Does My Loved One Need Rehab? How a Professional Assessment Decides

What you can do is get them in front of someone qualified and bring what you’ve noticed at home. If you haven’t raised it with them yet, start with how to bring it up calmly.

Isn’t a diagnosis enough to decide?

No, and this is where families often get stuck. A diagnosis answers whether there’s a substance use disorder and how severe it is. Clinicians use the DSM-5’s 11 criteria and rate it mild, moderate or severe depending on how many apply over 12 months.⁴⁵ (Our page on the signs of a substance use problem shows what those look like at home.)

Where and how someone gets treated is a separate call. Two people with the same diagnosis can need very different care, and NIAAA notes that no single treatment works for everyone; matching it to the person matters.⁵

Who can do the assessment?

Their primary care doctor is often the easiest place to start. A doctor can screen, check their overall health, talk about medication and refer them on.⁵⁶ Many primary care offices and ERs use a short screening approach called SBIRT, which ends in a referral to specialty care when someone needs more.⁶

You can also go directly to:

• an addiction medicine physician or addiction psychiatrist⁵
• a psychologist, licensed clinical social worker or licensed counselor with addiction training (addiction counselor credentials vary by state)⁵
• the intake clinician at a state-licensed program, after asking about their credentials and whether you’re under any obligation to enroll
• a hospital social worker, if your loved one is already there

For in-network names, call the behavioral health number on the insurance card. Without insurance, the SAMHSA National Helpline (1-800-662-4357) and FindTreatment.gov list providers near you; see treatment without insurance for more.

If they drink heavily every day or take benzodiazepines (like Xanax) daily, talk to a doctor before they try to quit, because stopping suddenly can cause seizures.⁷⁸ Here’s when withdrawal is dangerous.

Be wary of any call center that says your loved one needs a particular 30-day residential program before a clinician has spoken with them. That’s a sales pitch. We cover other red flags separately.

What does the assessment look at?

Expect detailed questions about what they use and how often, past withdrawal or overdoses, and any earlier treatment.¹ Most clinicians organize the answers with the ASAM Criteria, the American Society of Addiction Medicine’s standards for matching people to a level of care. The fourth edition, from 2023, covers six areas:¹²

One change in that edition matters to families. Readiness to change no longer decides the level of care on its own; it’s weighed under the sixth area and worked out with your loved one.¹ So an assessment is still worth doing when they’re ambivalent.

The result points to a level of care. ASAM numbers four broad levels from 1 to 4, with decimals such as 3.7 marking finer steps.¹ In practice that runs from outpatient visits, through intensive outpatient or partial hospitalization, to 24-hour residential programs and medically directed inpatient care.⁵ ASAM also favors a length of stay based on progress over a fixed “28-day program.”² You can compare the levels side by side.

Why two people get different recommendations

Take a typical case. Sam, 24, had been using pills he bought from a friend, and his mother assumed he needed 30 days at a residential program out of state. The clinician found opioid use disorder, no other serious health problems and a stable home. The plan was buprenorphine plus an intensive outpatient program three evenings a week, with a clear note on what would mean stepping up: a return to regular use, or missed sessions. Sam kept his job.

Someone with past withdrawal seizures, untreated trauma and nowhere safe to live would likely get a different plan, starting with supervised withdrawal management. For alcohol, ASAM’s guideline says withdrawal can usually be handled as an outpatient when risk factors are limited, while people with little support or an unsafe home may need more.⁷ Detox on its own isn’t treatment, though. The same guideline says withdrawal management alone isn’t effective and should lead into ongoing care.⁷

Plans should change over time, too. The ASAM Criteria call for regular reassessment, stepping down as someone improves or up if they don’t.¹

What to bring

Your loved one may not remember or mention everything, and specific, dated notes fill the gaps. You can share information with a clinician even when privacy rules limit what they can tell you back.

Questions to ask afterward

If the assessment came from a program that would gain from the admission, getting a second opinion from an independent clinician is reasonable. If insurance later pushes back on the level of care, that’s a separate fight; here’s how insurers decide medical necessity.