Being a substance abuse counselor is a big responsibility, as it truly is a life or death situation. Addiction to drugs or alcohol is a chronic, progressive and fatal disease. As in any therapeutic relationship or setting, in substance abuse treatment the counselor or therapist is the one of the keys to a positive outcome.
If a client trusts and feels comfortable with their therapist or substance abuse counselor they will be able to be more honest and forthcoming, which will benefit them in their treatment and recovery. If the therapist or counselor can understand and guide the client to new insights and awareness about themselves and their addiction, genuine progress and real change can happen.
According to the Substance Abuse and Mental Health Service Administration (SAMHSA) pamphlet on addiction counseling competencies:
“Regardless of professional identity or discipline, each treatment provider must have a basic understanding of addiction that includes knowledge of current models and theories, appreciation of the multiple contexts within which substance use occurs, and awareness of the effects of psychoactive drug use. Each professional must be knowledgeable about the continuum of care and the social contexts affecting the treatment and recovery process.
Each addictions specialist must be able to identify a variety of helping strategies that can be tailored to meet the needs of the individual client. Each professional must be prepared to adapt to an ever-changing set of challenges and constraints.” (http://store.samhsa.gov/product/TAP-21-Addiction-Counseling-Competencies/SMA15-4171)
Having a substance abuse counselor with a thorough knowledge of different treatment modalities, such as CBT, Motivational Interviewing and recovery programs, such as the 12 Step model and SMART Recovery, as well as being trauma informed and knowledgable about co-occurring mental health disorders is crucial to a positive treatment outcome and comprehensive aftercare planning.
What a Substance Abuse Counselor Can Do
Some people say that a good substance abuse counselor should also be in recovery so that they can empathize with and understand the client and so that the client can feel that their counselor knows what they’re going through, but that is not necessarily true. A good therapist doesn’t have to have had the same experience as the client to be able to have a productive therapeutic relationship. In fact, unless the therapist has had a lot of experience and knows how not to fall prey to countertransference, being in recovery can actually pose a challenge for the counselor.
Substance abuse is a field that requires the ability to see beyond the shroud of denial that often shadows the real issues. Addicts and alcoholics are well known for distorted thinking, denial and lying. Even an experienced therapist can fall prey to the manipulations of an addict trying to get what they want or lying to protect what they have.
A therapist that can set strong boundaries and challenge the client to honestly look at their behavior and the underlying issues that may exacerbate the addiction can make the difference between sobriety and relapse; between life and death.
That being said, it is important to note that the responsibility of a client’s success does not fully lie on the substance abuse counselor. Treatment and recovery are truly a collaborate effort between all parties involved; the treatment team, including the medical staff, the therapist, the case managers, the behavioral tech staff and, most importantly, the client.
You may wonder about what the letters after the clinical staff’s names mean. LCSW,
LMFT, LMHC, CAP, CAC, CAS, and the list of credential initials goes on and on.
In Florida, as in many other states, there are three licenses in mental health professions, Licensed Clinical Social Worker or LCSW, Licensed Marriage and Family Therapist, LMFT and Licensed Mental Health Counselor, LMHC. Stringent requirements precede licensure; including a Masters Degree in Social Work or Counseling and a minimum of two years of supervised work in the profession as a registered intern.
CAP, Certified Addiction Professional, CAC, Certified Addiction Counselor, and CAS, Certified Addiction Specialist are all Florida specific certifications that represent hours of training and supervised work experience, as well as meeting other specific criteria. Having a license and or certification insures that the counselor is thoroughly trained and qualified to practice in the field of addiction.
Lastly, choosing a treatment facility that is accredited by CARF and The Joint Commission is also a guarantee that the therapists and counselors are fully trained, have the appropriate credentials and are current in their education. These accreditations are achieved only by meeting rigorous standards that include having only qualified professional substance abuse counselors on staff.
By Elizabeth Ossip, LCSW, CAP, ICADC