accreditation.
What should we ask before saying yes?
Get the answers in writing where you can. A vague answer to any of these is a reason to keep looking.
Eight questions to ask before admission
The full list of 20 questions to ask a treatment center goes into staffing and daily schedules.
Will insurance cover it?
Most plans have to cover addiction treatment, but “covered” says nothing about what you’ll pay.
Marketplace plans must cover substance use disorder services and can’t refuse coverage over a pre-existing substance use condition.23 The federal parity law generally stops plans from making addiction coverage more restrictive than medical coverage.36 In May 2025 federal agencies paused enforcement of the newer parts of a 2024 parity rule; the law and the earlier rules still apply.24 State Medicaid programs must cover medications for opioid use disorder, a requirement a 2024 law made permanent,25 and Medicare covers opioid treatment programs, including methadone, and intensive outpatient care.2714
Your share depends mostly on whether the program is in network, what’s left on your deductible and out-of-pocket maximum, and whether the plan approves the stay in advance. Many plans require prior authorization for higher levels of care and review the stay as it goes.23 The gap can be large: in one sample plan on our rehab cost page, the same 21-day residential stay costs a family about $5,800 in network and up to about $27,540 out of network.
So call the plan yourself, using the member services number on the card. Ask whether this program is in network for this level of care, whether prior authorization is needed, and what’s left on your deductible. Write down the date, the representative’s name and a reference number. “We take your insurance” from a program is not a confirmed benefit, and even a verification of benefits isn’t a promise to pay. If a claim or stay is denied, you can appeal or file a parity complaint.
What if we can’t afford treatment?
Public and low-cost care exists in every state.
You can apply for Medicaid any time of year.29 Starting by January 1, 2027 (earlier in some states), many adults covered through Medicaid expansion must show 80 hours a month of work or other activities, but people in a drug or alcohol treatment program are exempt, as are people who are medically frail.26 Ask your state Medicaid agency whether a substance use disorder counts as medically frail where you live; see Medicaid and addiction treatment.
If you have no insurance, the SAMHSA Helpline can point you to state-funded and sliding-scale programs.18 Losing other coverage can open a special enrollment period on the Marketplace.37 If you’re paying yourself, you’re generally entitled to a good faith estimate before scheduled care.28 Free groups like AA, NA and SMART Recovery help too, though they’re support rather than medical treatment. More in treatment without insurance.
What happens during treatment?
Intake staff assess substance use, physical and mental health and home life, then write a treatment plan. After that come individual, group and often family therapy, medication where it fits, and, in a good program, discharge planning that starts soon after admission.
Treatment records are protected by a strict federal rule, 42 CFR Part 2, with updated requirements in force since February 16, 2026.30 A program generally can’t tell you anything unless your adult loved one signs a written consent,35 so ask them to sign one at admission. See privacy and release forms.
Go to family sessions and keep calls supportive. A call in the first few days begging to come home is common; talk to the treatment team before you react. More in what happens in rehab, day by day.
What happens after treatment?
The weeks after discharge are risky, so the next appointment should be booked before your loved one walks out the door. If opioids were involved, overdose risk is higher because tolerance drops while they’re not using.7 Know the signs to watch for.
A real discharge plan has:
- A first appointment at the next level of care (IOP, therapy or a medication prescriber) with a date, time and address
- A prescriber and pharmacy confirmed for any medication
- A safe place to live, at home or in a certified recovery residence
- Peer support, such as mutual-help groups, a recovery coach or an alumni program
- A written relapse-prevention plan naming triggers, warning signs and who to call
A printed list of meeting times is not a plan. At home, structure and connection do more than surveillance: agree on house rules together and notice progress. See supporting recovery after rehab.
What if things go wrong again?
A return to use is common. NIDA puts relapse rates for substance use disorders at 40–60%, similar to other chronic illnesses like high blood pressure and asthma.10 It means the plan needs changing.
If they’re intoxicated, don’t argue; wait until they’re sober. Then be direct: “I can see you’re using again, and I want to help you get back on track.” Call their counselor, prescriber or program the next day, since they may adjust medication or step up the level of care. Keep your boundaries without shaming, and look at what changed, whether that’s a new stress, a missed dose or a gap in aftercare. See what a relapse means.
How do we take care of ourselves?
Living with someone’s addiction wears you down, and caregivers need looking after too.33 A steadier family also helps: family support plays a big part in getting someone into treatment and keeping them there.339
Family groups such as Al-Anon, Nar-Anon and SMART Recovery Family & Friends exist just for you.34 SAMHSA’s free introductory guide for families is a good place to start.33 If there are children at home, keep their routines, tell them in words that fit their age that it isn’t their fault, and see how to talk to children about a parent’s addiction. Our support for families page lists groups and therapy options.
Does the plan change for teens, pregnancy, veterans and other situations?
Sometimes. Each of these has its own page.
- Teens and young adults: look for adolescent programs that involve the family. What parents can see differs for minors and varies by state. See teens and young adults.
- Pregnancy: don’t stop opioids suddenly. Recommended treatment includes methadone or buprenorphine with counseling.31 See treatment during pregnancy.
- Older adults: watch for prescription misuse and alcohol mixed with medications. See help for older adults.
