Addiction Counselor (formerly known as Substance Abuse Counselor)

What is an addiction counselor?

An addiction counselor (substance abuse counselor) provides expert care and support to people who have substance use disorder (SUD), like alcohol use disorder or opioid use disorder.

SUDs range from mild to severe and affect everyone differently. They’re very complex mental health conditions. Addiction counselors create tailored treatment plans for each person.

Licensed addiction counselors are experts at understanding the underlying causes of addiction. They use several techniques to help address the many factors that contribute to and reinforce substance use disorder.

Addiction counselors used to be called substance abuse counselors. But healthcare systems and organizations have steered away from using the word “abuse/abuser” when talking about issues with substances or behaviors. This is because there’s a lot of stigma and negativity associated with those terms. Studies show that stigma affects how people with addictions are treated and seek help:

• Feeling stigmatized can reduce the willingness of people with SUD to seek treatment.
• Stereotypes of people with SUD can lead others to feel pity, fear and anger toward people with SUD.
• Stigmatizing language can negatively influence how healthcare providers perceive people with SUD. This can impact the quality of the care they receive.

What does an addiction counselor do?

Addiction counselors have several roles, some of which include:

• Assessment: An addiction counselor assesses your mental and physical health and your SUD. Through discussions, they determine the severity of the addiction, your readiness for change and if you have other mental health conditions (dual diagnosis). They look for potential challenges that may affect your treatment and other needs and opportunities.
• Treatment planning: Addiction counselors develop personalized plans to address each substance use disorder. Treatment plans may involve medical care (like medication and hospital management), therapy, rehab programs, support groups and more. Counselors often create treatment plans in coordination with other healthcare providers. They tailor each plan to match your needs and goals.
• Referrals: An addiction counselor acts as a bridge between you and outside resources that may be necessary for your treatment plan. For example, a counselor might refer you to a support group, medical care or job placement services.
• Intervention: A counselor may have to intervene in crises when someone is endangering their life or the lives of others. They also intervene in noncrisis situations by encouraging a person with an addiction to get help. Friends and family members often request noncrisis interventions.
• Counseling: Addiction counselors often provide counseling (psychotherapy, or “talk therapy”) for individuals or groups of people with SUD. They may also provide therapy for family members and friends of people with SUD.
• Education: Addiction counselors may teach family members and friends about SUDs. They learn ways to support their loved one throughout treatment. Addiction counselors may also put together outreach programs for communities to help people identify the signs of addiction and other problematic behaviors.
• Case management documentation: Documentation is essential to helping addiction counselors, other healthcare providers, people receiving care and families track the progress of treatment. In some cases, addiction counselors may need to provide updates and progress reports to law enforcement or court systems.

Helping people with SUDs takes a lot of coordination with other experts. Addiction counselors often work with the following providers to develop treatment plans:

• Psychologists.
• Psychiatrists.
• Social workers.
• Primary care physicians.
• Registered nurses.

Addiction counselors may also work with specific populations, like teenagers, veterans or people with disabilities.

Where do addiction counselors work?

Addiction counselors can work in many different settings. A few examples include:

• Rehab facilities: There are several types of rehabilitation centers. Some centers are residential, where you live at the facility for around-the-clock care. Others are outpatient, meaning that you come to the facility but then go home after treatment each day. In addition, rehab centers can have a particular focus, like a religious or nature focus.
• Hospitals: Hospitals often have special units to monitor and care for people going through substance withdrawal (detoxification). They usually have other related treatment services as well, so addiction counselors may work in hospitals.
• Private practices: Some addiction counselors may have their own space to help people. These settings are mainly for people with mild SUDs or behavioral addictions and for those who have already gone through most of their treatment plans. It’s also a place where family members and friends can receive counseling.
• Corrections facilities: Addiction counselors can provide care, support and education for people in a prison setting.

How do I become an addiction counselor?

The requirements to become an addiction counselor (substance abuse counselor) can vary based on your employer and which state you live in in the U.S.

You’ll at least need a bachelor’s degree to practice addiction counseling. Many states require you to have a master’s degree for addiction counseling licensure and certification.

After you get your degree, you’ll likely need to pass an exam. This may be the International Certification & Reciprocity Consortium’s (IC&RC) Alcohol and Drug Counselor Examination or Advanced Alcohol and Drug Counselor Examination. Or it could be an exam through the National Certification Commission for Addiction Professionals (NCCAP).

Depending on the state you live in and the type of licensure you plan to pursue, you might also need to complete supervised professional practice.

The last step is to apply for licensure or certification in your state.

A note from Cleveland Clinic

Addiction counselors are experts in their field. If you’re experiencing challenges related to substance use, an addiction counselor can help you. While it can be overwhelming to acknowledge and seek help, it’s important that you do — and know that you’re not alone.