Key takeaway
NIAAA says a license to practice in your state is the start, not the whole check. Ask about addiction training, a full assessment, and whether medication is even an option. A therapist who stops care after one return to use is a warning sign in that guidance. The questions here are about the clinician.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
The building can look right and the person across from you can still be the wrong clinician. NIAAA separates questions for a treatment program from questions for a therapist with an addiction specialty. A program can hold a state license and still assign a counselor whose training you never asked about. A licensed counselor can be a poor fit if alcohol and drug problems are a thin slice of the practice. The facility questions are on the rehab-choice guide. The level of care is the program-comparison guide.
SAMHSA says therapy and counseling are part of most treatment plans and usually happen with a licensed behavioral health professional, either one to one or in a group. If you are in withdrawal from alcohol or benzodiazepines, or someone is overdosing, call 911. A first appointment is not emergency care. For a mental health crisis, call or text 988.
License, degree, and the language
Online directories go out of date, so confirm that the license or certification is current. Clinical psychologists, licensed professional counselors, and social workers should be licensed to practice independently in your state. A license does not ensure quality. Look for at least a master's degree and special training in treating addiction. Credential names vary. Examples for counselors include LPC, LCPC, LMHC, and LMFT, plus a doctoral degree for psychologists. Less common addiction-specific certificates exist too. Do not treat that list as every title a state uses. Ask the person to name the license, the addiction training, how long they have treated alcohol or drug problems, and how much of the week is that work.
Listen to the language. Addiction is a medical condition, not a sign that someone is weak. Avoid a therapist who uses words such as drunk or addict, or who wants a confrontational or "tough love" approach. Moral judgment does not match the science. Why those words keep people away from care is the shame guide.
Assessment, other conditions, and medicine
The fit depends on a full assessment, not a few questions about drinking. The interview should be structured and may take more than one visit. The domains are drinking, other substance use, mental health, family dynamics, employment, criminal justice, and social-service needs. Ask how many visits the assessment takes and how you take part in the plan that follows. Coordination with a physician, a social-service agency, or another specialist is part of the job.
NIAAA's search FAQ says at least one-third of people in addiction treatment for alcohol use disorder also have a mental health disorder, most often anxiety or depression. Treating one problem first and the other later is less effective than addressing both. Ask what training the therapist has with co-occurring conditions. The longer version is the dual-diagnosis guide. Only a medical doctor can fully assess physical health. The counselor should send you for a history and physical if you have not had one recently.
Most of these clinicians cannot prescribe. They should still coordinate with a doctor who can. For alcohol, three FDA-approved medicines are not addictive: naltrexone, as a daily pill or a monthly injection, plus acamprosate and disulfiram. Steer clear of a provider who rejects medication or who calls it trading one addiction for another. Opioid medicines follow different rules, on the medication FAQ. Do not start or stop a medicine because a listing named the brand.
What they expect after a return to use
Ask how many sessions, how long each one is, which days, and how many weeks. Some therapists expect a mutual-help group, a written agreement about medicine, or a phone app. Those are their expectations, not a national assignment. Be wary of all-or-nothing rules. The example is a policy that ends care if you relapse.
NIAAA says a return to heavy drinking can be part of a chronic condition, that it is not a failure, and that it should change the plan: goals, counseling, medication, or a combination. NIDA says detoxification alone is not treatment, so a counselor's plan still has to connect to ongoing care. Sometimes that means more intensive care, including a residential setting. What that change is for is the during-treatment guide. A therapist who treats one use as a discharge has told you the policy.
Also ask what happens when the first block of sessions ends. A good provider helps you step down and leaves a plan for booster sessions, check-in calls, and what to do if use returns. The wider sequence of care is the continuum guide. The handoff at the end of this course of therapy is the question to ask this clinician.
Costs vary by office. Ask whether insurance is accepted, what copays or missed-session fees look like, and, if insurance is not accepted, what a typical episode costs and whether a payment plan or a sliding scale exists. Get the numbers from that office.
A mutual-help meeting can sit beside therapy. It is not a license. Peer-program details are on the SMART Recovery overview. Programs you can call are on FindTreatment.gov.
Call or text (800) 653-9376 if you want help sorting a licensed clinician from a meeting or a residential program.
Additional Resources
Sources cited on this page:
- NIAAA: 10 questions for therapists with addiction specialties
- NIAAA: FAQs on searching for alcohol treatment
- SAMHSA: Types of treatment
- NIDA: Treatment and Recovery
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Is a state license enough?
It is required, and it is not the whole check. NIAAA says clinical psychologists, licensed professional counselors, and social workers should be licensed to practice independently in your state, and that a license alone does not ensure quality. It is best to find someone with at least a master's degree and special training in treating addiction. LPC, LMHC, and LMFT are examples, not a complete national list. Ask what the license is and whether it is current.
What should the first appointments cover?
NIAAA says a comprehensive assessment is a lengthy, structured interview that may take more than one session. It should cover drinking, other substance use, mental health, family, employment, criminal-justice involvement, and the need for social services. The counselor should send you for a history and physical if you have not had one recently, because only a medical doctor can fully assess physical health. Ask how the results become a plan you help write.
Can a counselor prescribe buprenorphine or naltrexone?
Usually no. Most psychologists, licensed counselors, and social workers cannot write prescriptions, and they should still coordinate with a doctor who can. For alcohol, NIAAA names naltrexone, acamprosate, and disulfiram, and says those medicines are not addictive. Steer clear of a provider who rejects medication or calls it substituting one addiction for another. Opioid medicines follow different rules. A dose is the prescriber's decision.
What if they say they discharge anyone who drinks or uses again?
Treat that as a poor fit. NIAAA says relapse is not a failure and that it calls for a change in the plan, which might be more counseling, a medicine, or a more intensive setting. Be wary of all-or-nothing rules. A policy of stopping treatment after a relapse is the example NIAAA gives. Ask what changes in the plan, and ask the program separately if a residential stay has a different rule.
How is this different from picking a rehab?
A facility question covers the program's license, accreditation, withdrawal care, and the level of care. These questions are about one clinician, in a solo or group practice or inside a program. SAMHSA says counseling usually happens with a licensed behavioral health professional, one to one or in a group. A mutual-help meeting is not that license.