Substance Abuse Counseling: Techniques, Theories, & Skills

Substance abuse counseling aims to reduce people’s out-of-control, harmful use of substances and change the environments that drive people to overuse.

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I have a good friend who, try as he might, cannot seem to stop or reduce his frequent marijuana use. We talk regularly, and in every conversation I hear the drive to get high—the urge is like a steady undercurrent to his words if he hasn’t already smoked that day. Around and around in circles we go, bouncing back and forth between his desire to stop and the clear (although temporary) relief that would come from using again.

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

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What Is Substance Abuse Counseling? (A Definition)

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.

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Benefits of 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.

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).

Examples of Substance Abuse Counseling

Substance abuse counseling can look many ways. It can mean attending multiple hours of therapy each day while staying at an inpatient treatment center, or daily sessions at an intensive outpatient program that one visits each day after work. For many people, it looks like weekly, one-on-one sessions with a substance abuse counselor. Within these sessions, client and therapist are likely to discuss what kinds of triggers the client experienced that week, the resources the client did and did not use to manage those triggers, and how they can plan to stay sober until the next time they meet with the counselor.

Additionally, medications are often an integral part of substance abuse counseling. Although substance abuse counselors do not prescribe medication themselves, they often work closely with psychiatrists to monitor clients’ use of medications that support sobriety. For more information on how medication is incorporated into substance abuse counseling, I recommend watching the following video:

Video: Medication for Substance Use Disorder

Substance Abuse Counseling Techniques

The techniques used by substance abuse counselors vary widely depending on their orientations (Dellazizzo et al., 2023). Counselors with a cognitive behavioral orientation might help their clients learn to challenge their thoughts about their addiction, such as: “I could never survive a day without getting high.” Counselors who work through family interventions would try to get the relevant family members in the same room to discuss how the family can avoid the kinds of interactions that trigger the client while also providing support when the client wants to get high or drunk.

Recently, substance abuse counselors have started to focus more on treating the high rates of trauma among people with substance use disorders (Giordano et al., 2016). It is now generally accepted that painful or even life-threatening experiences from our childhoods often drive addictions; many people learned to turn to substances at a young age to manage traumatic memories they couldn’t otherwise handle. Therefore, a focus on addressing and healing from trauma also informs most substance abuse counseling.

Substance Abuse Counseling Theories

Substance abuse counseling draws on various theories—it really tries to incorporate whatever works, since substance use disorders can be so difficult to treat and resolve in the long term (Prendergast et al., 2002). Motivational interviewing, with its focus on highlighting reasons to change, is often used by substance abuse counselors. As we have already noted, a cognitive behavioral approach would try to change thinking about the addiction to improve behaviors. A family systems approach would see the problem as existing in the context of the family, so resolution must come from working through family issues. Still other theories suggest that providing positive reinforcement for staying sober is one of the best approaches.

Substance Abuse Counselor Skills

As with any kind of psychotherapy, the ability to build a meaningful connection with one’s clients is one of the most important skills for a substance abuse counselor (Allen & Olson, 2016). Clients themselves, as observed by Allen and Olson (2016), say that the strength of the relationship between counselor and client is more important than the counselor’s approach to therapy.

That said, counselors who are flexible and able to motivate their clients also seem to be especially helpful. Simply put, if a counselor does not have the skills to help a client find their inner motivation for reducing or eliminating their substance use, it will be difficult for therapy to yield much in the way of results (DiClemente, 1999). Clients who are not motivated are less likely to show up to therapy in the first place and less likely to use the skills they are learning in therapy. Therefore, it is crucial for a counselor to know the right questions to ask in order to elicit reasons to change one’s behavior.

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Substance Abuse Counseling Goals

Common goals in substance abuse counseling include abstaining from substances, changing unhelpful thoughts about addiction, learning to manage and avoid triggers, and finding other people who can support one’s recovery (Linton, 2005). In some cases, people choose to target a reduction, rather than an elimination, of substance use, but for the most part, the goal is to stop using entirely.