- Veterans: the VA offers detox, outpatient and residential care, and medications such as methadone and buprenorphine.32 See options for veterans.
- Licensed professionals like nurses, doctors and pilots may have confidential monitoring programs. See treatment for professionals.
- Chronic pain: prescribed opioids and benzodiazepines shouldn’t be stopped suddenly. See chronic pain and prescribed medications.
- Legal trouble: drug courts and diversion programs may offer treatment instead of jail. See court-ordered treatment.
- LGBTQ+ loved ones often do better in openly affirming programs. See LGBTQ+ affirming care.
- Work: job-protected leave may be available. See FMLA and work leave.
Frequently asked questions
Do they have to hit rock bottom before treatment can work?
No. Treatment doesn’t need to be voluntary to work. Many people go in under pressure from family, an employer or a court and still benefit, and motivation often grows once treatment starts.9
How long does rehab take?
It depends on the person and the level of care. Detox is short, residential stays vary, and outpatient care can go on for months. Research suggests most people need at least three months in treatment, counting all levels of care, to significantly cut down or stop, and longer is often better.9 See how long rehab lasts.
Should I let them keep living at home?
There’s no single right answer. It depends on safety, whether children live there, and whether house rules are respected. Many families allow it with clear conditions, such as going to treatment and no use at home. If you say “you can’t stay here if you come home intoxicated,” be ready to follow through and have somewhere for them to go.
Sources
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- FDA — FDA Approves Second Over-the-Counter Naloxone Nasal Spray Product (July 28, 2023). fda.gov/news-events/press-announcements/fda-approves-second-over-count… — accessed Oct 2026
- NIAAA — Alcohol Use Disorder: From Risk to Diagnosis to Recovery (Core Resource on Alcohol). niaaa.nih.gov/health-professionals-communities/core-resource-on-alcoho… — accessed Oct 2026
- American Society of Addiction Medicine — The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (2020). asam.org/docs/default-source/quality-science/the_asam_clinical_practic… — accessed Oct 2026
- FDA — FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, Drug Safety Communication (September 23, 2020). fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning… — accessed Oct 2026
- American Society of Addiction Medicine and American Academy of Addiction Psychiatry — Clinical Practice Guideline on the Management of Stimulant Use Disorder (2023). asam.org/quality-care/clinical-guidelines/stimulant-use-disorders — accessed Oct 2026
- CDC — Evidence-Based Strategies for Preventing Opioid Overdose: What's Working in the United States (2018). cdc.gov/overdose-resources/pdf/2018-evidence-based-strategies_508.pdf — accessed Oct 2026
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- NIDA — Principles of Drug Addiction Treatment: A Research-Based Guide (3rd edition). nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf — accessed Oct 2026
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- Miller WR, Meyers RJ, Tonigan JS — Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology (1999). pubmed.ncbi.nlm.nih.gov/10535235/ — accessed Oct 2026
- Health and Human Rights Journal (via PubMed Central) — What's Old Is New Again in Addiction Treatment: The Expansion of Involuntary Commitment in the United States (2025). pmc.ncbi.nlm.nih.gov/articles/PMC12282872/ — accessed Oct 2026
- American Society of Addiction Medicine — The ASAM Criteria, 4th Edition (2023). asam.org/asam-criteria/asam-criteria-4th-edition — accessed Oct 2026
- Medicare.gov — Mental Health Care (Outpatient): Intensive Outpatient Program Services. medicare.gov/coverage/mental-health-care-outpatient-intensive-outpatie… — accessed Oct 2026
- Medicare.gov — Mental Health Care (Outpatient): Partial Hospitalization. medicare.gov/coverage/mental-health-care-outpatient-partial-hospitaliz… — accessed Oct 2026
- NIAAA — Treatment for Alcohol Problems: Finding and Getting Help (updated February 2025). niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol… — accessed Oct 2026
- SAMHSA — Find Substance Use Disorder Treatment. samhsa.gov/substance-use/treatment/find-treatment — accessed Oct 2026
- SAMHSA — National Helpline. samhsa.gov/find-help/helplines/national-helpline — accessed Oct 2026
- The Joint Commission — Search for Substance Use Disorder Treatment Providers. jointcommission.org/en-us/accreditation/behavioral-health-care-and-hum… — accessed Oct 2026
- CARF International — Find a Provider. carf.org/find-provider/ — accessed Oct 2026
- 18 U.S.C. § 220 — Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (Eliminating Kickbacks in Recovery Act, 2018). uscode.house.gov/view.xhtml?req=%28title%3A18+section%3A220+edition%3A… — accessed Oct 2026
- Federal Trade Commission — How to avoid scams when looking for drug treatment (August 2025). consumer.ftc.gov/consumer-alerts/2025/08/how-avoid-scams-when-looking-… — accessed Oct 2026
- HealthCare.gov — Mental health and substance abuse health coverage options. healthcare.gov/coverage/mental-health-substance-abuse-coverage/ — accessed Oct 2026
- U.S. Departments of Labor, HHS and the Treasury — Statement regarding enforcement of the final rule on requirements related to the Mental Health Parity and Addiction Equity Act (May 15, 2025). cms.gov/files/document/statement-regarding-enforcement-final-rule-requ… — accessed Oct 2026
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