Should You Start Treatment Now or Wait Until After the Holidays?

Fall is when a lot of people admit to themselves that their drinking or drug use has gone too far. It is also when many of them pick a start date: after Thanksgiving, after the holidays, January 1. The reasoning makes sense on the surface. Dinners and parties are coming, work gets busy, and a new year feels like a cleaner place to begin.

This guide walks through the most common reasons people wait, what research on addiction treatment says about delay, how outpatient and evening programs fit around family events and work, and how deductibles and out-of-pocket maximums behave at the end of a plan year. It is meant to help you decide with clear information, whichever way you go.

Common reasons people wait

Most reasons for waiting fall into a few groups:

• The calendar. Holiday gatherings, travel and family traditions feel hard to plan around, and nobody wants to explain an empty seat at dinner.
• A fresh start. January 1 carries weight. It can feel easier to begin a big change on a date that already means beginning.
• Work. Year-end deadlines, busy seasons and limited time off make treatment feel impossible to fit in.
• Money. People worry about the cost, and some plan to wait for a new insurance year.
• Not feeling ready. Many people are unsure whether their use is "bad enough," or they feel they should be able to fix it alone.

That last group deserves a closer look. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes that stigma leads many people with alcohol use disorder to feel too embarrassed to talk about it, or to believe they should be strong enough to handle it alone. NIAAA describes alcohol use disorder as a common medical condition that can happen to anyone, and says most people who have it recover or markedly improve (NIAAA).

What research says about waiting

Readiness comes and goes

In its research-based guide to treatment principles, the National Institute on Drug Abuse (NIDA) makes a point that applies directly to a holiday start date. People may be uncertain about entering treatment, so it matters to use services the moment someone is ready, and potential patients can be lost when treatment is not readily available. NIDA adds that, as with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes (NIDA).

NIAAA makes a similar point about alcohol. It lists eleven questions a health care provider might ask to assess alcohol use disorder, and it says that the more symptoms a person has, the more urgent the need for change (NIAAA).

You do not have to feel completely ready

Some people wait because they want to be sure first. NIDA's guide states that treatment does not need to be voluntary to be effective. Pressure or encouragement from family, an employer or the justice system can raise the number of people who enter treatment, how long they stay, and how well it works (NIDA). Starting because a spouse asked, or because a job is on the line, is a common way in, and it can still lead somewhere good.

Mixed feelings are also something treatment works on directly. NIAAA describes motivational enhancement, a short counseling approach that looks at the pros and cons of treatment, builds a plan for change, and strengthens confidence (NIAAA). Clinicians expect people to arrive unsure.

The holidays bring the triggers most tied to a return to drinking

NIAAA reports that people with drinking problems are most likely to return to drinking during periods of stress or when they are around people or places associated with past drinking (NIAAA). NIDA likewise names stress, cues such as people, places, things and moods, and contact with the drug itself as the most common triggers for relapse (NIDA). For many families, late November through New Year's Day packs all of those into a few weeks: travel, money pressure, parties with an open bar, and relatives and old friends who drink.

Starting in November or early December gives you a clinician and a group to help plan specific events before they happen, while waiting for January means facing that stretch with the same tools you have now.

If your plan is to stop on your own on January 1

Choosing a quit date is a real commitment, and for some people it works. For others it carries risks that are worth knowing:

• Alcohol. When someone who has been drinking heavily for a long time stops suddenly, withdrawal can be painful and potentially life-threatening, with symptoms that can include nausea, a rapid heart rate and seizures. NIAAA advises seeking medical help to plan a safe recovery (NIAAA).
• Benzodiazepines. The FDA warns that stopping these anxiety and sleep medicines abruptly, or cutting the dose too quickly, can cause withdrawal reactions, including seizures, which can be life-threatening (FDA).
• Opioids. After a stretch without use, the body is no longer adapted to the old amount. NIDA warns that a person who goes back to using as much as before can easily overdose (NIDA).

Getting through withdrawal is also only a beginning. NIDA notes that detoxification alone, without treatment afterward, generally leads to a return to drug use (NIDA).

