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A Day in the Life of a Substance Abuse Counselor

Substance abuse counseling is a demanding form of community outreach that requires patience, compassion, and a keen desire to help others who in crisis. A good portion of the addict population are people who need help in many areas of their lives. Often these people are unaware of the kinds of assistance available, whether they are eligible, or how to go about finding help. Counselors refer patients to a variety of other services that may help provide a stable platform from which they can fight their drug addiction. The abuser may be directed to a family agency, food pantry, physician or psychiatrist, vocational training center, lawyer, welfare agent or other professionals depending on the needs of the individual. One of the most frustrating aspects of the job, counselors report, is the bias that clients typically face when applying for other services. “People hold addicts more responsible for their problems,” griped one interviewee. Many who seek help do overcome their addiction-counselors estimate that 20 percent of the people in treatment programs can eventually return to work and function normally and these successful cases are a source of unique job satisfaction among counselors. But staying “clean and sober” requires ongoing vigilance, and recidivism (or backsliding) among substance abusers is a painful reality that can be a source of depression for counselors as well as the abusers themselves. Counselors see people in both group and private sessions. Each case varies according to the personality of the indivual. In the words of one counselor, “You never know what will come up. I spend a lot my time making referrals, but most of what I do is crisis intervention.” Crisis intervention demands a sympatheitc, nonjudgmental attitude and a supportive approach no matter what situation the addict is in, and, as one counselor put it, “You see everything.” Many people who are are drawn to this career have deep-seated personal or religious beliefs about its social value. Their commitment to the principle of helping others keeps them going through the setbacks they inevitably witness on the job. Probaly the most difficult aspect of the job is seeing patients die. Between drug addiction and the range of other problems that often accompany it, such as homelessness, mental illness, and AIDS, death is an unfortunately common sight. One of the great challenges of this noble avocation is learning to control emotions of anger, frustration and even bonds of friendship that can undermine the counselor-patient relationship. Not surprisingly, the burnout rate for substance abuse counselors is very high.

Paying Your Dues

Substance abuse counseling is considered one of the most challenging areas of human/social services. To become a counselor you need a B.A. plus two years of counseling in a related field or equivalent life experience. This could include other kinds of counseling, volunteer work, or experience as a former addict. Though certification is available from most states, it is not required. Some people believe this will change in the future as cutbacks are made and jobs become more scarce.

Present and Future

Though the clergy has always provided counseling to people in need of help, substance abuse counseling as a discrete profession evolved fairly recently. Its theory and practice have grown out of a synthesis of three older methodologies: the psychoanalytic/psychotheraputic model of mental health treatment, Alcoholics Anonymous’s “12-step” recovery program, and the Theraputic Community treatment model as used by organizations such as Synanon and Pheonix House. Promising pharmacological treatments currently in development may yet produce new breakthroughs in recovery programs. The future of substance abuse counseling rests largely on the financial commitment of government. Most substance abuse programs are state and federally funded, and as a result there is a lot of government oversight in most counseling clinics (and lots of paperwork). Cutbacks have already altered the landscape, and further reductions are possible in the current climate of anti-government sentiment. Notably, as we go to press a bill sponsored by Senator Phil Gramm and attached to the pending welfare reform package would make anyone convicted of a crime ineligible for Medicaid. Since Medicaid covers most substance abuse programs, many substance abusers with criminal records would be hindered in their efforts to get treatment. Counselors also report that the patients they see are in general sicker now than in past years; as many as 30 percent are HIV positive.

Quality of Life


New counselors are typically handling at least fifty cases at any given time. Much of the day is spent in contact with other agencies during the referral process. A counselor is also responsible for clinical assessments, group and individual counseling sessions, urine monitoring, and charting. People often burnout at this stage and pursue another path within human services.


At five years a counselor is performing many of the same daily tasks as before, but their case load decreases as their administrative responisbilities increase. A mid-level professional has more experience and judgment to handle the pressure of the job, and pay scales are increasing steadily, but there is heavy burnout at this stage too. Most counselors are constantly reassessing their commitment to the field.


Considering the high dropout rate in the field, ten years is relatively long career for a substance abuse counselor. They are likely to be serving now in an advisory capacity on a hospital staff or perhaps have taken on directorship of an agency at this point. Counselors at this level are responsible for the treatment of the most challenging patients such as those with severe mental illness.