Take this with you. The questions are ordered so the important ones come first, because tours run long and attention fades.
What matters as much as the answers is whether they are answered at all.
1. What happens in month nine, and who is responsible for it?
The single most useful question on the list. The evidence consistently points at duration and continuity rather than the intensity of the first thirty days. In the physician health programmes — the best-documented outcomes in the field — monitoring runs about five years, and 78.7% were licensed and working at year five.
Good answer: a named role, a defined period, specific contact intervals. Bad answer: “we have an excellent alumni programme.”
2. Will anyone who actually knows them still be involved in six months?
Continuity of person, not continuity of paperwork. A discharge plan handed over on the last morning is a document, not a relationship.
3. What happens if they miss two check-ins?
Days or months. This is the difference between a system that notices and one that files.
4. Is medication available if it’s indicated, and what’s your position on it?
For opioid use disorder this is close to decisive. For alcohol, acamprosate and naltrexone have numbers needed to treat of 12 and 20 respectively across 122 trials. A philosophical objection is a clinical decision being made on your behalf, and you are entitled to know it is being made.
5. What’s your outcome measure, over what period, and what’s your follow-up rate?
Four things in one question, deliberately. Which outcome, measured when, out of whom, and what proportion did you manage to reach. The field publishes papers arguing about what counts as success; an unqualified percentage means nothing.
Good answer: includes a follow-up rate and counts the unreachable separately. Bad answer: a number with no denominator.
6. Who treats the psychiatric side, and are they in this building?
Depression, anxiety and trauma are extremely common alongside substance use, and frequently go unaddressed. “We refer out” means the person leaves half-treated.
7. What’s the total duration of involvement — not the residential stay?
Ask for the number in months, and what happens in each phase.
8. What’s the plan for the first two weeks at home, specifically?
The transition out is the highest-risk window. If the answer is a weekly outpatient appointment and a phone number, there is no plan for roughly 165 hours a week.
9. Who is on the staff, what are their qualifications, and what’s the turnover?
High turnover is the quiet signal. It affects continuity more than anything on a brochure.
10. What does the family do, and what will you tell us?
Family involvement has real evidence behind it. Also ask what they will and will not share, so the confidentiality boundary is understood before it is tested at a bad moment.
11. What happens if it doesn’t work — if they leave early, or relapse in month two?
The most revealing question on the list. A programme that treats relapse as a failure of the client discharges people. One that treats it as information intensifies care — which is precisely what the physician programmes do, and they have the best results in the field.
12. What would make you say this isn’t the right place for them?
If there is no answer, the assessment is a sales process. Every good clinician can describe who they are not right for.
What to notice while you’re there
Whether anyone assesses before recommending. A programme that knows what someone needs before asking about them is selling a fixed product.
Who answers. Clinical questions answered exclusively by admissions staff is a signal about where the organisation’s weight sits.
Whether they discourage a second opinion. Any pressure to decide today, or discomfort at you looking elsewhere, is worth a great deal of attention.
How they talk about relapse. Language about people “failing treatment” tells you where responsibility gets placed when things go wrong.
The one thing to remember
Project MATCH randomised people to three different well-designed treatments and found little difference in outcome between them. The choice between reputable approaches matters less than families think.
What happens after — duration, monitoring, continuity, speed of response — matters more than families think, and is barely marketed at all.
So spend your questions there. That is what these twelve are for, and it is what we ask on behalf of families as part of placement and case management.
References
- McLellan AT, Skipper GS, Campbell M, DuPont RL (2008). Five year outcomes in a cohort study of physicians treated for substance use disorders. BMJ, 337, a2038. 10.1136/bmj.a2038
- Jonas DE, Amick HR, Feltner C, et al. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings. JAMA, 311, 1889-1900. 10.1001/jama.2014.3628
- Project MATCH Research Group (1997). Matching Alcoholism Treatments to Client Heterogeneity. Journal of Studies on Alcohol, 58, 7-29. 10.15288/jsa.1997.58.7
- Falk D, Wang XQ, Liu L, et al. (2010). Percentage of Subjects With No Heavy Drinking Days. Alcoholism: Clinical and Experimental Research. 10.1111/j.1530-0277.2010.01290.x
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