Common Questions About Addiction Recovery, Answered

These are the questions we hear most often from people in early recovery and from the families around them, answered as plainly as we can. Where a number or a research finding appears, we link to the source. Where the answer is our own clinical observation, we say so. If you are reading this because someone you love is in trouble tonight, two numbers matter more than anything below: the 988 Suicide & Crisis Lifeline (call or text 988) for a crisis, and the SAMHSA National Helpline at 1-800-662-4357 for treatment referrals.

Understanding addiction

Is addiction a disease or a choice?

The first drink or first pill is usually a choice. What follows for some people is a change in how the brain handles reward, stress, and self-control, and at that point willpower alone rarely fixes it. The National Institute on Drug Abuse treats substance use disorder as a chronic condition and compares its relapse rates to those of hypertension and asthma (NIDA). We find that framing useful because it takes the moral weight off without taking away responsibility. Nobody chooses diabetes, and everybody with diabetes still has to manage it.

What is the difference between heavy drinking and alcohol use disorder?

Heavy drinking is about quantity. Alcohol use disorder is about loss of control and consequences: drinking more than intended, failing to cut back, continuing despite problems at work or at home. NIAAA's Rethinking Drinking site defines binge drinking as five or more drinks for men, or four or more for women, in about two hours, and offers a self-assessment for people who are not sure where they stand (NIAAA Rethinking Drinking). Plenty of heavy drinkers do not have a disorder. Plenty of people with a disorder do not look like heavy drinkers from the outside.

Why can't they just stop?

Some people can, and do. For someone who has been drinking heavily every day, though, stopping abruptly can be dangerous. NIAAA warns that a person who has been drinking heavily for a long time "can go into a painful or even potentially life-threatening process of withdrawal" (NIAAA). That means the safest way to stop heavy daily drinking is with medical advice, sometimes in a supervised detox. Beyond the physical part, the habit is wired into routines, relationships, and ways of handling stress, and all of that has to be rebuilt.

Treatment and what comes after

What are the levels of care?

The ASAM Criteria are the standard most treatment programs use to match people to a level of care. In the fourth edition, Level 1.0 is ongoing monitoring for people in stable remission. Level 1.5 outpatient means fewer than 9 hours of clinical services a week. Level 2.1 intensive outpatient means 9 to 19 hours a week, mostly counseling and psychoeducation. Level 2.5 high-intensity outpatient means 20 or more hours a week (ASAM Criteria Fourth Edition summary, PDF). Residential and inpatient levels sit above those. A clinical assessment should decide where someone starts.

Do I need rehab, or is outpatient enough?

It depends on the assessment. NIAAA is blunt that "no single treatment will benefit everyone" (NIAAA). Someone with a safe home, a supportive family, and no medical complications can often do well in intensive outpatient care while sleeping in their own bed. Someone in withdrawal risk, or whose home is where the drinking happens, may need residential care first. What we push back on is the assumption that rehab is the whole answer. Rehab is the start. What comes after it decides most outcomes.

Are there medications for alcohol problems?

Yes. NIAAA lists three FDA-approved medications for alcohol use disorder: naltrexone, acamprosate, and disulfiram (NIAAA). They work differently and suit different people, and a prescriber decides which, if any, makes sense. Medications for opioid use disorder exist too, including buprenorphine, methadone, and naltrexone. A recovery coach cannot prescribe anything and should never tell a member to stop a medication. What a coach can do is help someone keep taking what their doctor prescribed.

What happens after treatment ends?

This is the question families forget to ask until discharge day. NIAAA describes recovery as "more a marathon than a sprint" and recommends making a continuing care plan alongside the initial one, particularly for moderate to severe alcohol use disorder (NIAAA). In practice, continuing care means some combination of therapy, medication, mutual-help meetings, and ongoing accountability such as recovery coaching and monitoring. Our guide on how to stay sober after rehab goes into the first 90 days.

How do I find good treatment?

Two places to start. NIAAA's Alcohol Treatment Navigator walks you through what quality alcohol treatment looks like and how to check a program (NIAAA Alcohol Treatment Navigator). The SAMHSA National Helpline at 1-800-662-4357 gives free, confidential referrals for any substance (SAMHSA National Helpline). Ask any program what its continuing care plan looks like and whether it coordinates with outside support. A program that cannot answer that question is telling you something.

Relapse

How common is relapse?

Common enough that you should plan for the possibility. NIDA puts relapse rates for substance use disorders at 40 to 60 percent, which is in the same range as other chronic conditions such as hypertension and asthma at 50 to 70 percent (NIDA). Those numbers are a reason to build the kind of support that catches a slip early, which is why we put so much weight on monitoring and on a coach who talks to the member every week.

Does relapse mean treatment failed?

