What Does a Substance Abuse Counselor Do?

In the most basic sense, you can break down a substance abuse counselor’s job responsibilities into the 12 Core Functions originally developed more than 40 years ago:

These functions were fleshed out further some years later with Global Criteria that detail the more rote steps substance abuse counselors take within each function – everything from specific documentation requirements to selecting treatment methods to referring back to applicable laws.

You get the point: substance abuse counselors have a lot of different roles and daily activities on their plate. But no matter what the official processes look like, all the functions and criteria are ultimately there to help substance abuse counselors serve as a critical resource and touchpoint that patients and their families can turn to when walking the path to recovery.

The Work Substance Abuse Counselors Do Between the Lines of the 12 Functions Framework

While the 12 Functions establish a framework for what substance abuse counselors do everyday, some of the most important aspects of the job may be invisible to patients.

Counselors are in fact trained to constantly be observing and assessing – tracking eyeball movements, finding tell-tale stains on skin or clothing, or sensing the faint odor of mints covering up alcohol on the breath. All of this becomes second nature for substance abuse counselors. Formal tests, like the Drug Use Disorders Identification Test (DUDIT) and the Alcohol Use Disorders Identification Test (AUDIT) are also in their assessment toolbox.

This information goes into treatment planning. The plan is constantly being revised, approved by supervisors, and integrated and coordinated with other service providers. Arranging for other kinds of supports is often critical to effective substance abuse therapy: a client who is constantly seeking illicit medication for chronic pain needs medical care to deal with the primary issue first, for example.

Particularly at clinical levels, substance abuse counselors provide more complete and complex treatments. Working with physicians, they can develop treatment plans that involve the prescription of other drugs, such as naltrexone for alcohol use disorders, or methadone to block the effects of opioids.

Patients may get psychotherapy, getting to the roots of other issues driving their addiction. And counselors can come up with small but practical tips and tricks to get patients through the day… meditation techniques, substitution exercises, or developing safety plans.

Through phone conversations, group therapy sessions, or in-person visits, the job of addiction counseling involves a lot of personal contact and conversation.

There is also a steady stream of personalized affirmation and motivation flowing to the client according to that treatment plan. They need to hear that they are worthwhile and worth saving.

Considering the scale of substance use disorders in America, much of the treatment offered by addiction therapists comes through group counseling sessions.

The Places Where Substance Abuse Counselors Perform Their Vital Work

The natural domain for substance abuse counselor jobs is in the human services industry. This complex web of agencies, non-profits, and contractors revolves around dealing with social problems and supporting individuals who have fallen through the cracks. Substance use disorder patients make up a substantial number of those people.

Substance abuse counselors are an important piece of the human services sector. They also rely on other services within it to assist with critical housing, healthcare, and food supply needs without which many clients cannot recover.

According to SAMHSA’s 2022 National Survey on Drug Use and Health, almost 60 percent of Americans over the age of 12 reported having used tobacco, alcohol, or some illicit drug in the month prior to the survey.

Not all of those uses are abuses. But SAMHSA estimates that around 20 percent of them are experiencing substance use disorders in need of treatment… and that less than 5 percent of them receive it.

According to Market Research.com, the drug and alcohol addiction treatment industry was worth $42 billion in 2020 and only poised for more growth for the foreseeable future. By 2025, it’s projected to be worth $53 billion, primarily funded by states and private insurers.

Substance abuse counselors take to the streets and to people’s homes… and also offer their services remotely.

Although the funding comes through state government initiatives in most cases, it’s becoming more common to see addiction counselors working in dedicated treatment facilities that are privately owned. These clinics frequently specialize in specific forms of addiction.

Treatment for everything from prescription painkillers like Oxycontin to illicitly manufactured street-grade synthetic opioids like Fentanyl are in particularly high demand these days. Alcohol addiction continues to be a perennial and growing problem, but one that is getting less media attention in recent years, overshadowed by the opioid addiction crisis.

The places where substance use disorder counselors work, and the treatment styles that go with them, fall into several categories that help define job responsibilities in different setting:

Outpatient - Like other clinics, patients visit for appointments but primarily engage in activities of daily living outside the oversight of counselors.
Inpatient - Inpatient treatment is more intensive, often similar to a hospital or nursing facility. Counselors oversee almost all aspects of daily routine, interspersed with formal therapy or treatments.
Residential - Residential facilities are more long-term than other inpatient programs and often offer more flexibility. They bring together groups of patients who may continue to work and have other outside activities. But with on-site counselor supervision, participants assist one another in their recovery efforts. Sober houses and other recovery facilities may fit this description.
Interim/Emergency - There simply aren’t enough slots for every patient in the system, so some counselors work out in the field and focus on putting out fires as individuals experience substance-induce crisis situations, including episodes of psychosis. This can include outreach efforts in homeless camps, or serving as counselor at a medical facility.

There are even increasing numbers of substance abuse counselors who are working remotely these days. While it’s a field that is notoriously important for having a personal touch, the necessity of delivering safe services during the COVID-19 pandemic created a crash course in telehealth treatment.

Data published in the Journal of Substance Use & Addiction Treatment (JSAT) has shown that remote substance abuse counselors can be very effective. With the flexibility and cost advantages remote services offer, it’s a trend that is likely to take off even further in the future.

Education and Prevention are Often Overlooked Job Duties in Substance Abuse Counseling

Anchored in the TAP-21 competency standards for all substance abuse counselors, community education is a duty that people outside the profession often overlook.

Provide culturally relevant formal and informal education programs that raise awareness and support substance abuse prevention and the recovery process.

~ SAMHSA Technical Assistance Publication Series 21 Competency 99

While it’s not as dramatic as the work they do putting Naloxone up the nostrils of dying overdose victims, it is often even more important. The hard work of helping a patient through recovery can take years of time and effort. The right information landing in their ears before they become addicted can save them and the system from all that pain and expense.

There is a separate career in most states for substance abuse prevention specialists. These professionals do not have any authority to treat SUD cases, however.

This is also critical in enlisting family and friends to provide support on the path to recovery. Even the best addiction counselor can’t be on the job 24/7 or available in every moment of weakness. It takes a village, and counselors have to help train the villagers how to offer critical support for patients.