Substance Abuse Counseling in Prisons

Substance abuse counseling has been offered in prisons for many years, and a wide variety of programs have been shown to be helpful to incarcerated people (Pelissier et al., 2005). Considering how many people in prison are there for drug-related offenses, and how often we punish substance abusers instead of assisting them, this is cause for celebration.

Substance Abuse Counseling for Adolescents

Similarly, since most people with substance use disorders started using in adolescence, it is encouraging to know that the research on substance abuse counseling with teenagers, although limited, suggests that many youth benefit from counseling and become abstinent (Williams & Chang, 2000). It helps if their families are closely involved in the process as well.

Substance Abuse Counseling for Families

On that note, involving families in substance abuse counseling can help improve family functioning as well as reduce rates of substance consumption (Esteban et al., 2023). Although there are not a great number of studies on this kind of counseling, the results thus far suggest that focusing on the whole family system yields benefits for the addict as well as their family members.

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Articles Related to Substance Abuse Counseling

Want to learn more? Check out these articles:

Books Related to Substance Abuse Counseling

If you’d like to keep learning more, here are a few books that you might be interested in.

Final Thoughts on Substance Abuse Counseling

Substance abuse counseling is provided by trained clinicians and trained ex-users, and it has helped many people over the years. That said, long-term abstinence is often difficult to achieve, so ongoing counseling may be necessary. This may also be why people keep returning to twelve-step meetings again and again: Although it is not formal substance abuse counseling, it does provide effective and cost-free support in continuing to abstain, one day at a time.

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References

Allen, R. S., & Olson, B. D. (2016). The what and why of effective substance abuse treatment. International Journal of Mental Health and Addiction, 14(5), 715–727.
Culbreth, J. R., & Borders, L. D. (1999). Perceptions of the supervisory relationship: Recovering and nonrecovering substance abuse counselors. Journal of Counseling & Development, 77(3), 330–338.
Dellazizzo, L., Potvin, S., Giguère, S., Landry, C., Léveillé, N., & Dumais, A. (2023). Meta-review on the efficacy of psychological therapies for the treatment of substance use disorders. Psychiatry Research, 326, 115318.
DiClemente, C. C. (1999). Motivation for change: Implications for substance abuse treatment. Psychological Science, 10(3), 209–213.
DuPont, R. L., Compton, W. M., & McLellan, A. T. (2015). Five-year recovery: A new standard for assessing effectiveness of substance use disorder treatment. Journal of Substance Abuse Treatment, 58, 1–5.
Esteban, J., Suárez-Relinque, C., & Jiménez, T. I. (2023). Effects of family therapy for substance abuse: A systematic review of recent research. Family Process, 62(1), 49–73.
Fadus, M. C., Squeglia, L. M., Valadez, E. A., Tomko, R. L., Bryant, B. E., & Gray, K. M. (2019). Adolescent substance use disorder treatment: an update on evidence-based strategies. Current Psychiatry Reports, 21, 1–10.
Fisher, D. G., Reynolds, G. L., D'Anna, L. H., Hosmer, D. W., & Hardan-Khalil, K. (2017). Failure to get into substance abuse treatment. Journal of Substance Abuse Treatment, 73, 55–62.
Gamble, J., & O’Lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health and Human Services Administration, 39(1), 141–159.
Giordano, A. L., Prosek, E. A., Stamman, J., Callahan, M. M., Loseu, S., Bevly, C. M., . . . & Chadwell, K. (2016). Addressing trauma in substance abuse treatment. Journal of Alcohol and Drug Education, 60(2), 55–71.
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Pasareanu, A. R., Opsal, A., Vederhus, J. K., Kristensen, Ø., & Clausen, T. (2015). Quality of life improved following in-patient substance use disorder treatment. Health and Quality of Life Outcomes, 13, 1–8.
Pelissier, B., Motivans, M., & Rounds-Bryant, J. L. (2005). Substance abuse treatment outcomes: a multi-site study of male and female prison programs. Journal of Offender Rehabilitation, 41(2), 57–80.
Prendergast, M., Podus, D., Chang, E., & Urada, D. (2002). The effectiveness of drug abuse treatment: A meta-analysis of comparison group studies. Drug and Alcohol Dependence, 67(1), 53–72.
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