The work of recovering from any level of substance use disorder mostly falls onto the patients themselves. It’s a titanic internal struggle with demons of biochemistry and neural divergence, one that ultimately requires a rewiring of thought patterns and behaviors that even the most compassionate counselor can’t accomplish from the outside.
With roots in psychology, physiology, and culture, substance use disorders are complex conditions. Treating them requires an advanced understanding of all of those factors.
This takes the most advanced practice of substance use disorder (SUD) counseling into the realm of clinical counseling.
In some states, in fact, this is the highest level of substance use disorder counseling practice and licensure you can achieve.
What Is the Clinical in Clinical Addiction Counselor All About?
The clinical aspects of SUD counseling are similar to the unique aspects of licensed clinical social work and licensed clinical mental health counseling:
- Evaluating patients and observing co-ocuring mental health issues
- Referring patients to psychologists or mental health counselors for services outside the SUD scope of practice
- Diagnosing substance use disorders
- Developing advanced treatment plans
- Implementing and managing treatment plans with other counselors and peer recovery specialists
So the domain of clinical SUD counseling largely comes down to the severity of the issues patients are experiencing, and the complexity of the treatment required to address those issues. But there’s even more to it than that.
Clinical counseling for addictions comes out of the growing recognition that substance use disorders are diseases to be managed and not moral failings to be shamed.
Where Does Clinical Addiction Counseling Come From?
To find the roots of clinical substance use disorder counseling, you have to look back along the psychology and human services family tree.
Counseling, family therapy, and social work all have clinical aspects that are rooted in psychology. Psychotherapy emerged in the late 1800s as a systematic tool for exploring thoughts, behavior, and emotion. Those tools are useful when applied to many different human issues. Substance use disorder is no exception.
Counselors, first emerging in the late 1800s as an outgrowth of traumatic wars and displacement caused by the Industrial Revolution, use clinical treatment to address specific, solvable problems for individuals.
That makes counseling a particularly good fit for addressing addiction, which has a fairly defined set of behaviors and solutions. Clinical mental health counselors have long addressed individual issues in the same way. Clinical substance use disorder counselors bring that same problem-solving approach to the specialty of addiction therapy.
The expertise to practice at this level only comes with a lot of experience and schooling. These are the professionals who are overseeing much of the substance abuse counseling workforce after all, heading up treatment facilities, nonprofit organizations, and government agencies dealing with the substance abuse crisis in every corner of the country.
With few exceptions, practicing addiction therapy at the clinical level requires a master’s degree.
Like other substance use disorder counselors, they are responsible for helping patients, their families, and entire communities beat the scourge of substance abuse. Through prevention, direct counseling, and a variety of other kinds of treatment, they use their advanced skills to help guide other counselors and to help patients along the road to recovery.
In fact, clinical positions often come with titles that are similar to what you’d see for any licensed SUD counselor role:
- Substance Abuse Counselor
- Addiction Counselor
- Outpatient Clinician for Substance Abuse
- Senior Substance Abuse Therapist
- Alcohol & Drug Counselor
- Chemical Dependency Counselor
- Crisis Counselor
- Clinical Counselor in Substance Abuse
But you will find some significant differences in the actual duties and responsibilities at the clinical level.
Clinical SUD counselors are in the best position to deal with the vortex of chemical, emotional, physical, and environmental factors that lead some people down the whirlpool of addiction. Their knowledge and skill is the core of the lifeline that hauls people back to dry land and stability again.
What Do Clinical Substance Abuse Counselors Do?
SAMHSA, the Substance Abuse and Mental Health Services Administration, has a handy eight-point guide that outlines the expectations for anyone working at any level in SUD counseling. Clinical SUD counselors have the greatest responsibilities and very nearly the broadest authority to perform these kinds of functions:
- Clinical Evaluation - Clinical counselors have the skills and experience to evaluate new and continuing patients and diagnose substance use and co-occuring disorders, such as anxiety or bipolar disorders. They follow up on the initial impressions made by lower-level counselors and get to the roots of symptoms and risk factors.
