Problems confront addicts when they decide to seek mental health services. They can be serious problems, but they are not impossible. Here are a few of the big ones:

Biased recommendations. If a fellow addict recommends a certain path to recovery, be it self-help a group, psychotherapy, or grandpa’s hangover remedy, he or she usually recommends what worked for them. As I’ve said, friends may assume their path is the only path that will work for everyone, and they will be reluctant to suggest things they are not familiar with. Also, if you ask a physician for a referral, he or she will probably recommend another physician such as a psychiatrist, and then you are far more likely to end up with a prescription for some kind of drug; so far, although certain medications may be helpful, there are no miracle drugs or magic bullets to cure addiction. A non-medical psychologist may recommend another psychologist, and then you might miss discovering an important and relevant medical problem. If you happen to see a marriage and family counselor, chances are very good your family is going to be dragged in for therapy because that’s what these folks do.

Almost everyone you are likely to consult will hold an opinion that is biased in some way. Biased, of course, means that something is short of being completely rational. We must make our own choices, so it is best to ask more than one other person for suggestions; in fact, ask as many as you can. Also, weigh the costs, time commitment, and the level of trust you feel you can place in any potential therapist once you meet that person. A therapist who works in a multi-disciplinary practice that includes a social worker, a psychiatrist, a psychologist, and counselors is usually better able to use appropriate resources in helping you. In other words, find a professional group practice and avoid the fellow working out of his garage.

If you don’t really like and admire a prospective therapist you should probably keep on shopping. Not that a good therapist has to agree with you and flatter you, but you will have to feel trust in the therapist. They may have to tell you things you don’t want to hear, but compassion and kindness are important. If you succeed in manipulating a therapist, if you play word games to avoid real change, then addiction wins, you lose, and nothing changes. Play it straight and honest at all times.

Poor regulation. Although a therapist may have impressive certificates, licenses and degrees on the office wall, none of this is any kind of guarantee of effectiveness. Of course, you should read every word on these pieces of paper and be sure you know what they mean and how the therapist earned them. If the clinician holds a state license, you can call the licensing board to ask if there have been any complaints lodged against the therapist in the past. The degrees held should be from recognized colleges and universities. Beware of certification and certificates; they are often awarded by special interest, non-profit organizations. Some certificates are based only on short workshops, a relatively few hours of supervised experience and a review of a person’s general qualifications, not on formal education. I worked my way through years and years of education, so naturally I’m biased in favor of formal academic training.

Don’t be afraid to ask the big questions such as, “How many different addicts have you treated?” “How long have you been in practice?” “What is your success rate and how do you measure success?” The least hesitation or reluctance to answer, or vague answers, should make your B.S. detectors go into alert mode. Any good therapist is going to badger you with endless questions, so you might as well get a few in yourself before the grilling begins.

There have been few studies to prove that state licensing or certification result in superior results. Overall, however, if you know the clinician holds a valid state license in a relevant mental health field, it will help you avoid unqualified or fly-by-night charlatans. In general, advanced degrees suggest that the therapist had the patience and intelligence to attend college for a significant period. Be very careful if the potential therapist holds only a certificate of some sort and has little or no higher education. Such a person should be working under professional supervision.

Pride. Your own pride can get it the way. Some potential mental health consumers feel they are above the simple self-help groups that are readily available. Some addicts, egotistically, believe they are too complex or too advanced in their addiction to be helped by self-help groups. Others simply look down on group participation and see it as something for uneducated and simple-minded people. In fact, a simple mind may be the ticket to a healthier life, but that’s a different story. Let’s just say that most addicts are far too complex for their own good.

To be understood at the deepest emotional levels by a paid counselor with advanced training seems much more dramatic and interesting than a self-help group. However, unlike many products and services, mental health is very poorly regulated in terms of the consumers’ interests. There is no requirement that clinicians post their success records. Most do not bother to inform the client of potential risks. Only the most serious of ethical violations ever come to the attention of licensing or certification boards. The fact that a particular therapist or treatment method has little proven success is seldom a cause for investigation. In fact, there is no requirement that treatment effectiveness be investigated or reported. Most professionals are ethical and honest, but it is still up to you to make the final selection.

If you buy a bad mattress, chances are you can return it for something better; if you buy bad or ineffective therapy, you’re stuck, and you may not even know it. By the way, many people with health insurance seem to feel that they are getting free treatment if the insurance company pays. As they say, however, there is no such thing as a free lunch. Somebody pays for everything, and the more different diseases the insurance people have to pay for, you will end up with higher premiums in the future. Treatment for an addiction problem need not be expensive, and a good program might cost as much as a good used car.

I recall talking with a lady who admitted that she had lost more at the casino in one evening than the cost of the entire program she was considering, and yet she was irate when told the cost of treatment. Somehow, in the minds of some gamblers and other addicts, real money is much harder to spend on real services, and they prefer gambling money which they firmly believe can somehow be won back unlike real money that is gone for good once spent for anything mundane like rent, food or therapy. I think drug and alcohol people often show the same kind of thinking.

Fashion. Mental diagnoses wax and wane in popularity or fashion. Clinicians are just as subject to fads and fashions as anyone else. Architecture is a profession, for example, that shows how architects are affected by changing styles; look around any big city and admire how building styles have changed over the years. Architects of the mind, therapists, if you will, are always thinking up and trying out new tricks and fads. Sometimes these are even based on research evidence, but sadly, the evidence we have to work with is often incomplete.