His treatment plans can involve antidepressants; medication for anxiety, A.D.H.D. and chronic pain; anti-relapse medications; psychotherapy; and family training. Patients may come for a single consultation, or be treated for years.

The question of effective treatment for alcohol- and substance-use disorders is more pressing than ever. According to a recent article in The New England Journal of Medicine, the number of Americans admitted to treatment programs for prescription opioids more than quadrupled from 2002 to 2012. Deaths from heroin overdoses nearly quadrupled from 2002 to 2013, the Centers for Disease Control and Prevention reported.

In addition, an estimated 18 million Americans have alcohol use disorder, according to the N.I.A.A.A., and a study published in JAMA last year found that the number of Americans who drank to excess was rising.

Last month, President Obama proposed $1.1 billion in new federal spending to fight the growing epidemic of heroin and prescription opioid addiction. His 2017 proposed budget designates $920 million for states to expand access to drug-assisted treatment over the next two years. It also calls for more prescription-drug monitoring programs and increasing the use of the opioid-reversal treatment naloxone.

Only 10 percent of those with alcohol- and substance-use disorders ever seek treatment, said Brad Stone, a spokesman for the Substance Abuse and Mental Health Services Administration. The Affordable Care Act covers treatment for alcohol- and substance-abuse disorders, but many who need it fear they will be stigmatized if they ask for help.

A Range of Therapies

Many people in need of treatment believe that the only way to recover is to spend time at a rehab facility, which can cost as much as $50,000 a month. Yet there is no reliable evidence that intensive inpatient treatment is more effective than continual outpatient care, Anne M. Fletcher, the author of the 2013 exposé of the treatment system, “Inside Rehab,” said in an interview.

Dr. Willenbring founded his outpatient center, Alltyr, in St. Paul in 2012. Instead of spiritual confession, he relies on a range of behavioral therapies to help patients identify the triggers that lead to risky behaviors. They include motivational interviewing, in which therapists ask a series of questions intended to help clients understand why they drink or use drugs, and cognitive behavioral therapy, short-term counseling that helps patients recognize and avoid high-risk situations.