No. NIDA says a return to use "can be part of the process" and is a signal that treatment needs to be resumed or adjusted (NIDA). Our own rule is that relapse is information. It tells us what the plan was missing: a trigger nobody named, a gap in the week, a medication that stopped being taken. When a member has a positive result, the plan changes and support goes up. What we try hard to avoid is the shame spiral, where one bad night turns into a bad month because the person is too embarrassed to tell anyone.

What is the difference between a lapse and a relapse?

A lapse is a single use or a short episode, followed by a return to recovery. A relapse is a return to the old pattern. The distinction matters because how someone responds to a lapse largely decides whether it becomes a relapse. A person who drinks on Friday, tells their coach on Saturday, and is back at a meeting on Sunday has had a lapse. A person who drinks on Friday, hides it, and decides the whole thing is pointless is heading somewhere worse. This is our clinical framing, and it is why we want monitoring results to reach someone quickly.

How many tries does it usually take?

More than one, for many people. NIAAA cites a national survey in which the median number of serious recovery attempts was two, with a mean of five (NIAAA). The gap between the median and the mean tells you that a smaller group of people needed many attempts. If your loved one is on their third try, they are not unusual, and nothing about a third try predicts a fourth. What each attempt does offer is information about what went wrong last time.

Peer recovery coaching

What is a peer recovery coach?

SAMHSA defines peer support workers as "people who have been successful in the recovery process who help others experiencing similar situations" (SAMHSA). A peer recovery coach is that person with training and a credential, usually a state Certified Peer Recovery Specialist (CPRS) or the National Certified Peer Recovery Support Specialist (NCPRSS) issued through NAADAC (NAADAC). They help with goals, routines, and the practical work of staying sober, and they can say things that only someone who has been there can say. We wrote a full guide on what a recovery coach is.

How is a coach different from a therapist or counselor?

A therapist or addiction counselor is licensed to diagnose and treat. A coach is certified, not licensed, and SAMHSA's core competencies for peer workers cover collaborative relationships, sharing lived experience, recovery planning, and linking to resources, with diagnosis and treatment deliberately left out (SAMHSA core competencies, PDF). Therapy is mostly about why. Coaching is mostly about how. Many of our members have both. See recovery coaching vs therapy and recovery coach vs addiction counselor.

Does recovery coaching actually work?

The evidence is encouraging and incomplete. A 2019 systematic review of 23 studies on peer recovery support and recovery coaching found tentative support for reduced substance use and relapse, better treatment retention, and better relationships with providers, alongside many null findings and weak comparison groups (Eddie et al., Frontiers in Psychology, 2019). We would not call it settled. What we see in our own members, without a number attached, is that the ones who stay connected after treatment do better than the ones who go it alone.

Is coaching a replacement for AA or other meetings?

No, and we do not want it to be. A 2020 Cochrane review found that manualized AA and Twelve-Step Facilitation produced higher rates of continuous abstinence at 12 months than other established treatments such as CBT, with effects holding at 24 and 36 months (Kelly, Humphreys and Ferri, Cochrane, 2020). That is strong evidence, and coaches encourage meetings whether that means AA, NA, SMART Recovery, or something faith-based. A coach adds one-on-one attention and, in our program, monitoring. We compare the two in recovery coaching vs AA.

Helping a parent or loved one

How do I get someone into treatment if they refuse to go?

The best-studied approach is CRAFT, Community Reinforcement and Family Training, which teaches family members to change how they respond to drinking and to reward sober behavior. In a 1999 randomized trial of 130 concerned family members, CRAFT got 64 percent of drinkers into treatment within six months, compared with 30 percent for a confrontational intervention and 13 percent for Al-Anon facilitation (Miller, Meyers and Tonigan, 1999, summarized in Meyers et al., 2005, PDF). SMART Recovery's Family & Friends program is built on CRAFT (SMART Recovery Family & Friends). Our guide on how to help someone with addiction goes deeper.

Should we stage an intervention?

The televised kind, where the family gathers in a living room with a letter each, is the confrontational approach that got 30 percent of drinkers into treatment in the trial above, less than half the CRAFT rate (Miller et al., 1999). It can work, and sometimes it is the only option left. But it burns a lot of trust in one afternoon. We usually suggest families try the slower, steadier approach first: clear boundaries, no covering up consequences, warmth when the person is sober, and a treatment option ready to go the moment they say yes.

Am I enabling them?

Maybe, and it is worth an honest look. Enabling means absorbing the consequences of someone's drinking so they never feel them: calling in sick for them, paying the fine, cleaning up before the grandchildren arrive. Stopping that does not mean withdrawing love. You can refuse to lie to their boss and still make dinner together. Al-Anon exists for exactly this question, and many families find it steadying (Al-Anon Family Groups). If your loved one is enrolled with us, our weekly family group is another place to work through it. Read more on our page for families.

How do I talk to my parent about their drinking?

