What happens when you ask for help with alcohol or drugs

Asking for help usually begins with a conversation and a screening or assessment, after which a clinician and the person agree on a level of care. There is no single route, and the first contact can be a primary care visit, a treatment referral line or an emergency service.

Many people delay asking because they do not know what will follow. This page outlines the common steps, based on public health agencies in the United States and the United Kingdom. It describes the general picture only. A qualified clinician decides what fits a particular person.

Where the first conversation can happen

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes a visit to a primary care provider as "an important first step". That provider can evaluate drinking and overall health, prescribe medications, refer to specialists and help build a plan. Referrals can also come through a health insurance plan, a local health department or an employee assistance program.

The National Institute on Drug Abuse (NIDA) gives similar advice: speak to a healthcare provider, who has screening tools and can refer a person to treatment or other services. In the United Kingdom, the NHS suggests seeing a GP or an alcohol support service.

A telephone route also exists. SAMHSA's National Helpline, 1-800-662-HELP (4357), is a free, confidential treatment referral and information service. SAMHSA says it runs 24 hours a day, 365 days a year, in English and Spanish, and that it does not provide counseling. Its online locator is FindTreatment.gov.

What a screening or assessment involves

A screening is a short set of questions that shows whether substance use may be causing problems. An assessment goes further and gathers the detail needed to plan care. The NHS says a GP or support service will ask about drinking and how it affects daily life, may use a questionnaire, and may order blood tests to check health.

The assessment also looks at the wider picture. NIDA notes that people with a substance use disorder often have other mental health conditions, and that it is usually better to treat these at the same time rather than separately. For more on that, see co-occurring mental health conditions.

Levels of care in outline

Levels of care describe how much structure and supervision a person receives. NIDA lists these main settings:

• Outpatient care: regular office or telehealth visits for counseling, medication support or both, one-on-one or in groups.
• Intensive outpatient care: more coordinated outpatient care, which may involve hours of services each week.
• Inpatient care: an overnight stay in a hospital or clinic for a few days or weeks, usually for people who need 24-hour care for health problems or to manage withdrawal.
• Residential care: inpatient programs that provide extended care, usually for a few weeks to a few months.
• Opioid treatment programs: care for opioid use disorder that usually combines medications with behavioral therapies.

NIAAA's treatment navigator suggests starting with the least intensive type of care that fits, moving to more intensive care only if needed. It says most people begin with outpatient counseling, that residential programs can offer structure to people without stable housing or support, and that hospital inpatient care is for people with other health conditions that need medical attention.

What treatment generally involves

NIDA says the most common treatments for substance use disorders are individual, group and family counseling or psychotherapy, delivered by a licensed professional. Examples include cognitive behavioral therapy, motivational interviewing and contingency management.

Medications are part of care for some conditions. NIDA describes methadone, buprenorphine and naltrexone as standard of care for opioid use disorder, and notes that medications are also available for alcohol use disorder. See medications used in treatment for detail.

When a person has been drinking or using heavily, safe withdrawal may come first. NIAAA says that stopping suddenly after long, heavy drinking can be dangerous and that medical help should be sought to plan it. Withdrawal and detox are covered on a separate page.

Peer-led mutual-help groups are a different thing. NIDA states that they are not led by healthcare professionals and so are not the same as treatment, though many people find them useful alongside it. See mutual-help groups, described.

Treatment is not one-size-fits-all

NIAAA states that "there is no one-size-fits-all solution", so what helps one person may not suit another. NIDA adds that treatment should be tailored to each person's drug use patterns and to their medical, mental health and social problems.

NIDA also describes substance use disorders as chronic conditions. It says a return to use can be part of the process and is a signal to talk with a healthcare provider about resuming or changing the plan, not proof that treatment has failed.

When it is an emergency

Some situations cannot wait for an appointment. The NHS advises getting emergency help straight away if someone has severe withdrawal, such as visible shaking, confusion, hallucinations or a seizure, and says not to drive yourself. NIDA describes an overdose as using enough of a drug to cause life-threatening symptoms or death. NIAAA also points to a national crisis lifeline for anyone with suicidal thoughts. In any of these cases, contact local emergency services or go to the nearest emergency department.