How to Be a Substance Abuse Counselor
Substance abuse counselors experience the rare opportunity to transform people's lives. While the challenges of this job are extraordinary, the level of job satisfaction is, too, as there are few accomplishments as gratifying as wresting back a life commandeered by addiction. Substance abuse is widespread - there are more than 17 million alcoholics alone in the United States today - and it wreaks havoc on the lives of those who suffer from it.
Substance abuse counselors help addicts with both crisis- and long-term management issues that range from finding immediate medical help to preventing a return to addiction on an ongoing basis. Counselors help their clients find housing, employment, medical help, and peer support through groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), and assist their clients in navigating public aid systems. An addiction counselor is also available to his or her client for moral support, as the transformative changes that recovery requires can be daunting.
Regardless of work setting, most substance abuse counselors provide essentially the same services. Nearly all of these counselors work firsthand with clients (with the exception of some high-level managers and administrators). Broadly speaking, all counselors are expected to interview and assess clients’ addictions and mental health issues and work with the client to determine the best course of treatment. An effective drug and alcohol counselor will develop treatment plans that benefit the client, the client’s family, and society at large.
Addiction counselors work one-on-one with clients in therapeutic settings, determining the causes and triggers of their alcohol or drug abuse. Together, the client and counselor work to determine a treatment plan that will help the client to get clean or remain drug and alcohol free. Treatment plans may include weekly or bi-weekly therapy appointments; involvement in group therapies such as AA or NA; completion of various recovery “steps” (as in the AA/NA model); use of drugs such as methadone; and behavioral planning. Counselors may also work with a client’s family, romantic partners, or employers to help determine the best behavioral course of action.
In addition, substance abuse counselors provide addiction-prevention resources to the community. Counselors may work in public outreach, informing community members about the risks of substance abuse. This may occur in educational settings; at public libraries or YMCAs; or as part of public events, such as health fairs or parades. Outreach counselors teach individuals how to recognize addiction in their peers and family; how to responsibly use alcohol; and how to navigate public services to obtain addiction treatment.
Drug and alcohol abuse counselors work in a variety of environments including hospitals, residential treatment facilities, and governmental facilities such as prisons, juvenile detention centers and probation offices. Working hours include days, evenings, nights, and weekends. Jobs are usually full time. Many counselors experience high caseloads and work greater than forty hours per week.
The workplace of a counselor is often challenging and requires stress management and trauma-coping skills. Counselors must remain a source of emotional strength and steadfastness to a large caseload of clients, some of whom are under the influence of drugs or alcohol or in the midst of emotional crisis. Among drug counselors with high caseloads, burnout is fairly common. In order to maintain emotional and mental health in this stressful and emotionally taxing line of work, counselors are advised to locate their own sources of support – such as religious and social communities, group or individual therapy, and family.
In institutional settings such as correctional facilities and juvenile detention centers, recidivism is high; a substance abuse counselor must be able to navigate his or her own emotions when some clients inevitably return to drug or alcohol use. These counselors rely on good stress management skills and emotional maturity in order to thrive in a work environment that poses unique challenges.
In therapeutic settings, secondary trauma (experiencing a trauma response after helping another person deal with negative experiences) is a potential risk. This can be dealt with using therapy, or by counselors taking advantage of their religious and social support systems. Other counselors can also provide invaluable insight and emotional support to their colleagues.
Requirements for a job as a substance abuse counselor depend on the hiring agency and the nature of the treatment program. In some settings and treatment programs, counselors may only require a high school diploma and certification, while others programs require a bachelor’s degree or master’s degree. Depending on the philosophy of the treatment program, past experience with addiction may be required or seen as beneficial. In drug treatment programs based on an AA or NA framework, for example, the majority of counselors are addicts in recovery, or have firsthand experience with addiction in their personal lives.
Counselors with more education will be trusted with less immediate supervision and licensed counselors can provide one-on-one counseling. Increasingly, drug and alcohol counselors are encouraged to pursue a background in mental health, or obtain some education in psychology or mental health treatment, due to the strong relationship between addiction and other mental health issues. In order to operate a private practice, a substance abuse counselor must possess a license – though this is also true of addictions counselors in the majority of public (e.g., prison and social service) counseling sites as well.