- Treatment Planning - Plans for recovery from substance use disorders can be complicated by environment, physiology, and resources, but clinical counselors have the skill and collaborative ability to put together solid, actionable treatment plans for any patient.
- Referral, Service Coordination, and Documentation - These three functions represent the paperwork and administrative side of the job. Clinical counselors review notes and documentation made by other staff and handle high-level referral coordination with other treatment agencies.
- Counseling - The actual delivery of trauma-informed therapeutic care to groups and individuals experiencing the toughest road to recovery is usually reserved for clinical counselors. They also contribute to advising and mentoring other staff in prevention, treatment, and recovery counseling.
- Client, Family, and Community Education - Therapy for substance use disorders is almost always a collaborative effort. Clinical SUD counselors can marshal their advanced training to help families learn how to support patients in recovery, and work to educate the community about how to handle ongoing substance abuse crises.
- Professional and Ethical Responsibilities - In a field that comes loaded with risks and stigmas, clinical substance abuse counselors are responsible for upholding the highest standards in patient confidentiality, professional behavior, and organizational ethics.
In most cases, clinical addiction counselors will be supervising regular SUD counselors, associate counselors, and technicians as part of their duties. They, in turn, may very well report to and be overseen by independent clinical SUD counselors, the professionals at the absolute highest rung of the license ladder in the field.
While these are the basic mechanics of the job, the gritty details that you find in your own clinical SUD counseling position will depend on the population and problems you choose to work with.
Identifying Co-Occuring Mental Health Problems is at the Core of Clinical Substance Use Disorder Counseling
Clinical addiction counseling jobs may all fall into the eight dimensions SAMHSA outlines, but the reality on the ground can be very different from position to position.
One thing that is true across the board, though, is that you’ll spend most of your time carrying on conversations and making connections. You can’t help people from any walk of life or with any level of disorder unless they, and those around them, listen to what you’re saying.
As you engage with patients and the community, you’ll also put to use your training in observation and evaluation. Most people with substance use disorders don’t believe they have a problem—you have to penetrate the surface and determine what’s really really going on.
This often means encountering a whole host of co-occurring mental health problems, which presents one of the biggest conundrums in addiction therapy: which came first, the mental health problems or the substance use disorder.
From there, critical thinking and problem-solving skills go into action. No two cases are the same in any kind of SUD treatment. So counselors develop unique plans and treatment methods to reach every individual.
It also falls to clinical SUD counselors to be the primary point of contact with all the other kinds of social, medical, and human services typically needed in the addiction recovery process. They’ll be the ones on the phone with social workers, lining up a shelter bed for the night to get someone out of an encampment awash in fentanyl. They help coordinate psychiatric treatment for patients who are drifting in alcohol-induced dementia.
A Look at the Different Organizations That Hire Clinical Substance Use Disorder Counselors
Job descriptions are written by employers. In the field of addiction counseling, who you are working for makes a huge difference in how you are spending your day as a clinical counselor.
As a licensed clinical substance abuse counselor, you’ll have the right qualifications to work in any kind of treatment facility or therapy center. There are positions for clinical SUD counselors in hospitals, jails, and public health departments. Each setting offers a different slice of the many facets of substance abuse treatment.
Teen substance abuse counseling
Working with younger generations experiencing substance use disorders is some of the most vital and most rewarding work a clinical counselor can perform. In schools, dedicated treatment facilities, or group therapy, this is where you get a chance to catch addiction before it utterly destroys lives full of promise.
This is a lot of one-on-one work, getting kids away from the social pressures that influence them. It is also inherently educational in nature. Without understanding consequences or the harmful effects of alcohol, marijuana, or nicotine, it’s tough to make good decisions about their use.
Criminal justice addiction counseling
According to the National Institute on Drug Abuse, around 65 percent of the American prison population is also struggling with a substance use disorder. In many cases, this is the root of their criminal behavior. Clinical substance abuse therapists work hard to turn that around, dealing with special challenges in environment, lack of treatment resources, and official attitudes that focus on criminalizing substance use rather than handling it as a public health issue.
