What Is Addiction Counseling?

Addiction is one of the most common behavioral health conditions impacting millions of Americans every day. One of the most impactful strategies to treat addiction is substance use counseling, also called addiction counseling.

Addiction counseling is a scientifically researched and developed treatment for those with substance use disorders. It is generally done with an educated and experienced counselor who provides direct feedback and education about the disease of addiction and the recovery process.

Counselors are an important part of addiction therapy, and their role and involvement in the treatment process is instrumental to recovery.

Addiction counseling can be found in almost all inpatient and outpatient treatment programs. Many people’s first experience working with a substance use counselor will be at a local detox center or treatment program after coming to terms with their substance use problem. Most addiction counselors have a bachelor’s or master’s degree and have proper credentials as certified or licensed addiction counselors, licensed professional counselors, licensed clinical social workers, licensed psychologists, or similar credentials.

Some counselors are primarily focused on substance use. Their credentials will be directed primarily at treating substance use disorders. Others may also have the expertise to treat co-occurring conditions such as depression or anxiety disorders simultaneously (dual diagnosis). Many programs operate in teams of counselors, therapists, medical providers, and others, so it’s important to know who can help with what during substance use counseling. Once the relationship is started, the process of healing and finding recovery can begin.

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How Does Counseling Work?

The process of substance use counseling is similar to other types of therapy. First, they both involve a counselor and an individual building a safe relationship through conversation, learning about the individuals’ experiences with substances, understanding their goals, and developing a plan of action to help meet those goals. Both addiction counseling and therapy assist with learning how to establish healthy relationships in recovery by reconnecting with important family/friends or through peer support network building.

Everyone has different needs, which means the counseling process will look different from person to person. Still, it uses the same framework to develop a safe method of making progress into recovery-oriented living. It is important to note that while counseling can provide education and different strategies to improve overall wellness, it does not provide advice or instructions on how to live life, so the decision on what happens in a session is always the individual’s.

I contribute hard work, and my friends at AA, for helping me stay sober. I’m still in contact with my counselor at the Greenhouse, my rehab. I love talking to other recovering addicts.

- Janis J, recovering addict

When starting addiction counseling, the counselor will ask a variety of questions focused on things like family history, childhood experiences, life skills development, and other life experiences involving substance use. They will also review medical history, mental health conditions, family support, relationship dynamics, relapse potential, and external stressors such as finances or legal system concerns.

After this initial assessment, the addiction counselor will begin discussing goals the individual would like to achieve and potential needs that the counselor has observed. When all these concepts are incorporated together, a treatment plan is established. The treatment plan is the list of goals that will be addressed during the treatment period.

Treatment plans for substance use disorders are often developed using the American Society of Addiction Medicine (ASAM) framework. This framework uses six dimensions that help to ensure every important area of one’s life is being assessed and having proper goals set if needed. Once the treatment plan is in place, the counselor and individual can begin to work on the identified goals.

Dimension I: Acute Intoxication/ Withdrawal Potential Reviewing current or past substance use concerns and need for potential medical treatment. The counselor may perform this, but it often is an important element of medical assessment with a medical provider.
Dimension II: Biomedical Conditions & Complications Reviewing health history and potential complications to treatment that need to be addressed.
Dimension III: Emotional, Behavioral, and Cognitive Conditions Reviewing mental health history needs and assigning a treatment team to assist.
Dimension IV: Readiness to Change Reviewing motivations for change and current readiness to act includes understanding what detracts from motivation as well.
Dimension V: Relapse, Continued Use, or Continued Problem Potential Reviewing potential relapse triggers, current substance use, or other concerns that may require additional attention.
Dimension VI: Recovering/Living Environment Reviewing the current living situation, the safety of the living environment for recovery, and other potential concerns that may impact one’s treatment.

Working on these goals is usually done through individual and group therapy settings. Group therapy for substance use is one of the most useful types of therapy, as it provides the greatest ability to build positive sober relationships while also not feeling alone. Most counselors will perform individual and group therapy with their clients to help find the best mixture of topics and issues to be addressed.