A substance abuse counselor who has a bachelor’s or master’s degree will not likely need any training before beginning a substance abuse counselor position. However, those counselors who have only a high school diploma do typically require training. Training is often conducted on the job, with the particular clientele the counselor will serve. Often, more seasoned counselors will serve as the primary point of contact with the client, while the counselors-in-training “shadows” them. Training typically covers subjects such as how to respond to crises; how to maintain privacy and confidentiality; how to speak to clients and provide services; and how to perform administrative tasks relevant to the position.
Licensing and/or Certification
Addiction counselors who wish to open a private practice must have a license. In most states, licensure requires a master’s degree and 2,000-3,000 hours of clinical experience under the supervision of a licensed counselor. Counselors must also pass a licensing exam in the state where they wish to practice (each state has a unique licensing exam and approval process). Licensing requirements vary from state to state; the National Board for Certified Counselors can provide information about state regulating boards.
Requirements for counselors who do not have a private practice also vary from state to state; in some states a license is still required to provide substance abuse services, while in others supervision is adequate. Information about state licensing boards can be found at the Addiction Technology Transfer Center.
In order to maintain a license, substance abuse counselors must take a fixed number of continuing education classes per year. This ensures that counselors remain up-to-date on the best practices in substance abuse, and expand their skill sets as their careers progress. Examples of common continuing education course topics include: managing client depression, ethics in the client/counselor relationship, responding to client suicidality, substance abuse in teenagers, and addiction treatment for clients with personality disorders.
Necessary Skills and Qualities
Substance abuse counselors must possess excellent listening and speaking skills and be able to communicate with a broad spectrum of people with varying educational levels. Compassion must inform their desire to work in this field, as the clientele is a challenging one that can resist treatment and respond confrontationally or even with violence.
Counselors must be able to maintain calm under duress, and should be able to manage chronic stress. A mentally healthy counselor can “leave the work at work”, and not become overwhelmed by clients’ needs. It is an absolute necessity that substance abuse counselors possess and maintain a healthy relationship with substances such as alcohol and painkillers. Finally, a fundamentally optimistic nature also helps, as the road to recovery tends to be a long and hard one with many setbacks.
Opportunities for Advancement
Overall, the field of addiction counseling offers fewer opportunities for career advancement than are enjoyed in other fields. The majority of counselors work at the treatment level, with salaries and job titles that are fairly static, especially compared to other professions. Opportunities for advancement are most likely for those counselors who work in hospitals or residential facilities that employ multiple counselors. Counselors can advance to supervisory, management and/or training positions; education, specialized training, years of experience, and a strong rapport with clients and co-workers will determine how far and how fast an addiction counselor advances.
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According to the U.S. Bureau of Labor Statistics, the average annual salary for a drug and alcohol abuse counselor is $41,090 as of 2013. Salaries vary from $25,200 (the median wages of the bottom 10%) to $60,160 (the median salary of the top 10%). Pay is highest for counselors who work in hospitals or who possess advanced degrees, while those who work in residential facilities tend to receive the lowest rate of pay for this job. Counselors who operate private practices or who work in high-end rehabilitation facilities can also earn a higher rate of pay, particularly if they specialize in wealthier clients. This is not the norm, however, as the majority of substance abuse clients are low-income.
The Bureau of Labor Statistics expects jobs in this field to grow by 31% from 2012 to 2022, which is much faster than average job growth.
The Affordable Care Act mandates that most employer-provided health plans cover addiction treatment, which has led to a rise in available drug counselor positions in the United States. This, combined with the mandate that all citizens enroll in health insurance, has led experts to project significant growth in the field.
In addition, courts have recognized that offenders sentenced to drug or alcohol rehabilitation rather than jail are less likely to re-offend, contributing to an increased need for substance abuse counselors. This shift from jail time to rehabilitation also reduces the burden of overcrowding in prisons. Many former prison inmates are also recommended or required to enroll in outpatient drug treatment or halfway houses as a condition of their parole or release from prison. For all these reasons, job opportunities in prison, jail, and halfway house positions are expected to rise in the next decade.
Finally, an increasing number of policy makers and local government officials are recognizing the cost-effectiveness of addiction treatment as a method of allaying poverty and preventing crime. In some cities, this has led to increased support and funding for public, non-residential drug treatment programs, including more financial support for group therapy programs and AA. Substance abuse counselors may enjoy job growth in these sectors as well, since they are often the front line in the wars on poverty and crime.