Substance Abuse Counselor: Your Addiction & Substance Abuse Therapist

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a substance abuse counselor?

A substance abuse counselor specializes in providing advice, counseling and support during treatment for substance abuse. A substance abuse counselor’s goal is to help a person live a sober and substance-free life. Substance abuse counselors work with patients of all ages who have addictions to illegal drugs, alcohol, prescription medications, and tobacco products. 

A substance abuse counselor provides various services depending on the counselor’s education and training, practice setting, and state regulations. A substance abuse counselor may:

  • Gather information about a patient’s medical history, history of substances the patient is using or has used, mental health status, employment or school status and performance, family and living situation, and history of past substance abuse treatment

  • Assess a person’s ability to perform everyday living activities, such as holding a job, paying bills, eating, dressing, and driving

  • Devise a treatment plan to address a patient’s and his or her family’s support needs during substance abuse treatment

  • Provide different types of talk therapy or psychotherapy, if qualified to do so. Therapies may include individual cognitive behavioral therapy and group therapy.

  • Help monitor medication usage (with supervision from a doctor such as an addiction psychiatrist) to determine if the medication is working, and if side effects are occurring

  • Support detoxification treatment (with supervision from a doctor) to safely wean patients off of the substances to which they are addicted

  • Consult with other members of a patient’s support team including their families, doctors, social workers, home healthcare providers, lawyers, welfare care workers, and occupational therapists

Substance abuse counselors may also be known by the following names: substance abuse treatment counselor, addiction counselor, substance abuse therapist, addiction therapist, drug abuse counselor, psychologist, nurse, and social worker.

Who should see a substance abuse counselor?

People of all ages who have a substance addiction problem should consider seeing a substance abuse counselor. In many cases, a psychologist, addiction psychiatrist, primary care doctor, or other provider will refer people to a substance abuse counselor for treatment.

In addition, patients who are voluntarily or involuntarily admitted to an inpatient or outpatient addiction or substance abuse rehabilitation treatment center will generally receive ongoing counseling and support from a substance abuse counselor.

Substance abuse can affect your mental and physical health, your relationships, your performance at school or work, and your ability to take care of yourself and keep yourself safe. If you or a family member is abusing or addicted to drugs or other substances, seeking help from an experienced substance abuse counselor may help prevent serious mental disorders, physical diseases, and other serious problems.

When should you see a substance abuse counselor?

Consider seeking care from a substance abuse counselor, or care at a substance abuse treatment facility, if you abuse prescription medications, alcohol, or illegal drugs. A substance abuse counselor can help you with substance abuse including the following emotional or lifestyle-related symptoms: 

  • Feelings of needing to use the substance regularly and frequently

  • Inability to stop using the substance

  • Irritability or anxiety when the substance is not available

  • Hiding your use of the substance from people who care about you

  • Exhibiting detrimental behaviors, such as lying or stealing

  • Losing interest in activities that do not involve using the substance, such as working, spending time with your family, and participating in hobbies you used to enjoy

  • Spending excessive amounts of money on alcohol, prescription drugs, or street drugs

  • Participating in risky behaviors, such as having multiple sexual partners or driving while impaired

What conditions and diseases does a substance abuse counselor treat?

A substance abuse counselor treats addiction to the following types of substances:

  • Alcohol including wine, beer and liquor

  • Illegal drugs including marijuana, cocaine (and crack cocaine), heroin, and methamphetamine

  • Inhalants including volatile gases, solvents and aerosols commonly found in household cleaners, beauty products, and other household or office products

  • Performance-enhancing substances including anabolic steroids, human growth hormone, diuretics, and red blood cell stimulating drugs

  • Prescription medications including painkillers, anti-anxiety medications, stimulants, and sedatives

  • Tobacco products including cigarettes and chewing tobacco

What services does a substance abuse counselor provide?

Substance abuse counselors provide support and treatment to manage substance abuse disorders. They can help you live a sober and substance-free life. Substance abuse counselors may help you recover in an inpatient rehabilitation center and on an outpatient basis in a private office or clinic. They are often part of an entire substance abuse treatment team that includes doctors, nurses, psychologists, and social workers.

A substance abuse counselor provides various services depending on the counselor’s education and training, practice setting, and state regulations. A substance abuse counselor may provide:

  • Initial clinical assessment including determining a patient’s needs, determining the family’s particular support needs during substance abuse treatment, developing treatment goals, and planning treatment

  • Contingency management including incentives for staying clean

  • Detoxification support including intensive support during the period of withdrawal from addictive substances

  • Maintenance therapy including long-term counseling and medication management

  • Substance abuse counseling including cognitive behavioral therapy, psychotherapy (talk therapy), motivational interviewing, individual therapy, marriage and family counseling, and group therapy. During counseling with a substance abuse counselor, you may talk about your feelings and coping strategies for your substance cravings, and how to maintain your relationships, your job, and other important elements of sobriety.

Substance abuse counselor training and certification

In the United States, the states regulate and license substance abuse counselors. Educational, licensing and certification requirements for substance abuse counselors vary greatly depending on individual state regulations and the practice setting. Some states only require a high school degree and a certification in substance abuse counseling. Other states require a master’s level degree in counseling, professional experience, and passage of a licensing examination.

Organizations, such as the National Board for Certified Counselors (NBCC) or the Association for Addiction Professionals (NAADAC), provide certification for substance abuse counseling. In some states, a substance abuse counselor may be licensed to practice without being certified. However, certification is an important element in establishing a substance abuse counselor’s level of competence. Certification organizations offer different levels of certification with varying requirements.

Substance abuse counselors with higher levels of education and training can work more independently and provide more services to their clients. Substance abuse counselors who work in private practice must be licensed.

Licensed substance abuse counselors have:

  • Earned a master’s degree

  • Completed 2,000 to 3,000 hours of supervised clinical experience

  • Passed a state-recognized exam

  • Completed continuing education every year

In order to maintain licensure and certification, substance abuse counselors generally must participate in professional development and continuing education.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2017 Nov 27
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. NCC AP Credential FAQs. The Association for Addiction Professionals.  
  2. Certification. National Board for Certified Counselors.  
  3. Substance Abuse, Behavioral Disorder, and Mental Health Counselors. Bureau of Labor Statistics.  
  4. Treatments for Substance Use Disorders. Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.