A lot of this is group work. With patients far outnumbering counselors, and variable timelines for working with them, it can involve a lot of triage and reliance on peer counselors under your guidance. You may work in correctional facilities directly, or with parolees or in transitional housing. This is a particularly important area for clinical counseling since a high rate of co-occuring disorders makes treatment complex.
Opioid addiction therapy
Opioids are the deadliest substances on the scene today. Data from the CDC shows opioid related deaths on top of the charts of all substance overdoses for decades. As of 2021, they were responsible for three quarters of overdose deaths. That makes them a priority for many public and private SUD treatment facilities.
Clinical treatment for opioid addictions are often a combination of medicine and behavioral therapies like CBT or contingency management. Clinical SUD therapists bring their knowledge of both the physiological and psychological elements of addiction to work every day in inpatient and outpatient therapy settings that focus on this tidal wave of both legal and illicit drugs.
Alcohol treatment centers
While opioids get all the press, there’s an even bigger killer out there in the world of substance abuse. The CDC tied alcohol back to nearly 180,000 deaths from 2020 to 2021 alone. In fact, it’s also associated with around 17 percent of opioid overdoses. And as far and away the most widely available substance prone to abuse, many people don’t even realize they have a problem with it.
Clinical SUD counselors are the experts in therapeutic approaches that break that log jam. They work in inpatient centers and with private clients and their families to stage interventions, offer education, and deliver counseling. They understand the close relationship between alcohol use disorders and suicide, and know how to head off that tragic outcome.
It can seem like a lot more than just 12 steps to beating an alcohol use disorder, but clinical addiction counselors are there no matter how long it takes.
There are many other focus areas in the industry, ranging from gender-based addiction care to homeless outreach. Each of them offers a different set of challenges for the unique clinical treatment capabilities you will put together for this role.
Clinical Addiction Counselor Salary – How Much Do Clinical Addiction Counselors Make?
Although this isn’t a field that anyone goes into for the money, clinical SUD counselors come in toward the top end of the pay range.
That’s very likely to put jobs filling those role at least into the top 25 percent of all substance abuse counseling jobs. According to Bureau of Labor Statistics data from 2023, that works out to an annual salary of $70,130.
With the right experience and education behind you, over time you can expect to work your way up the ladder, too. The top ten percent of substance abuse counselors can make more than $89,920 per year.
That all depends on a few factors beyond your individual skills and training, however. Different industries have different baselines when it comes to salary. For example, the top industries where clinical SUD counselors work pay the following median salaries:
- Hospitals - $59,090
- Offices of other health practitioners - $55,410
- Outpatient mental health and substance abuse centers - $51,130
- Individual and family services - $51,010
- Residential mental health and substance abuse facilities - $46,880
Different parts of the country also have different economic factors influencing clinical substance abuse treatment funding and paychecks. It can depend on local or regional challenges, political support, and even the type of substances most often abused. While it’s tough to generalize at the clinical level, you can check job listings in areas where you might like to practice to see what the differences are.
A Master’s Degree and Years of Experience Gives Clinical Addiction Counselors the Edge in Treating Complex Substance Abuse Cases
What differentiates clinical addiction counselors from other roles in substance use disorder treatment is the advanced expertise in interdisciplinary treatment models. How that is defined exactly comes down to the licensing or certification model each state uses for the position.
That is generally covered by five points of qualification. The SAMHSA model identifies the ideal set of qualifications for each of these factors. Each state, however, may have very different requirements in one or all of these categories:
- Level of degree - A master’s degree is the most common requirement, although it does not need to be in SUD counseling in particular—an MA in social work, mental health counseling, or psychology is often accepted. A very few states accept anything less.
- Specific education hours - At least 300 hours of specific SUD training are required as part of or in addition to a master’s degree. Many states, however, require far less, as few as 40 in some cases.
- Number of practice hours - Most states hit at least the ideal of 3,000 hours of supervised on-the-job experience in SUD counseling, with at least 2,000 of those in direct patient contact. Many go much higher—6,000 or more in some cases.