Types Of Counseling

Beyond group therapy, individual therapy can incorporate various treatment models based on the counselor’s training and credentials. Some of the more commonly used therapies include some of the following.

Biofeedback And Neurofeedback

Biofeedback and neurofeedback therapies use active displays of an individual’s physical vital signs, including blood pressure, respiration rate, and pulse. These vitals are directly connected to managing discomfort, including anxiety and stressful situations. An addiction counselor can use these therapies to help teach individuals that how they feel physically can impact how they feel emotionally. Through conditioning, the counselor can help improve their patient’s control over their physical and vital signs to improve their emotional regulation.

Cognitive Behavioral Therapy (CBT)

CBT is a long-standing, evidence-based treatment that has proven effective in helping addiction and mental health conditions. CBT has many different forms; however, they primarily focus on the relationships between thoughts, emotions, and behaviors. By learning how each interacts with the other, the individual can improve their experience by managing each thought, emotion, and behavior more effectively. This is commonly used when working through substance use triggers and negative thoughts.

Dialectical Behavior Therapy (DBT)

DBT is another long-standing, evidenced-based model similar to CBT. It works for various substance use and mental health conditions by teaching individuals how to manage discomfort and distress while it occurs at the moment. In addition, DBT helps teach coping strategies to manage stress and regular emotions healthily. Again, this can impact substance use, where stress tolerance is often very low in early recovery.

Motivational Interviewing (MI)

MI is a therapy that focuses on finding the motivation to complete the goals that someone has identified. In addition, it works on recognizing what stage of change someone is currently in and what they would need to take the next step in finding their goal. MI is often found in substance use treatment as motivation is a tricky topic for many, with external factors often placing people in treatment in the first place. Finding an internal factor is crucial in recovery, which counselors utilizing MI work to establish.

Eye Movement Desensitization And Reprocessing (EMDR)

This therapy was designed to treat and address trauma-based conditions. It works by utilizing bilateral stimulation (eye movements) and working through a system of memories connected to that trauma. EMDR is structured and standardized, which requires additional training on the counselor’s part. It is helpful for those who have experienced trauma at any age and has other “protocols” which allow it to be used in treating substance use disorders, often through reducing triggers for substance use. Many people who struggle with a substance use disorder also have underlying trauma concerns.

Meditation, Guided Imagery, And Mindfulness

Mindfulness is an umbrella term for many of these exercises, including meditation and guided imagery. These are fewer therapies and more techniques in multiple therapy practices, especially DBT. They are used primarily to proactively reduce anxiety symptoms and improve an individual’s ability to be present. The use of mindfulness in recovery has been researched for many years, and many have found it helpful during recovery.

Holistic Therapies

In addition to traditional treatment methods, holistic therapy helps patients practice introspection and learn healthy coping skills. It also gives patients who are not comfortable opening up in traditional therapy sessions a way to communicate their deepest fears and issues in a non-threatening manner. A few forms of holistic therapy that can be useful in treating addictions are yoga, art therapy, music therapy, and equine therapy.

The Importance Of Starting Counseling

Finding support can be difficult, especially when there may not be others around who understand your situations and experiences. Addiction counseling is beneficial for anyone struggling with a substance use disorder and who may feel alone or lost in their struggles. Having a direct line of support who can help provide care and offer potential options to assist in reducing the stress of early recovery can be essential in maintaining long-term recovery.

Oftentimes, the hardest part of getting help is asking for it. For many, this obstacle can be the only thing between them and sobriety. Fortunately, the popularity of online therapy in recent years has greatly improved addiction counseling access for millions of people. Online therapy can not only be a helpful tool for dealing with the mental health concerns of addiction, but it can also be a stepping stone for those who may be wary of taking those first steps toward treatment. If you or someone you know is currently struggling with a substance use disorder and believe addiction counseling may be the next step, please start the journey for a better tomorrow by contacting a therapist today.

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