When to Seek Help for Drug and Alcohol Use

One of the biggest questions I get and have gotten throughout the course of my career is, “When should my family member seek help for their substance use?” There are usually multiple answers to this question, and I want to walk you through each one.

1. You can’t make someone seek help. It is a natural response to see our loved ones struggling with something and know they need help. You want them to talk to someone about their substance use and get help that you can see that they need, but no one is going to change their behavior unless they want to. My biggest piece of advice to family members is to continue to provide support, but not to enable the addiction. When they come to you saying that they are ready, be supportive and help them get to help.
   
   
2. How much is too much? This depends on the type of substance. In terms of illicit substances, any amount can be considered too much. As clinicians, we look at the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM). There are 11 criteria to meet to diagnose a substance use disorder (otherwise known as an addiction), of which only 2 have to be met in a 12-month period to meet the criteria for a mild substance use disorder. Some of these criteria include: cravings, tolerance (needing more and more of the substance to achieve the same effect), withdrawal, unsuccessful attempts to stop using, using more and for longer periods of time, and using despite having interpersonal consequences (American Psychological Association, 2022).
   
   
3. But what if they are drinking? The answer is similar, but we have a little more data to back up our answer. The criteria from the DSM are the same, but it is tailored to the specific substance. When it comes to alcohol, there have been some specific numbers defined for heavy drinking and binge drinking. But first, we must establish what a standard drink is. A standard drink is different depending on the alcohol. It is 12oz of beer, 5 oz of wine, or 1.5 oz of hard liquor (typically one shot worth) (National Institute on Alcohol Abuse and Alcoholism, 2025). With that being said, the definition of heavy drinking is more than 8 standard drinks a week for women and 15 or more standard drinks per week for men (Centers for Disease Control and Prevention, 2024). The difference between heavy drinking and binge drinking is the time. Binge drinking is a pattern of drinking that brings the person’s blood alcohol concentration (BAC) above .08% in one episode, which usually is 4+ drinks for women and 5+ drinks for men in less than 2 hours (Centers for Disease Control and Prevention, 2024).
   
   
4. Does my loved one need to go to rehab? To quote the late Amy Winehouse, “They tried to make me go to rehab, and I said no, no, no.” Rehab, or inpatient rehabilitation as it is called clinically, is the most structured form of substance use treatment. As clinicians, we are looking at their symptoms using the domains developed by the American Society of Addiction Medicine (ASAM). These domains are biomedical, psychological, readiness for treatment, recovery environment, withdrawal potential, and relapse potential (American Society of Addiction Medicine, 2023). Inpatient rehabilitation is the highest level of care, where individuals live at the facility receiving around-the-clock medical care, and receive therapeutic care 5 days a week, up to 30 hours a week. Then, following the continuum of care, the “step down” would be partial hospitalization (PHP). These programs are less intensive, as people are allowed to go home afterwards. They receive weekly medical care, as well as 24 hours of therapeutic care a week. These programs typically last anywhere between four and eight weeks. Afterwards, the next “step down” is an intensive outpatient program (IOP). This is less intensive, with patients still receiving weekly medical care and 10 hours of therapeutic care weekly. These programs are typically between 12 and 16 weeks. After a successful completion of that, one would start outpatient counseling. That is the type of counseling that is provided both in person and virtually, such as the services that myself and other providers give here on Tava. This is counseling once or twice a week, and medical care is not required, but it is encouraged (Center for Substance Abuse Treatment, 2006). Someone binge drinking once and a while, would not meet the criteria for an inpatient rehab center, but if you have any questions, there are many professionals that would be willing to help as well as resources online.
   
   
5. Can they recover? Yes. But it’s hard. Substance use disorder has recovery rate of 75%. That means 3 out of 4 adults who identify has having a substance use disorder, will reach long term recovery (Mann, 2022).
   
   
6. How do I find treatment? There are many excellent and skilled providers here on the Tava platform as well as in the state that you are in. It can be beneficial to seek out an addiction specialist, someone who has extensive education and experience specifically in substance use disorder. In my state, North Carolina, they are known as Licensed Clinical Addictions Specialists (LCAS or LCAS-A) (North Carolina Addictions Specialist Professional Practice Board, n.d). 

People can use substances without developing an addiction. They can use substances without causing any major impacts to their overall wellbeing. And that is not the goal, to have everyone in the public remain abstinent. But if there have been times where people you love have told you that you use too much, treatment might be helpful. More importantly, if you have felt like you need help reducing the amount of alcohol and/or drugs you use, there are many outlets for you to recover. 

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References: 

1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
2. Centers for Disease Control and Prevention. (2024, October 7). Facts about excessive drinking. U.S. Department of Health & Human Services. https://www.cdc.gov/drink-less-be-your-best/facts-about-excessive-drinking/index.html  
3. National Institute on Alcohol Abuse and Alcoholism. (2025, December). What is a standard drink? U.S. Department of Health and Human Services. https://www.niaaa.nih.gov/alcohols-effects-health/what-standard-drink 
4. American Society of Addiction Medicine. (2023). The ASAM criteria: Treatment criteria for addictive, substance‑related, and co‑occurring conditions (Vol. 1: Adults, 4th ed.). American Society of Addiction Medicine.  
5. Center for Substance Abuse Treatment. (2006). Chapter 3. Intensive outpatient treatment and the continuum of care. In Substance abuse: Clinical issues in intensive outpatient treatment (TIP Series No. 47). Substance Abuse and Mental Health Services Administration. In NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64088/  
6. Mann, B. (2022, January 15). There is life after addiction. Most people recover. NPR. https://www.npr.org/2022/01/15/1071282194/addiction-substance-recovery-treatment  
7. North Carolina Addictions Specialist Professional Practice Board. (n.d.). Licensed clinical addiction specialist. https://www.ncsappb.org/credentialing/licensed-clinical-addiction-specialist/