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Updated on October 18, 2021

What Do Substance Abuse and Behavioral Disorder Counselors Do?

Counselors provide support and guidance for those dealing with addiction or behavioral disorders.

Their goal is to uncover the cause of addiction and help patients learn coping strategies.

Counselors do the following: 

  • Help patients understand why treatment is important and recognize their disorder's effect on themselves and others
  • Understand the behavior patterns that lead them to abuse substances
  • Collect and provide information about support groups and other resources.
  • Educate family and caregivers regarding the patient’s disorder 
  • Oversee family therapy sessions

A substance abuse counselor plays an active role in a patient’s recovery from beginning to end. They work with doctors and other health professionals to create an addiction treatment plan. 

They also evaluate the effectiveness of that plan, monitor progress, and look for signs of relapse.

Addiction professionals talk to patients throughout treatment and help them understand and manage their disorders. 

This is done through individual face-to-face counseling sessions, group therapy sessions, and more. 

Most play a role in all aspects of treatment, from detox to recovery support to long-term sober living. 

Substance Abuse Counselor Requirements

The requirements to become a substance abuse counselor can differ depending on the state and employer. 

Bachelor’s degrees are increasingly expected for entry-level positions.5, 7 Beyond entry-level, advanced degrees are often required. 

Counselors must also complete continuing education courses annually and pass a state-issued exam. 

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What Makes a Good Addiction Counselor?

A substance abuse counselor works with their patients to identify their needs and goals. They help develop a personalized treatment plan with their patients.

A good addiction counselor is compassionate and an excellent listener. The first counseling sessions help lay the foundation for mutual trust, essential for a successful outcome.

Many counselors are former addicts themselves, although this is not a requirement. As such, many counselors are empathetic and patient. A good addiction counselor can help create a safe environment for the user to communicate openly.

Good communication between the counselor and patient can help identify the problems driving the addiction.

This is crucial - without understanding the underlying issues, long-term recovery is more challenging.

A good counselor can also diagnose and treat any co-occurring mental health problems. 

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Types of Therapies Offered

Mental health issues and behavioral disorders often coincide with addiction. There are a variety of behavioral health therapies for dealing with co-occurring disorders. 

The therapy used varies based on whether the counselor is part of a clinic or works in private practice. Those in private practice have more control over case management and treatment.

The settings counselors work in also play a role. These include long and short-term residential, outpatient, individual, and group counseling programs. 

Here are some behavior disorder and addiction treatment approaches:

Cognitive Behavioral Therapy (CBT)

CBT is about assisting people with a disorder to recognize and change their behaviors. It helps the patient develop identify risky behavior patterns, learn coping skills, and avoid relapse.

Contingency Management (CM) 

CM treats several types of substance use disorders and encourages and reinforces sobriety. It uses positive reinforcement such as monetary prizes to reward good behavior. 

CM is not one of the most well-known counseling approaches, but studies show it is very effective.4

Motivational Interviewing (MI) 

This involves resolving ambivalence in individuals so they can embrace their treatment. It’s a collaborative approach in which a counselor explores the individual’s own motivations for change.

Dialectical Behavioral Therapy (DBT)

DBT focuses on treating severe personality disorders. It also assists with reducing cravings, avoiding situations, and learning healthy coping skills. 

It was originally developed to address borderline personality disorder. It’s now also used for substance abuse counseling.

Rational Emotive Behavior Therapy (REBT) 

REBT assists with understanding one’s thoughts and developing better habits and positive thinking. It helps the patient reduce harmful or self-limiting beliefs. 

Some techniques used in REBT include meditation, journaling, and positive visualization.

Matrix Model (MM)

MM employs a behavioral modification while also teaching self-esteem, dignity, and self-worth. It’s often used for patients addicted to stimulants such as cocaine.

According to the Substance Abuse and Mental Health Services Administration, patients who receive MM therapy are 27% more likely to complete treatment than those receiving standard therapy.6

Group Counseling

This is support and guidance in a group setting. Group counseling is commonly seen in 12-step programs such as Alcoholics Anonymous.

How Does Someone Become a Substance Abuse Counselor?

Job requirements for substance abuse counselors vary by state and specialty. 

