Substance Abuse Counseling
Substance abuse is a maladaptive pattern of alcohol or other drug use that causes social, physical, legal, vocational, or educational distress or impairment. In addition to those trained specifically as substance abuse counselors, mental health and rehabilitation counselors work with individuals who abuse alcohol and other drugs.
Counselors who work with substance abusers should have the same qualities as other counselors. For example, they should be able to pose direct questions and confront clients, self-disclose appropriately, identify counter-transference issues, and recognize the effect of their own beliefs on the counseling relationship. Essential qualities include empathy, sincerity, warmth, genuineness, and nonjudgmental acceptance.
In order to assess, diagnose, and treat substance abusers, counselors must have general counseling skills and abilities in addition to specialized skills and abilities relative to this population. Counselors working with substance abusers must have knowledge of assessment instruments and techniques in order to communicate with other professionals and make treatment recommendations.
Substance abuse counselors develop a treatment plan based on the individual client's needs. The information necessary for the individual's treatment plan is gathered through interviews in conjunction with assessment instruments.
Major substance abuse counseling theories include reality therapy, psychodynamics, grief therapy, clientcentered therapy, rational emotive therapy, and cognitive-behavioral. Additional approaches such as life-skills training and behavior modification are often included.
Mental health counselors work with individuals and groups to promote optimum mental health. They deal with addictions and substance abuse, suicide, stress management, problems with self-esteem, issues associated with mental and emotional health, and family and marital problems. Mental health counselors work closely with other mental health specialists, including psychiatrists, psychologists, clinical social workers, psychiatric nurses, and school counselors.
Substance abuse among people with disabilities exceeds that of the general public. According to the Americans with Disabilities Act of 1990, recovery from alcohol or drug addiction is considered a disability. Rehabilitation counselors work with people with disabilities resulting from birth defects, illness or disease, accidents, or the stress of daily life. They help people with disabilities deal with the personal, social, and vocational effects of their disabilities. Rehabilitation counselors evaluate the individual's strengths and limitations, provide personal and vocational counseling, and arrange for medical care, vocational training, and job placement. They interview individuals with disabilities and their families, evaluate school and medical reports, and confer and plan with physicians, psychologists, occupational therapists, and employers to determine the capabilities and skills of the individual. By conferring with the client they develop a rehabilitation program, which often includes training to help the person develop job skills. Increasing the client's capacity to live independently is also a priority. To enhance the likelihood that the substance abuse client will continue to recover, many counselors encourage or support the client's attendance at meetings of Alcoholics Anonymous or Narcotics Anonymous.
Substance abuse counselors work in a variety of settings including residential and outpatient treatment programs, hospitals and clinics, government agencies, private practice, schools, and correctional facilities. Substance abuse counseling takes place individually and in groups. To enhance continued recovery, counselors also work with family members.
Rehabilitation counselors usually work a traditional 40-hour week. Counselors in private practice and those working in mental health and community agencies often work evenings to counsel clients who work during the day.
Education and training
Some employers provide training for newly hired counselors. Many have work-study programs so that employed counselors are able to pursue graduate degrees. However, most employers require, or prefer, that counselors have a master's degree. At least 45 states and the District of Columbia have some form of counselor credentialing, licensure, certification, or registry legislation governing practice. Although requirements vary from state to state, many require a master's degree.
Accredited master's degree counseling programs include a minimum two years of full-time study, including 600 hours of supervised clinical internship experience. Counselors with a master's degree who work with substance abusers come from a variety of disciplines, including substance-abuse counseling, rehabilitation counseling, agency or community counseling, clinical mental health counseling, counseling psychology, and related fields.
Graduate-level counselor education programs in colleges and universities are most often located in education or psychology departments. Course work is grouped into a number of core areas including human growth and development; social and cultural foundations; helping relationships; group work; career and lifestyle development; appraisal; research and program evaluation; and professional orientation. Most accredited graduate programs require the student to complete 48–60 semester hours of course work, including a period of supervised clinical experience in counseling. More than 100 institutions offer programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). These include programs in substance abuse, mental health, rehabilitation, and community counseling. Graduate programs in rehabilitation counseling are accredited by the Council on Rehabilitation Education (CORE).