Clear Steps Recovery is an outpatient program and does not provide detox on site. When medical withdrawal care needs to come first, admissions arranges it with a partner facility and plans the first day of outpatient care for afterward. Our pages on getting into detox in New Hampshire and Massachusetts explain how that works.

How outpatient care fits around family events and work

Outpatient treatment means living at home and coming in for scheduled sessions. NIDA describes outpatient care as regular visits for counseling, medication support or both, and intensive outpatient care as more intensive, coordinated care that can involve hours of treatment each week, including individual and group sessions (NIDA).

At Clear Steps Recovery, the levels of care differ by state:

• Londonderry, New Hampshire: Day Treatment (partial hospitalization, or PHP), an intensive outpatient program (IOP), Evening IOP, standard outpatient care, and medication-assisted treatment.
• Needham, Massachusetts: Day Treatment, Evening Treatment, standard outpatient care, and medication-assisted treatment.

The evening programs in both states meet Monday through Thursday from 6 to 9 pm, which leaves the workday free. A clinician recommends the level of care at your assessment.

A few practical steps help treatment and the holidays fit together:

• Name the dates that matter. At the assessment, tell the clinician which gatherings you want to attend. NIDA's guide says a treatment plan should be assessed continually and changed as a person's needs change (NIDA).
• Ask about the weeks you care about. Program calendars can shift around holidays, so ask admissions how your schedule would work during those weeks.
• Plan each event. A counselor can help you decide which events to attend, how long to stay, what to say when someone offers a drink, and who to call if it gets hard.
• Bring family in. NIAAA reports that strong family support through family therapy increases the chances of staying abstinent compared with individual counseling alone (NIAAA). Clear Steps runs a family support program for relatives.

If you need time away from work for a daytime program, our guide to keeping your job during treatment explains federal family and medical leave, Massachusetts paid leave and New Hampshire's leave plan in plain terms.

How deductibles and out-of-pocket maximums work at year end

Cost is a fair reason to think about timing, and it helps to know how the numbers work before you decide. HealthCare.gov counts deductibles among a plan's yearly costs (HealthCare.gov) and defines the main terms this way:

• Deductible. The amount you pay for covered services before your plan starts to pay. After you meet it, you usually pay only a copayment or coinsurance (HealthCare.gov).
• Copayment. A fixed amount you pay for a covered service, usually after you have paid your deductible (HealthCare.gov).
• Out-of-pocket maximum. The most you have to pay for covered services in a plan year. Once you have spent that amount on deductibles, copayments and coinsurance for in-network care, the plan pays 100% of the cost of covered benefits. Premiums, services your plan does not cover, and out-of-network care do not count toward it (HealthCare.gov).
• Plan year. The 12-month period of coverage. For an employer plan it may not match the calendar year, so check your plan documents or ask your employer when yours begins (HealthCare.gov).

What that means for you depends on your plan and where you stand. A few possibilities to ask about:

• If you have already met your deductible this plan year, or come close to your out-of-pocket maximum through other care, treatment before the plan year ends may cost you less than the same care after it resets, depending on how your plan shares costs.
• Depending on your plan, treatment that starts late in the plan year and continues into the next one may be subject to both years' deductibles, so ask how the cost would split across the two years.
• If you are changing plans during open enrollment, the new plan may have a different deductible, copayments and network, so check how it covers addiction treatment before you switch.

Every plan is different. Clear Steps Recovery checks your benefits with the insurer at no cost and explains any deductible, copay or coinsurance before you start. Our cost and payment guide walks through the terms in more detail.

What a first step can look like

A first step can be small, and calling does not commit you to anything. At Clear Steps Recovery, admissions answers (603) 769-8981 around the clock, and a confidential assessment with a licensed clinician is often available the same day you call. A family member can make the first call.

Other places to start in New Hampshire, Massachusetts and nationally:

• New Hampshire: dial 2-1-1 to reach The Doorway, which helps people get into every level of treatment.
• Massachusetts: call or text the Massachusetts Substance Use Helpline at (800) 327-5050, free and open 24/7 (Massachusetts DPH).
• Anywhere in the U.S.: SAMHSA's National Helpline, 1-800-662-4357, free and confidential.