Pick a sober moment, lead with a specific worry instead of a verdict, and ask a question you actually want answered. "I noticed you fell last month and I'm scared" lands differently than "you have a drinking problem." Plan for more than one conversation. Adult children often feel they have no standing to raise it, but in our experience a parent usually hears it, even when they argue. We wrote a full guide on how to talk to your parent about drinking, along with one on the signs to watch for.

Virtual support and older adults

Does virtual recovery support work?

The research so far says yes, with caveats. A 2019 systematic review of 12 studies on telemedicine-delivered treatment for substance use disorders found high patient satisfaction and concluded telemedicine appeared to be "an effective alternative, especially when access to treatment is otherwise limited," while noting substantial methodological limitations and no non-inferiority trials (Lin et al., Journal of Substance Abuse Treatment, 2019). For ongoing support after treatment, we see people keep appointments by video that they would have skipped in person. Our guide does virtual recovery support work walks through the evidence.

Is drinking really a problem for older adults?

More than most families realize. NIAAA reports, using 2024 national survey figures, that 26.6 million people aged 65 and older (44.5 percent) drank in the past month, 6.8 million (11.4 percent) binge drank, and 2.9 million (4.8 percent) met criteria for past-year alcohol use disorder. CDC data cited on the same page show that 40.9 percent of alcohol-attributable deaths in 2022 and 2023 were among people 65 and older (NIAAA, Alcohol and Older Adults Ages 65+). Our guide on substance use in older adults covers this in depth.

Why is alcohol riskier after 65?

Bodies change. NIAAA notes that older adults are "more sensitive to the sedative effects of alcohol, as well as its effects on balance, coordination, attention, and driving skills," that lower muscle mass and body water can mean higher blood alcohol concentrations from the same drink, and that mixing alcohol with common medications "could cause the medications to not work properly or make them dangerous or even deadly" (NIAAA, Older Adults). The National Institute on Aging suggests healthy adults over 65 who drink stay at no more than one drink a day for women and two for men (NIA, PDF).

Can my 72-year-old parent really do video sessions and at-home testing?

In our experience, yes, and often more reliably than younger members. A standing weekly appointment suits a retiree's calendar, and the same coach every week matters a great deal to someone who is lonely. The breathalyzer pairs to a phone, saliva screening is done on camera with the coach walking them through it, and an adult child can be looped in to receive results with the parent's consent. Our guides on addiction after retirement and relapse prevention for seniors cover what changes with age.

Where does Accountable fit in all of this?

We are the part after, and alongside, treatment. Members get weekly one-on-one video sessions with a certified peer recovery coach, messaging in between, an at-home Bluetooth breathalyzer, saliva toxicology screening scheduled daily and at random, daily peer group meetings, a weekly family group, and care coordination with providers when the member wants it. We do not diagnose or treat, and our program is aligned to ASAM Level 1.0 long-term remission monitoring. We are covered by a growing list of commercial health plans, with more added each month, and private-pay plans start at $375 per month. You can check your coverage or call (646) 450-7641.

Sources

• National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction, Treatment and Recovery.

• National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking.

• National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help.

• National Institute on Alcohol Abuse and Alcoholism. Support Recovery: It's a Marathon, Not a Sprint.

• National Institute on Alcohol Abuse and Alcoholism. Alcohol Treatment Navigator.

• National Institute on Alcohol Abuse and Alcoholism. Alcohol and Older Adults Ages 65+.

• National Institute on Alcohol Abuse and Alcoholism. Older Adults.

• National Institute on Aging. Older Adults and Alcohol (PDF, April 2023).

• Colorado Department of Health Care Policy and Financing. The ASAM Criteria, Fourth Edition: Summary (PDF). See also the ASAM overview of the Criteria.

• Substance Abuse and Mental Health Services Administration. Peer Support Workers for Those in Recovery.

• SAMHSA, Bringing Recovery Supports to Scale Technical Assistance Center Strategy. Core Competencies for Peer Workers in Behavioral Health Services (2015).

• NAADAC, the Association for Addiction Professionals. National Certified Peer Recovery Support Specialist (NCPRSS).

• Eddie D, Hoffman L, Vilsaint C, Abry A, Bergman B, Hoeppner B, Weinstein C, Kelly JF. Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Frontiers in Psychology. 2019;10:1052.

• Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, CD012880.

• Miller WR, Meyers RJ, Tonigan JS. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology. 1999;67(5):688-697. Summarized in Meyers RJ, Smith JE, Lash DN (2005), International Journal of Behavioral Consultation and Therapy 1(2):90-100 (PDF).

• Lin LA, et al. Telemedicine-delivered treatment interventions for substance use disorders: A systematic review. Journal of Substance Abuse Treatment. 2019;101:38-49.

• Al-Anon Family Groups. al-anon.org.

• SMART Recovery. Family & Friends.

• 988 Suicide & Crisis Lifeline. 988lifeline.org. SAMHSA National Helpline. 1-800-662-4357.