Substance Abuse Counseling: Techniques, Theories, & Skills

What keeps my friend trapped in this loop? First and foremost, getting high seems to relieve some of his social anxiety, which is a constant factor that holds him back from engaging in many regular activities in his day. Second, he does not have much else going on: He is underemployed, has few social outlets, and spends most of his time in his room. Third, he is living in his parents’ home and feels a lot of shame about not having his own place. Finally, as he grew up, my friend regularly received the message that he was worthless or not doing enough—and being high helps distract him from how that message continues to rattle around in his head.

My friend would be an excellent candidate for substance abuse counseling, because he needs help not just in abstaining from smoking pot but also in changing his internal environment (the negative thoughts in his head) and his external environment (where he lives and what he does each day)—both of which are perpetuating his use

Substance abuse counseling can be defined as any kind of therapy with the primary goal of reducing or eliminating out-of-control, harmful use of substances, whether legal or illegal (Culbreth & Borders, 1999). This includes commonly used substances, such as alcohol and marijuana, as well as the substances we typically think of as highly impairing and dangerous, such as heroin and methamphetamines. Whenever somebody is receiving formal treatment for their dependency on a substance, whether it is in weekly therapy sessions or a locked, inpatient treatment center, they are receiving substance abuse counseling.

Substance abuse counseling differences from traditional mental health counseling in a couple pretty substantial ways. First of all, a lot of substance abuse counseling is provided by addicts in recovery. It is the one field of mental health disorders in which people who have experience with the disorder itself, including successful recovery from the disorder, can operate as licensed care providers for that disorder.

In fact, it is not uncommon for people who have achieved long-term sobriety through enormous effort to say that they can best maintain their sobriety by helping other addicts as much as possible, hence their desire to work as substance abuse counselors. Counselors in recovery are such an accepted part of the substance abuse counseling field that research has even been done on what it means to have a counselor in recovery. For example, one study found that substance abuse counselors in recovery see self-disclosing about their own experiences with recovery to be an essential tool in helping others (Ham et al., 2013). In another study, Culbreth and Borders (1999) found that substance abuse counselors-in-training who are in recovery benefit from being matched with supervisors who are also in recovery.

Addiction Recovery Training
None of those addicts in recovery can provide substance abuse counseling without some level of formal training and supervision; every state has its own system of licensing people as addiction counselors. Because these counselors are expected to work exclusively with clients on their addictions, their training can look different—less intense, shorter, and with a different focus—from that of a more generalist mental health counselor.

Despite the flexibility of licensing boards in getting people into their roles as substance abuse counselors, many people have a great deal of difficulty accessing this kind of mental health care. When researchers asked people with substance use disorders why they had trouble accessing care, some of the reasons they gave included a lack of money, long waiting lists, relapsing, not qualifying for care, and even ending up in jail before they could start treatment (Fisher et al., 2017). People who are addicted to substances can need a lot of support, and often a lot of luck too, to get connected with quality substance abuse counseling.

A recent meta-analytic review of studies on substance abuse counseling outcomes indicates that a variety of approaches can have small to medium-size effects across a range of substances (Dellazizzo et al., 2023). In other words, substance abuse counselors who use techniques such as motivational interviewing, contingency management, or cognitive behavioral therapy stand a decent chance of helping people reduce, if not eliminate outright, their compulsive use of substances.
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Other research suggests that what is most effective are treatments that look at the systems people live in or that draw on multiple approaches at once (Fadus et al., 2019). To understand why this might be true, we can think of the friend I described earlier. Cognitive behavioral therapy (CBT) could help him question his addiction-related thoughts and develop helpful counter-thoughts, but if he continues to live in a situation that reinforces his negative thoughts about himself, the CBT intervention may not be enough. He will likely do better if his family learns how to support him in his sobriety, or if he gets connected to a career counselor who can help him find meaningful work.

For the many people who are not willing, or do not have the resources, to engage in substance abuse counseling, there is the option of attending twelve-step meetings—groups of addicts who meet regularly, without a counselor present, to use spiritual principles to heal from their addictions. Research shows these groups can also help substance abusers reduce their consumption and sometimes even stay sober for many years (Gamble & O’Lawrence, 2016).

A main benefit of any and all forms of substance abuse counseling is, hopefully, an increase in one’s overall quality of life (Pasareanu et al., 2015). People without exposure to substance use disorders have limited understanding of just how completely impairing such an addiction can be; even getting a little bit of sobriety can help people make other changes that substantially improve their quality of life. That said, the benefits of substance abuse counseling may not be fully felt until years later, when a person has had ample time to live their life differently (Dupont et al., 2015).

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