There are instances in which people offer guidance to those with substance use disorders without official credentials. An example of this is leading 12-step group counseling programs such as Alcoholics Anonymous.

However, bachelor’s degrees are increasingly expected, even for entry-level roles.

Here’s the typical counselor career path:

Earn a Bachelor’s Degree

Though it is possible to work without it, most counselors have at least a bachelor’s degree.

Possible degrees include: 

  • Counseling
  • Social work
  • Sociology
  • Human services
  • Behavioral health
  • Psychology

These are the types of degrees required for admission to a Masters-level program. Requirements vary from state to state, so make sure you know what is required in your state.

Earn a Master’s Counseling Degree

Those interested in more than an entry-level position in substance abuse, behavioral disorder, and mental health counseling need an advanced degree.

Complete an Internship or Practicum

Most states require counselors to participate in a supervised internship as part of their coursework. 

This is a great opportunity to gain hands-on experience and observe experienced professionals within the field. It’s also an opportunity to learn more about a more specific career path. 

You might find that you want to pursue further education or work with a specific type of patient.

Earn Professional Credentials

Standards vary from state to state, but most require a certain amount of education, hands-on work, and ongoing training. 

There's also a licensing exam. Substance abuse counselors are required to be licensed to practice legally. 

Once someone is working in the field, the next step to further their education is to earn a doctorate.

How to Find a Substance Abuse Counselor

Most people find a drug or alcohol counselor in one of two ways:

  1. Researching their options on their own
  2. Referral from a friend, family member, or another professional

It’s important to determine if a counselor is right for you before pursuing a long-term relationship. 

In addition to the counselor’s reputation, this also includes their work experience and credentials. 

However, just because someone has strong credentials doesn't mean they're a good fit. It’s also important to check patient reviews. This information alone is not enough to make your decision. It’s the first step in the process.

You’ll want to schedule a consultation either in person or by phone. This allows you to speak to the person and see if there is an initial connection.

Additionally, you’ll want to look at the counselor’s area of expertise and consider their therapeutic approach. 

You can learn this information from their website or by scheduling an initial meeting. 

Though some people will want to know methods in detail, others just want to know if they like a counselor. 

If you feel comfortable with a counselor and their methods, chances are you have found someone you can work with.

It's okay not to make a decision right after meeting with just one counselor. Some people have to meet with two or three before finding their choice. 

You can let each potential counselor know that you are “shopping around.” 

The best counselors recognize that they are not selling you a product. Instead, the goal is to begin a therapeutic relationship.

Remember that even if you find a counselor you like, the relationship could change over time. 

After a few meetings, some people realize the arrangement is no longer what they want.

Others work with a counselor and achieve progress but ultimately need to work with someone else. All of these are acceptable and expected parts of being a substance abuse counselor.

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Resources

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Brown, Geeta. “Do You Have What It Takes to Become An Addiction Counselor? The Key Traits and Qualifications of a Successful Drug & Alcohol Counselor.intercoast.edu. Center for Substance Abuse Treatment. “7 Training and Supervision.Substance Abuse Treatment: Group Therapy [Internet]., Substance Abuse and Mental Health Services Administration (US), 2005. www.ncbi.nlm.nih.gov. National Institute on Drug Abuse. “Types of Treatment Programs.www.drugabuse.gov, 2018. Petry, Nancy M. “Contingency management: what it is and why psychiatrists should want to use it.The psychiatrist, vol. 35, no. 5, 2011, pp. 161-163. www.ncbi.nlm.nih.gov. Rieckmann, Traci. “The Substance Abuse Counseling Workforce: Education, Preparation and Certification.Substance abuse, vol. 32, no. 4, 2011, pp. 180-90. www.ncbi.nlm.nih.gov. National Registry of Evidence-based Programs and Practices. “Matrix Model.web.archive.org, 2016. U.S. Bureau of Labor Statistics. “Substance Abuse, Behavioral Disorder, and Mental Health Counselors.www.bls.gov, 2020. Vilardaga, Roger. “Burnout among the Addiction Counseling Workforce: The Differential Roles of Mindfulness and Values-based Processes and Work-site Factors*.Journal of substance abuse treatment, vol. 40, no. 4, 2011, pp. 323-35. www.ncbi.nlm.nih.gov.

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