• Kinds, amount, and length of time of substance or alcohol use
• Cultural issues around use of alcohol or drugs
• Effects of drug or alcohol use on the persons life
• Medical history
• Current medical problems or needs
• Current medications (including pain medication)
• Mental health issues or behavioral problems
• Family and social issues and needs
• Legal or financial problems
• Educational background and needs
• Current living situation and environment
• Employment history, stability, problems, and needs
• School performance, problems, and needs, if relevant
• Previous treatment experiences or attempts to quit drug or alcohol use.

The counselor may invite you, as a family member, to answer questions and express your own concerns as well. Be honest--this is not the time to cover up your loved ones behavior. The counselor needs to get a full picture of the problem to plan and help implement the most effective treatment. It is particularly important for the counselor to know whether your family member has any serious medical problems or whether you suspect that he or she may have an emotional problem. You may feel embarrassed answering some of these questions or have difficulty completing the interview, but remember: the counselor is there to help you and your loved one. The treatment team uses the information gathered to recommend the best type of treatment. No one type of treatment is right for everyone; to work, the treatment needs to meet your family members individual needs.

After the assessment, a counselor or case manager is assigned to your family member. The counselor works with the person (and possibly his or her family) to develop a treatment plan. This plan lists problems, treatment goals, and ways to meet those goals.

Based on the assessment, the counselor may refer your family member to a physician to decide whether he or sheneeds medical supervision to stop alcohol or drug use safely.

Medically supervised withdrawal (often called detoxification or detox) uses medication to help people withdraw from alcohol or drugs. People who have been taking large amounts of opioids (e.g., heroin, OxyContin, or codeine), barbiturates or sedatives (downers), pain medications, or alcohol--either alone or together--may need medically monitored or managed withdrawal services. Sometimes, alcohol withdrawal can be so severe that people hallucinate, have convulsions, or develop other dangerous conditions. Medication can help prevent or treat such conditions. Anyone who has once had hallucinations or seizures from alcohol withdrawal or who has another serious illness or (in some cases) a mental disorder that could complicate detoxification may need medical supervision to detoxify safely. Medically supervised withdrawal can take place on a regular medical ward of a hospital, in a specialized inpatient detoxification unit, or on an outpatient basis with close medical supervision. Detoxification may take several days to a week or more. During that time, the person will receive medical care and may begin to receive education about his or her disease. Not everyone needs inpatient medically supervised detox. People with mild withdrawal symptoms from alcohol or drugs and people using cocaine, marijuana, opioids, or methamphetamine do not generally need to be hospitalized for detoxification. However, they may need outpatient medical care, a lot of support, and someone to ensure their well-being.

Social detoxification can meet this need. Sometimes social detoxification centers are part of a residential treatment program; other times they are separate facilities. Social detoxification centers are not hospitals and seldom use medication, but the person does stay there from several days to 1 week. The social detoxification staff includes nurses and counselors. The staff watches each persons medical condition closely, and counselors are available to help him or her through the most difficult part of withdrawing from alcohol and drugs. It is important to know that detoxification is not treatment; it is a first step that can prepare a person for treatment.

Questions And Answers

Q: My wife just started treatment. I called the program yesterday to ask the counselor some questions. The counselor said that she could neither confirm nor deny that my wife was even there! What is that about?

A: Federal and State laws protect an individuals privacy in treatment. Before the counselor can talk to anyone (including you) about your wifes treatment, the program must first have her permission, in writing. Even if the counselor knows that you know your wife is there, she still can not even say that your wife is in the program until your wife signs a release of information or disclosure authorization form. You may want to talk to your wife and be sure she understands that you would like to be involved in the treatment program.