- Number of supervision hours - Making the most of those hours requires supervision, of which anywhere from 100 to 300 hours may be needed.
- Standardized tests - Most states rely on one of two different standardized exams for clinical counseling roles. The Master Addiction Counselor (MAC) exam from NAADAC or the Advanced Alcohol & Drug Counselor exam from IC&RC are most often used. Some states may have their own unique test, generally very similar to the standards; others accept other IC&RC or NAADAC tests, or even the other MAC, Master Addiction Counselor exam from NBCC, the National Board for Certified Counselors.
Only 40 states have a license offered at this level. In 14, it is the highest level of SUD counseling license available. In others, it may only be a temporary credential, to authorize you for advanced practice while you are accumulating hours toward the peak independent clinical SUD counseling license.
An Advanced Degree Builds Your Expertise in Clinical Counseling and Addictions Therapy
The single most significant way that clinical SUD counselors are prepared for the job is through earning a master’s degree in the field.
This is a step that puts clinical substance abuse counselors at the same level of preparation and expertise as licensed clinical social workers or licensed professional counselors. The year or two of study at the highest levels of diagnosis, treatment, and interdisciplinary approaches to addiction counseling give you next-level preparation to help patients climb out of the deepest, darkest throes of addiction.
When you get that phone call at 3am from a patient on their very last dangling thread of connection to sobriety, a bottle sitting on the table in front of them, you need something deep and wise to draw on to talk them down. When a junior counselor comes to you with a family that has been put through the shredder by a child addicted to prescription painkillers, you have to have case studies, referral resources, and treatment techniques to draw on as well as an ocean of compassion.
You get that expertise through a Master of Science in Addiction Counseling, a Master of Arts in Addiction Studies, or similarly focused degrees. It’s also common to find related majors that offer specific concentrations in substance use disorders. A Master of Science in Psychology with a Concentration in Addictions, or Master of Arts in Professional Mental Health Counseling Addictions Specialization will come with much of the same coursework.
Naturally, you need to make sure that you are meeting the required educational hours for a clinical SUD counseling license in your state. If for whatever reason your degree doesn’t have that coursework, it’s possible to continue on with a Graduate Certificate in Addiction and Substance Use Related Disorders, or even a post-graduate version that checks the box.
Putting in Years of Experience Allows You to Hone Your Addiction Counseling Skills
Book learning only ever goes so far when it comes to complex problems like substance use disorders. So the time you spend putting your expertise to use under the watchful eye of professors and practicing clinical SUD counselors is the other half of the key qualifications for this level of practice.
Master’s programs in SUD counseling recognize this necessity and usually include significant practicum or internship placements as part of your studies. You’ll carefully integrate your classroom training with real-world applications of theory and technique.
These hours will usually count toward your license requirements, as well, but they aren’t typically going to be enough to qualify you at the clinical level. Instead, you will have to continue on after graduation, working at a lower license level or in other ways accepted by your state to build clinical contact hours under supervision.
Degree Requirements To Become a Licensed Clinical Substance Abuse Counselor in Your State
Although a master’s degree is the most common level of education required for licensure in these positions, that’s not true in every state. It’s definitely something you’re going to want to know about before you get started down that educational path. So we’ve put together a grid for you, listing each state that has a clinical SUD counseling license, along with the degree requirements for that credential.
States that don’t have a license at this level show NA in the title column; those that do have a license but don’t list a specific degree requirement are identified accordingly in the degree column.