Many counselors pursue national certification by the National Board for Certified Counselors (NBCC). To be certified a counselor must hold a graduate degree in counseling from a regionally accredited institution, have at least two years of supervised field experience in a counseling setting, and pass the NBCC's National
The Commission on Rehabilitation Counselor Certification offers national certification for rehabilitation counselors, which is required by many employers. To become certified, rehabilitation counselors must graduate from an accredited educational program, complete an internship, and pass a written examination. To maintain certification, counselors must complete 100 hours of acceptable continuing education credit every five years.
Most clinical mental health counselors have a master's degree in mental health counseling, another area of counseling, psychology, or social work. Certification is available through the NBCC. To be certified as a clinical mental health counselor, a counselor must have a master's degree in counseling, two years of post-master's experience, a period of supervised clinical experience, a taped sample of clinical work, and pass a written examination.
Prospects for advancement vary by counseling field. Rehabilitation, mental health, and substance-abuse counselors can become supervisors or administrators in their agencies. Some counselors move into research, consulting, college teaching, or go into private or group practice.
A study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 1996 the cost for alcohol and drug abuse treatment surpassed $13 billion. The combined costs of substance abuse and mental health treatment services ranked third after spending for heart disease, injury, and trauma. As a result, employment for counselors is expected to increase from 21–35% through 2008. Demand is expected to be strong for rehabilitation and mental health counselors.
Due to the toll substance abuse takes on worker productivity, an increasing number of employers offer employee assistance programs that provide alcohol and drug abuse counseling services. A growing number of people are expected to use these services, creating a demand for counselors as many seek ways to maintain their recovery from substance abuse while dealing with the stresses associated with job and family.
For general information about counseling, as well as information on specialties such as substance abuse, mental health, or rehabilitation counseling, contact the American Counseling Association, 5999 Stevenson Ave., Alexandria, VA 22304-3300. <http://www.counseling.org>.
For information on accredited counseling and related training programs, contact the Council for Accreditation of Counseling and Related Educational Programs, American Counseling Association, 5999 Stevenson Ave., 4th floor, Alexandria, VA 22304. <http://www.counseling.org/cacrep>.
For information on national certification requirements for counselors, contact: National Board for Certified Counselors, Inc., 3 Terrace Way, Suite D, Greensboro, NC 27403-3660. <http://www.nbcc.org>.
Cohen, Monique. Counseling Addicted Women: A Practical Guide. Sage Publications, Inc., 2000.
Fisher, Gary, and C. Harrison. Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors. Allyn Bacon, 1999.
Curry, L. "12-Step Self-Help Programs Prove Successful Regardless Of Participants' Religious Background, Study Suggests." APA Monitor Online 30, no. 11 (December 1999).
American Counseling Association. 5999 Stevenson Ave., Alexandria, VA 22304-3300. (800) 347-6647. <http://www.counseling.org>.
Council for Accreditation of Counseling and Related Educational Programs (CACREP). 5999 Stevenson Avenue, 4th Floor, Alexandria, VA 22304. (800) 347-6647, ext. 301. <http://www.counseling.org/cacrep>.
National Board for Certified Counselors, Inc. 3 Terrace Way, Suite D, Greensboro, NC 27403-3660. (336) 547-0607. <http://www.nbcc.org>.
National Center on Addiction and Substance Abuse at Columbia University. 633 Third Avenue, 19th floor, New York, NY 10017-6706. (212) 841-5200. <http://www.casacolumbia.org/>.
Substance Abuse and Mental Health Services Administration. 5600 Fishers Lane Rockville, MD 20857. <http://www.samhsa.gov/statistics/statistics.html>.
National Clearinghouse for Alcohol and Drug Information. <http://www.health.org/>.
Substance Abuse and Mental Health Data Archive. <http://www.icpsr.umich.edu/SAMHDA/>.
U.S. Department of Labor. Bureau of Labor Statistics. "Occupational Outlook Handbook." <http://stats.bls.gov/oco/ocos067.htm>.
Bill Asenjo, MS, CRC