What we treat
When drinking or using becomes a disorder.
How to tell the difference between heavy use and a substance use disorder — what the clinical criteria actually are, what treatment involves, and where to start if you are not sure this is you.
The signs that matter clinically.
The question people ask is how much is too much. That is not the question the diagnosis turns on — quantity varies enormously between people. What clinicians look at is control and consequence.
- Intending to have two and routinely having six, or intending days off that do not happen
- Needing more than you used to for the same effect
- Feeling physically bad when you stop — shakes, sweats, nausea, sleeplessness
- Time and planning increasingly organized around use, or around hiding it
- Continuing after it has cost you something real: work, a relationship, your health, a license
- Dropping things you used to care about because they conflict with use
- Trying to stop, meaning it, and not being able to
How a substance use disorder is actually diagnosed.
The DSM-5-TR defines substance use disorders with eleven criteria covering impaired control, social consequences, risky use, and physical dependence. Severity is graded by how many are present — a small number indicates a mild disorder, more indicates moderate, and a majority indicates severe. Two matters follow from that structure.
First, it is a spectrum rather than a binary. There is no line you cross to become a different kind of person, which means the question is never whether you are an alcoholic — it is which criteria are true for you right now and what that indicates. Second, you do not have to accept any label to be assessed or treated. Plenty of people arrive saying only that something has gotten away from them.
One safety point before anything else. If you drink heavily and daily, or use benzodiazepines, stopping abruptly can be medically dangerous. Withdrawal from those substances is a medical matter that can require detox first — an outpatient program is not a detox. Tell us at intake and we will help you sequence it properly rather than starting you in the wrong place.
Treatment
What treatment involves.
Treatment for a substance use disorder is skills, structure, and enough contact to survive the ordinary weeks — not a lecture about consequences you can already list better than anyone.
The intensive outpatient track
Twelve hours a week across four evenings, in a group working recovery specifically. Craving management, relapse prevention built from your actual risks, and the logistics of ordinary hours.
Whatever is underneath it
For a large share of people, use started as a working solution to anxiety, depression, or trauma. Treating only the drinking leaves the reason intact, which is what the co-occurring path exists to prevent.
Medication as a real question
Medication is part of the treatment of alcohol and opioid use disorder for many people. It is a question for your psychiatric evaluation, where a prescriber can tell you what applies to your situation and what they can and cannot prescribe.
Goals set with you
What you are working toward gets decided with your clinician rather than issued to you. We are not a twelve-step program, and we work alongside fellowships for people who use them.
When weekly therapy is not enough for it
Everything above can be treated at a weekly appointment, and for many people that is the right dose. When it is not, the next step up is not the hospital — there is a level of care in between, and most of Hawaii has never been offered it.
From your island
Care is delivered by video by licensed Hawaii clinicians, on all of the islands. Stepping up your level of care no longer means a flight to Oahu, a day off work, and a hotel room if the weather turns.
Related
Questions
Straight answers.
How much drinking is too much?
Volume is the wrong instrument, which is why the clinical criteria do not use it. Two people can drink identical amounts with completely different consequences. What matters is control — whether you can stop when you intend to — and cost: what it is taking from your health, your work, and the people around you.
Am I an alcoholic?
That word is not a clinical term and you are not required to adopt it. The clinical question is whether you meet criteria for an alcohol use disorder and, if so, at what severity — a spectrum, assessed in a conversation. Many people get treated well without ever using that label about themselves.
Do I have to commit to quitting forever before I can start?
You have to be honest about what is happening and medically safe to treat as an outpatient. Treatment goals get set with your clinician, and arriving uncertain about the long term is an extremely common starting point — considerably more common than arriving fully decided.
Is it safe to just stop on my own?
For some substances, yes. For heavy daily alcohol use and for benzodiazepines, no — withdrawal from those can be medically serious and sometimes requires supervised detox. If you are physically dependent, get medical guidance on stopping rather than white-knuckling it, and tell us at intake so the order of care is right.
You do not need a label to make the call.
Say what is happening. The assessment works out what it is, and whether this is the right level of care for it.