State | Titles | Degrees |
Alaska | Chemical Dependency Counselor II | No Degree Required, but Earning a Degree at Any Level Can Reduce Experience Hour Requirements |
Alabama | Qualified Substance Abuse Professional I | Master’s |
Arkansas | Advanced Certified Alcohol & Drug Counselor | Master’s |
Arizona | Advanced Alcohol & Drug Abuse Counselor | Master’s |
California | Licensed Advanced Alcohol Drug Counselor/Substance Use Disorder Certified Counselor-Advanced | Master’s/Master’s |
Colorado | NA | |
Connecticut | Certified Addiction Counselor | Degree Level Not Specified |
Washington DC | Advanced Certified Alcohol & Drug Counselor/Certified Addiction Counselor II | Degree Level Not Specified/Bachelor’s |
Delaware | Certified Advanced Certified Alcohol & Drug Counselor | Master’s |
Florida | Certified Master’s Level Addiction Professional | Master’s |
Georgia | Certified Certified Alcohol & Drug Counselor/Certified Addiction Counselor II | Bachelor’s/Bachelor’s |
Hawaii | Certified Substance Abuse Counselor | No Degree Required |
Iowa | International Advanced Alcohol & Drug Counselor | No Degree Required |
Idaho | Advanced Certified Alcohol-Drug Counselor | Master’s |
Illinois | Certified Advanced Alcohol & Other Drug Counselor | Master’s |
Indiana | Licensed Clinical Addiction Counselor Associate/Certified Alcoholism & Drug Abuse Counselor IV | Master’s/Bachelor’s |
Kansas | Licensed Masters Addiction Counselor | Master’s |
Kentucky | Licensed Clinical Alcohol & Drug Counselor Associate | Master’s |
Louisiana | Certified Advanced Alcohol & Drug Counselor | Master’s |
Massachusetts | Licensed Alcohol & Drug Counselor II | No Degree Required |
Maryland | Licensed Graduate Alcohol & Drug Counselor | Master’s |
Maine | Licensed Alcohol & Drug Counselor | No Degree Required |
Michigan | Certified Advanced Alcohol & Drug Counselor | Master’s |
Minnesota | Licensed Alcohol & Drug Counselor | Bachelor’s |
Missouri | Certified Alcohol Drug Counselor | Master’s |
Mississippi | Certified Alcohol & Drug Counselor II/Provisionally Certified Addictions Therapist | Master’s/Master’s |
Montana | NA | |
North Carolina | NA | |
North Dakota | Licensed Clinical Addiction Counselor | Bachelor’s |
Nebraska | NA | |
New Hampshire | Licensed Alcohol & Drug Counselor | Associate |
New Jersey | NA | |
New Mexico | Certified Alcohol & Drug Counselor | Degree Level Not Specified |
Nevada | Licensed Alcohol & Drug Abuse Counselor | Master’s |
New York | Master Credentialed Alcoholism & Substance Abuse Counselor | Master’s |
Ohio | Licensed Chemical Dependency Counselor III | Bachelor’s |
Oklahoma | NA | |
Oregon | NA | |
Pennsylvania | Certified Alcohol & Drug Counselor | Bachelor’s |
Rhode Island | Licensed Chemical Dependency Professional/Certified Advanced Alcohol & Drug Counselor | No Degree Required/Master |
South Carolina | Certified Addictions Counselor II | Bachelor’s |
South Dakota | NA | |
Tennessee | NA | |
Texas | Licensed Chemical Dependency Counselor | Associate |
Utah | Licensed Advanced Substance Use Disorder Counselor/Advanced Alcohol & Drug Counselor | Bachelor’s/Master |
Virginia | Certified Advanced Alcohol & Drug Counselor | Master’s |
Vermont | NA | |
Washington | Substance Use Disorder Professional | Associate |
Wisconsin | Clinical Substance Abuse Counselor | Associate |
West Virginia | NA | |
Wyoming | Provisional Addictions Therapist | Master’s |
Some states have more than one credential at this level, offering different paths to practice authorization. Some states may also offer separate tracks or offer practice authority to professionals who are already licensed for clinical counseling in similar fields, like a licensed clinical social worker or licensed clinical mental health counselor.
In other cases, states use licenses at this level as a provisional credential so you are covered as you are building your practice hours toward the next level: independent clinical SUD counselors. In those cases, these licenses aren’t intended to be permanently held, and may not be renewable. You’ll usually see provisional or associate in the title where that’s the case.
Coming to Clinical Substance Abuse Counseling From Other Professional Paths
Licensed clinical substance abuse counselors aren’t the only clinical professionals who are dealing with addiction disorders. These treatments also fall into the wheelhouse of professions like social work, psychology, marriage and family therapy, and even more general mental health counseling.
