What happens in an addiction treatment center? If you or a loved one is struggling with an addiction, you may have asked yourself this question. Having a basic knowledge of what happens in a recovery center and what clinicians should be looking for can help you determine the best course of treatment.

A comprehensive assessment or screening is the first thing that should happen. The counselor needs to determine whether the person needs medical detox, residential treatment, outpatient treatment, mental health referrals, and other services. Depending on how far along a person is in their addiction, medical detox may be required. This is something that usually happens in a medical facility, or at a different location other than the treatment center, although some treatment centers can offer both. This initial piece is crucial to determine because without medical supervision, detox from substances such as alcohol or benzodiazepines can be lethal.

Addiction counselor and Therapist Betsy Byler, (who was featured recently on the Recovery and Company Podcast) says initially she tries to determine whether the client can do any sober time at all. In other words, can they piece together a few days of sobriety here and there. If not, medical detox is probably necessary. She also says it is important to assess the withdrawal risk factors. For instance, opioid withdrawal is extremely painful and difficult and treatment does not usually stick without the assistance of medication-assisted treatment like methadone, buprenorphine, or naltrexone. These are all addiction medications we offer at The Life Change Center.

Detox, cravings, and physical withdrawal symptoms need to be dealt with initially for treatment to be successful. This is the first battle for anyone struggling with addiction.


A good initial assessment will determine the extent of a person’s substance use. It is important to know how long the individual has been using substances and how entrenched it is in their life. The counselor will initially ask a lot of questions such as age of first use, usage history, family history of addiction, and how much is typically used at one time. Assessments for other addictions besides the one in question will also happen. For example, many individuals present to counseling with a primary addiction such as opioid use disorder, but also have a secondary addiction such as methamphetamine use disorder, which is common.

This process is quite long and can take anywhere from an hour to up to three hours depending on the clinic and the services offered. It is more of an informational gathering session so that the therapist and client can work together to develop the best treatment plan. Keep in mind that each person is unique and so are their reasons for use. For instance, many individuals may begin use due to trauma or another underlying mental health disorder, which we will cover in the next post.

The assessment will also help the counselor determine the level of treatment appropriate for the client.


Generally, there are around four levels of treatment. Level four would be the most intensive and would require inpatient detox services along with 24-hour nursing. Level three would be clinically managed, low intensity, residential treatment. Level two would be intensive outpatient services and level one would be mainly outpatient services. For instance, detox would include medical supervision, inpatient treatment would be a live-in treatment center, and outpatient treatment would be something like counseling and going to meetings, etc.

After the initial assessment, an effective counselor will be able to tell you the correct level of care needed and why. They should also provide resources, referrals, payment options or other recommendations.

“If a person doesn’t fit in the level they’re at, they won’t make it” says Byler.


This is why it is so important initially to get a comprehensive assessment so the individual has a better chance at recovery. In addition, staff meetings about the best treatment courses, medication doses and other things to make it work for the person all happen daily or weekly behind the scenes.

This is a short summary of what happens in the beginning stages of recovery at a typical treatment center. The initial assessment will also include a shortened mental health and suicide screening which will help determine if the individual is suffering from one or more co-occurring mental health disorders. We will address this topic as well as what happens after the initial assessment in the next post.

Be sure and listen to the Recovery and Company Podcast to hear my interview with addiction counselor and therapist Betsy Byler. In this two part series she shares her story about how she went from teen addiction to becoming a therapist. We also dive deeper into what happens in treatment.