Substance Abuse Counseling: An Interview

An interview with JS, a substance abuse counselor who works with people from all walks of life.

JS is a certified substance abuse counselor who works at a residential treatment center in northern Virginia. The following article is about his work, thoughts on relapse, what it’s like to lose a client, stigma, and valuable advice for anyone considering a career in addiction counseling.


Interview: “They Are Just People”

JS works at an intermediate-length residential center for adults with substance use and mental health disorders. The clients live in shared dorms and adhere to a daily schedule that includes counseling, psychoeducation, groups, 12-step meetings, and medication therapy.

Once a client successfully completes the inpatient portion of treatment, they transition to “re-entry.” In re-entry, clients reside in sober living homes and receive continuing care services. They are able to look for employment, start working, and “re-enter” the larger community. JS provides counseling and support services for this component.

Inspired to help

JS has personal experience with addiction. “I am a person in recovery… About a decade ago I found myself in a very dark place and had to get help… I met a substance abuse counselor [who] changed my life. He educated me, engaged me, and challenged me. He was instrumental in turning my life around.”

With his counselor’s encouragement and support, JS made the decision to get back on track. He realized that he wanted to help others who struggled. “My own experiences with addiction allow me to have an incredibly deep empathy for the clients I serve and the fulfillment I receive in return is unreal.”

“Addiction does not discriminate”

JS works with people from all walks of life. He’s worked with individuals who are homeless to young fathers to successful businessmen; from people in their teens to adults in their late 80’s. “There is no age, sex, gender, race, sexual orientation, religion, occupation, or economic class that is safe from addiction.”

As for the substances abused, the list is never ending, but JS regularly sees people addicted to alcohol, opiates (including heroin), cocaine, methamphetamine, and PCP. Many of the clients he counsels also have mental illness such as depression, anxiety, or bipolar disorder.

No typical days

According to JS, “typical” days don’t exist where he works. “There is no way to describe a typical day in this field. One day I could be [providing therapy] and another day could involve a trip to the emergency room or helping out with chores… I never know what to expect and I never get bored.”

Effective treatment planning is important for substance abuse counselors; JS meets with his clients to develop an individualized service plan. Clients come up with their own goals, and JS supplies interventions to help them achieve their goals over the next couple of months.

According to JS, client goals vary, ranging from attending 12-meetings to obtaining a driver’s license to enrolling in school; basically, a goal can be any life skill a person may need for success. Corresponding interventions could include providing bus tokens to get to AA meetings, linking to driving school, and helping to fill out college applications and apply for financial aid.

JS explained that adults who have been incarcerated or dealing drugs for a living miss out on major milestones such as learning to drive, attending college, renting an apartment, etc. Furthermore, basic skills that many of us take for granted, such as filling out an online form or depositing a check can be overwhelming for someone newly in recovery who never learned how.

JS meets with his clients at least once per week for therapy sessions. I asked what comes up in a typical session and his response was “anything and everything.” Sessions may involve reviewing goals, learning coping skills, poop jokes (his clients are all men), or processing childhood trauma.

Substance abuse and relapse

“Not good” was JS’s response when I asked what the success rate was for someone who completes re-entry. He explained that this is a reflection of the general rates of recovery in substance abuse, which are low. “It can be disheartening, working with someone for months and when they leave, they relapse in less than a week.”

JS explained that while relapse is a deterrent to the field for some counselors, he sees it differently. “For me, it will never be a deterrent. My battle with addiction was not easy, nor was it accomplished in a single attempt. Relapse is a part of my story. I would not be here if people gave up or lost hope that I could get better. For that, I will never give up or lose hope that my clients can recover, no matter how many times they relapse.”

For JS, losing a client, not relapse, is the hardest part of the job. “I’ve worked with many clients who didn’t make it. I’ve lost clients to overdose, suicide, and homicide. It never gets easier.”

JS grieves for his lost clients. “I find myself wading through the stages of grief until I reach some level of acceptance.”

What everyone needs to know about substance abuse

“The people I work with are just people. They are your sister, your cousin, your neighbor, or the guy in line at the grocery store. They are people with families, jobs, hobbies, and dreams.”

JS discussed ignorance and stigma; he shared that individuals with substance use disorders are often subjected to mistreatment, even from professionals in the field. “There are substance abuse counselors who perpetuate harmful addiction myths, once widely accepted as fact, but discredited by the scientific community decades ago.”

JS shared examples of common myths:

  • “All addicts are liars.”
  • “Addicts are lazy and selfish.”
  • “It’s not a disease, it’s a choice.”

“The lack of compassion when it comes to substance abuse is mindboggling and painful to encounter. Often, it stems from a lack of understanding or knowledge about substance abuse and those with substance use disorders. They are just people who are struggling with something far beyond their control. And those in treatment? They are just people trying to get better. And in case I didn’t make it clear; they are just people.”

Advice for new substance abuse counselors

“Be willing to learn. The field of addiction treatment is constantly changing. Standard practices from 20 years ago are now ineffective and outdated. If you want to do this work, be open to learning the newest treatment models, medications, and research on addiction. This field is not static, and we do our clients a major disservice when we quit learning.”

As a last piece of advice, JS suggested self-care for substance abuse counselors as a way to combat burnout. “Identify ways to decompress. This job is not easy. Some of the people you help will die. Compassion fatigue is a real thing and you must take care of yourself to care for others.”

“They are just people.”

JS