State practice laws take on these intersections in various ways.
- Some states allow licensed professionals in related areas to practice substance use disorder therapy without any additional qualification or official endorsements, as a part of their existing license authority
- Other states require that even currently licensed professionals earn an additional license as a clinical SUD counselor, although often with some abbreviated educational and practice hour requirements
- A few states offer specific licensees in areas like co-occuring disorders that are available to existing professionals whose practice overlaps with chemical dependency counseling
In almost all cases, the kind of advanced qualifications for jobs like LCSW (Licensed Clinical Social Worker) and LMHC (Licensed Mental Health Counselor) already include a master’s degree that will be accepted for clinical SUD counseling licensure. Since required educational hours can often be covered in certificate programs that also cover continuing education requirements for those credentials, it’s very common to find people who combine licenses in both fields.
Taking Your Clinical Counseling Degree Further With National Certification
NAADAC, the Association for Addiction Professionals, and IC&RC, the International Certification and Reciprocity Consortium, do more than just provide standardized tests for counselor licensing. Those tests are also associated with professional certifications that can extend your qualification and expertise as a clinical counselor in almost any state.
IC&RC’s Certified Advanced Alcohol & Drug Counselor credential is awarded by affiliated state-level boards, not by the national organization itself. While each of those state boards has to at least hit the minimum requirements specified by IC&RC, they are also free to set their own standards. While they don’t all match, the CAADC is generally accepted by all states that recognize IC&RC credentials.
NAADAC’s approach is a little different. Their MAC (Master Addiction Counselor) credential is only offered nationally and has the same standards for everyone:
- Master’s degree or higher in SUD treatment or a related field
- A current credential or license in SUD or a related field
- At least 6,000 hours of supervised experience as a substance abuse counselor
- A minimum of 500 contact hours of education and training, with six each of ethics and HIV/pathogen training
- A passing score on the MAC, AADC, or eMAC (NBCC) exam
Some states accept these certifications as qualification for licensing or practice authority in the first place. That’s particularly useful if you are moving to a new area after already getting licensed somewhere else in the country.
Specialist Certifications Show Your Expertise in Specific Areas of Clinical Addiction Counseling
Clinical SUD counselors are also working at a high enough level they may be exploring specializations in substance abuse counseling. There are certifications available in some of those areas, too, like NAADAC’s National Certified Adolescent Addiction Counselor or National Certification in Nicotine and Tobacco Treatment. IC&RC offers a Certified Criminal Justice Addictions Professional credential.
Both organizations also have certifications for Clinical Supervisors. These aren’t strictly required to provide clinical supervision in each state, but some states do recognize them as meeting qualifications for officially providing supervision hours to other counselors. Since that’s a common part of the job for licensed clinical SUD counselors, picking up your IC&RC Clinical Supervisor (CS) or NAADAC National Clinical Supervision Endorsement (NCSE) is a natural step on the career path for many.
The requirements for the CS are also set by state boards, but are typically similar to the NCSE:
- Bachelor’s degree or higher in SUD or a counseling-related major
- Current credential to practice SUD counseling
- At least 5 years full-time work as a SUD counselor, with a minimum of 4,000 hours performing direct clinical supervision, and another 200 hours receiving supervision as a clinical supervisor
- At least 30 contact hours of specific training in SUD counseling supervision, with six hours each in ethics and HIV/pathogen training
- Passing the National Clinical Supervision Endorsement exam or the AADC and CS exams from IC&RC
Clinical SUD counselors are in a good position to pay back the wisdom and compassion they drew on to get to the level of practice they have achieved. It’s a role where you’ll find yourself not just lifting patients out of despair and disease, but also lifting junior counselors and technicians to new levels of expertise.
In a country that needs experts in addiction therapy more than ever, this is a job that allows you to do more good than most.
2023 US Bureau of Labor Statistics salary and employment figures for Substance Abuse, Behavioral Disorder, and Mental Health Counselors reflect national data, not school-specific information. Conditions in your area may vary. Data accessed April 2024.