Substance abuse and addiction disorders are among the toughest illnesses to treat. Substance abuse counselors, sometimes referred to as addiction counselors, provide the mental, emotional and behavioral health services individuals need to recover from drug and alcohol abuse, gambling addictions and other behavioral issues. They create a supportive, judgment-free environment that provides patients with the resources they need on their recovery journey.

Substance abuse counseling is a demanding yet rewarding career. Students who want to effect social change in their community and help individuals heal from addiction should explore master’s in counseling programs that can provide a strong foundation in addiction counseling.

Substance abuse counselors are experts in the impacts of addiction and substance abuse as well as the mental and physical treatments for these issues. They evaluate patients’ health, recommend treatments and help them develop skills to aid in recovery.

Counselors also work with families to help them better understand their loved one’s illness and guide their interactions with them. Their role may also encompass community outreach such as working with job placement services, support groups and schools, all to support their patients’ goals of living healthier lives.

Although they share some characteristics, substance abuse and addiction are different issues and therefore require different treatments.

• Substance abuse is the misuse or overuse of alcohol or an illicit or prescription drug.
• Addiction is the use or abuse of a substance that causes chemical changes to the brain. Addiction is a chronic disease.

When working with a patient, counselors start with an evaluation to determine whether their condition is classified as substance abuse or addiction. They then use the following techniques to create a positive and supportive environment that helps patients achieve success and makes them more resilient in the face of setbacks.

The decision to seek treatment for addiction is not an easy one. Patients may have been referred against their will. They may feel vulnerable or ashamed, since many cultures and communities view addiction as a moral failing rather than a disease. For treatment to succeed, substance abuse counselors must create a strong bond with their patients, known as a therapeutic alliance.

While this trust takes time to develop, patients should eventually feel comfortable speaking freely during sessions, feel relief after an appointment and feel a desire to go back.

Characteristics of a therapeutic alliance include:

• Sense of connection. The counselor and the client should feel a sense of connection or a bond. While they have a professional relationship, they should be respectful of each other and committed to a shared goal.
• Collaboration. The counselor and the patient should work together on the recovery process, sharing decision-making.
• Trust. The counselor and the client should trust one another. The client shouldn’t be skeptical of the process, and the counselor should trust the client’s emotional and mental investment in treatment.

It’s part of the counselor’s responsibility to establish a therapeutic alliance. Strong alliances can be made by:

• Ensuring patients know the counselor is interested in their well-being
• Being attentive during sessions
• Expressing empathy for the client’s problems
• Understanding and communicating the foundational issues at play in recovery

Therapeutic alliances are a key factor in addiction recovery. By creating an environment where patients feel comfortable and welcome discussing their hardships, counselors can better help their clients on the road to recovery.

Encourage Patient Recovery

Recovering from addiction is difficult, as many individuals with alcohol or drug dependency fail to recognize their own patterns of abuse, or have ambivalent feelings about seeking treatment. In substance abuse treatment, the patient’s motivation to change can be a source of frustration, as counselors have little control over a patient’s desire to change.

The counseling community is rethinking current approaches to motivation and empowering counselors to elicit and enhance their clients’ motivation and find a style that will best meet their clients’ needs.

Although change is ultimately in the hands of the patient, counselors can adapt their style to help enhance their clients’ motivation throughout each stage of recovery. The counselor’s role goes far beyond simply listening, teaching and offering advice.

Instead, the counselor’s responsibility is to help patients recognize their problematic behaviors, guide them into recovery, and empower them to take action and change these behaviors.

Help Patients Develop a Relapse Prevention Plan

The chronic nature of addiction means that a large percentage of patients will relapse at some point during recovery. According to a 2022 survey by The Recovery Village, of 2,136 American adults who wanted to stop drinking, only 29% reported never relapsing. The survey illustrated that relapse is a significant factor in a patient’s recovery process. But relapse doesn’t mean treatment has failed. Rather, it serves as an indicator that the treatment plan needs to be adjusted.

Once a patient decides to seek treatment, it’s important they are well equipped to avoid relapses. Preventing relapse requires more than just the willpower to say “no” when temptation arises, and prevention needs to start early in the recovery process. Developing a comprehensive relapse prevention plan is an essential function of the counselor’s role in addiction recovery.

Plans should be tailored to the needs of each individual patient, but essential elements include:

• A detailed account of the patient’s experience with substance abuse, including previous relapses
• Warning signs and ways patients can best manage them
• A detailed list of family, friends and counselors that can be used as a support network
• An emergency relapse plan
• Specific lifestyle changes that patients can implement to prioritize their well-being

Meet with Family Members to Provide Guidance

For family and friends of patients in recovery, addressing the addiction is one of the most difficult aspects of helping loved ones recover. Daily interactions with loved ones can inadvertently enable the addict, and many family members choose to ignore the problem out of fear that they will push away their loved ones if they confront them.

Substance abuse counselors must educate families and friends about addiction and recovery and provide them with resources that will help them support their loved ones in recovery. These resources can include family therapy sessions and support groups.

The support of friends and family plays an integral role in recovering from addiction. Since recovery is a lifelong journey, having supportive family members who understand the process is of profound importance. Family members who are informed about addiction recovery can help keep their loved ones accountable and greatly increase their chances of success. Substance abuse counselors can help families understand the complex road to recovery, and offer support for the difficult journey ahead.

Refer Patients to Outside Support Groups

A variety of outside resources are available to those recovering from addiction, which can be beneficial when combined with counseling treatment. As a counselor, referring patients to programs such as Alcoholics Anonymous and Narcotics Anonymous can add another level of outside support.

These community-based programs provide an additional layer of accountability for those seeking rehabilitation, and by attending meetings, patients will be surrounded by individuals with similar backgrounds and can further share their stories, wisdom and struggles in a nonjudgmental environment.

The role of the counselor in addiction treatment involves far more than just talking an addict through treatment. Counselors have to be highly empathetic people, who have a passion for building relationships with their patients.

Developing the skill set to support patients in recovery typically entails years of education and training. While each counselor’s individual path may vary, common steps to becoming a substance abuse counselor include:

• Education. A master’s program in counseling teaches students key concepts related to human growth and development, social and cultural foundations, group work, and program evaluation, among others.
• National Counselor Examination. Passing the NCE is required for licensure in most states.
• Supervised hours. Depending on the state, counselors must work a certain number of hours under the supervision of a licensed counselor before qualifying for licensure.
• State license. All counselors must be licensed to practice. Requirements vary by state.

According to the U.S. Bureau of Labor Statistics (BLS), the demand for substance abuse, behavioral disorder and mental health counselors is expected to grow 22% between 2021 and 2031, adding nearly 80,000 new jobs.

The median substance abuse counselor salary was $48,520 in 2021, the BLS reports.

A career as a substance abuse counselor requires compassion, empathy and determination. If you’re interested in learning more about substance abuse and addiction counseling, explore Wake Forest University’s online Master of Arts in Counseling program and discover how you can help people in your community heal and recover from addiction.