Nine Questions to Ask a Rehab Before You Commit

Almost every family that calls a treatment program is asked to make a decision within hours, about tens of thousands of dollars, on the basis of information the program controls. Here are the nine questions that separate a clinical program from a marketing operation, and what the answers tell you.

1. Are you licensed in this state, and what is your licence number?

Every state licenses residential substance use facilities, and you can verify a licence yourself through the state health or behavioral health department. A program that hesitates here, or that answers with a vague reference to being fully accredited, has told you something. Ask separately about accreditation by the Joint Commission or CARF, which is voluntary and meaningful.

2. Am I speaking to the treatment center, or to a call center?

Many websites that appear to be local providers are lead generation operations that sell your phone call to whichever facility bid highest that day. This is legal and widespread. The question is not rude, and the answer reframes everything else you are told in the conversation.

3. Who is the medical director, and what are they board certified in?

You are looking for board certification in addiction medicine or addiction psychiatry. Ask how often you will actually see a physician or psychiatrist, not whether one is affiliated. Affiliated can mean a signature on paperwork once a month.

4. How many individual therapy sessions per week?

Ask for a number. Some programs are almost entirely group based, which is far cheaper to staff, and a brochure describing intensive individualized care can be built on one 50 minute session a week. Groups have real value, and they are not a substitute for individual work.

5. Do you prescribe medication for opioid or alcohol use disorder?

This is the single most informative question on the list. Buprenorphine and methadone roughly halve mortality in opioid use disorder compared with counseling alone, and naltrexone and acamprosate have solid evidence in alcohol use disorder.

If a program says no, or says it prefers an abstinence based approach, it is declining to offer the intervention with the strongest evidence for keeping patients alive. That is a philosophical position rather than a clinical one, and you are entitled to weigh it accordingly.

6. Will I keep taking my psychiatric medication?

Any program that requires you to stop prescribed psychiatric medication as a condition of admission should be ruled out. Treating a co-occurring depression, bipolar disorder, PTSD or ADHD is part of recovery rather than a compromise of it, and roughly half of people with a serious mental illness also have a substance use disorder.

7. What happens if I relapse during treatment?

Relapse is a symptom of the condition being treated. A program that discharges patients for it is selecting for easy cases and reporting the resulting outcomes as success. Ask directly what the policy is.

8. What will I owe, in dollars, in writing?

Ask whether the program is in network with your plan, what your expected out of pocket cost is, whether you will be billed after discharge, and whether laboratory and drug testing charges are billed separately. That last question matters: excessive urine drug testing billed at inflated rates has been one of the most persistent abuses in this industry.

Also ask what happens if your insurance stops authorizing care partway through. Some programs discharge when benefits run out rather than when clinical criteria are met, and you want to know that before you are three weeks in.

9. What is the step down plan?

What happens in week five predicts the outcome better than what happens in week one. Ask who arranges continuing care, whether the program operates the next level down or refers you elsewhere, and how the handover works. Most people who fall out of treatment do so at a transition between providers.

The red flags that should simply end the conversation

• Any offer of something valuable in exchange for enrolling. Paid travel, covered rent, waived deductibles. Paying for patient referrals is illegal in many states, and the offer tells you your placement is being sold rather than clinically decided.
• Guaranteed success rates. Nobody can guarantee this. Published figures such as 95 percent success are marketing, not data.
• Pressure to decide today, or a flight booked before anyone has clinically assessed you.
• Refusal to discuss cost in writing.
• Testimonials and luxury photography where clinical detail should be.

A reasonable sequence

1. Get an assessment from someone who is not selling you a bed: a primary care physician, a county behavioral health line, or the SAMHSA helpline at 1-800-662-4357.
2. Establish the level of care actually indicated, and whether medically supervised detox has to come first.
3. Search FindTreatment.gov, which is a government directory rather than paid placement.
4. Verify licensing with the state, and check for Joint Commission or CARF accreditation.
5. Ask the nine questions above. A good program answers them without irritation, and irritation is itself informative.
6. Get the cost in writing before admission.
7. Plan the step down before you start.

One last thing worth saying plainly: cost correlates poorly with clinical quality in this industry. What predicts outcomes is medication where indicated, real individual therapy, treatment of co-occurring conditions, and length of engagement across the whole continuum. None of that requires a mountain view.