The Counselor’s Role in Treating Substance Abuse

Where Do Substance Abuse Counselors Work?

Substance abuse counselors work in a wide variety of settings, including alcohol and drug treatment centers, where they provide both inpatient and outpatient services. Many counselors offer therapy in private practice counseling offices, community mental health agencies, hospitals, correctional facilities, and juvenile detention centers. Counseling may be delivered in person or online through telehealth. Services include individual counseling, group therapy, family counseling, and referrals to medication management, as needed.

Substance Abuse Treatments to Know

12-Step and Non-12-Step Recovery

It is often recommended that counselors who work in the substance abuse field attend a variety of recovery meetings, including twelve-step meetings. This helps counselors understand how these programs work, what the twelve steps are, and how group members experience the recovery process.  

The most popular groups include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), but clients may also attend Cocaine Anonymous, Crystal Meth Anonymous, Heroin Anonymous, or SMART Recovery groups. Religious and spiritual organizations may also offer substance abuse counseling for individuals and groups.

Families of those affected by substance misuse often need their own support and healing. Groups such as Nar-Anon (families and friends of those with drug addictions), Al-Anon (families and friends of alcoholics), and Alateen (ages 13 to 18 who have been affected by someone else’s drinking) offer a space to share experiences, strength, and hope. SMART Recovery Family & Friends is a non-12-step program focusing on developing effective coping and communication skills for families affected by addiction. Many families and friends have found support, understanding, and healing through peer groups such as these.

Harm Reduction

Sometimes the goal of treatment is not abstinence, but rather a reduction in the use of or a safer use of substances. Harm reduction meets the client where they are and reduces the harm of addiction. Some harm reduction methods can include supplying clean needles to those who use heroin or teaching a family member how to use Narcan to give to a person who is having an overdose. 

In the counseling session, harm reduction means counselors offer these types of resources and programs to their clients or families. Counseling outcomes focus more on the reduction of substances as a therapeutic goal, rather than abstinence.

Cognitive- Behavioral Therapy (CBT)

The counselor’s role in cognitive-behavioral therapy is to help the client identify and modify faulty thoughts and behaviors that lead to substance use. Clients learn to develop and utilize healthy coping skills, rather than turning to substances.

A part of the therapy will include creating a relapse prevention program. This will identify the client’s triggers to substance use and alternative behaviors to avoid use. Some common client triggers are stress, boredom, hanging out with friends who use substances, or going to places where substance use took place. Clients learn about early warning signs of substance use, in an effort to choose self-care or contact a supportive person or group. 

When relapses occur, the client has a pre-established plan, such as contacting their sponsor or counselor, or attending a meeting. Assure the client that relapses are a normal part of the recovery process. The sooner the client seeks help after a relapse, the better their chances are for recovery.     

Motivational Interviewing (MI)

Motivational interviewing uses the Stages of Change Model. The stages of change consist of precontemplation, contemplation, preparation, action, maintenance, and termination.

Clients in the precontemplation stage are using substances and are not thinking about making a change in their usage. Psychoeducation about the substances, health risks, or negative consequences of substance use can be helpful in this stage.

In the contemplation stage, clients know they need to make a change but are unsure how to do so. Offer clients resources to think about, such as peer recovery groups.  

When clients move into the preparation stage of change, counselors help them weigh the pros and cons of using substances. Counselors assist clients in developing relapse plans and identifying triggers to use.

The action stage finds clients ready to change their behavior and take action. In this stage, clients attend their first recovery meeting, commit to substance abuse counseling, or enter a detoxification unit.

Clients, in the maintenance stage, have changed their usage. They look to create consistency and stability in their lives. Clients can choose to be abstinent or consistent with their harm reduction goals.

Termination occurs when the client has no desire to use substances again. As clients move through the recovery process and experience relapse, they move through the stages of change again.

It is normal for clients to experience ambivalence as they make changes in their substance use. The counselor helps assess the client’s readiness for change and supports motivation as the client moves throughout each stage of change.

Involving the Family in Treatment

Counseling the family or recommending family therapy is an important part of substance use counseling. Ask the client who they consider their family. If the family is resistant to treatment, encourage them to attend one initial session. The counselor could also speak with a family member by phone or virtually if they are unable to attend in person. When the client signs a release of information to talk with their family, the counselor can ask for their input about family dynamics and communication styles.

The family, in an addictive system, often takes on roles and rigid rules to keep the family functioning. These roles do not allow the full expression of any family member, and become dysfunctional for all. In family counseling sessions, the counselor helps the family learn communication and assertiveness skills. Also, the counselor raises awareness of any codependency and enabling patterns. Family therapy is not recommended in cases of violence with substance use.

The counselor can construct a genogram with the client or the family. A genogram is similar to a family tree but provides details about functioning, communication styles, relationship dynamics, substance use, health issues, and vocational information. It can be useful to visualize the family system to understand the issues, strengths, and resiliency. This is an ongoing tool, meaning it can be revisited at later sessions. Family members who do additional research can add to the genogram: 

Genograms are an evolving and flexible tool that can be utilized not only for the practical purposes of information gathering and the organization of complex family systems, relationships, and patterns but also as a vehicle for a range of therapeutic purposes. Modern genograms have been adapted to overcome the limitations of the traditional genogram.  Genograms are collaborative, strengths-focused, solution-focused, and often narrative tools that can be utilized in sensitive contexts such as individual or community-based trauma (Joseph et al., 2022).