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What does a Substance Abuse Therapist do?

By Caitlin Kenney
Updated May 17, 2024
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A substance abuse therapist evaluates and treats people struggling with addictions to alcohol or other drugs. The job is emotionally strenuous and most employers are looking for a counselor with patience, compassion, and a good deal of staying power. Often, counselors are also expected to have a bachelor’s or even a masters’s degree, though it is possible to get certified as a substance abuse therapist with a two-year degree or high school diploma and work experience.

A substance abuse therapist may specialize in family counseling, private sessions, group sessions, teen counseling, preventative education, assessment, and criminal justice. This job may also include working with people who have gambling problems or eating disorders. The place of employment may also vary, including hospital setting, private practice, addiction treatment centers, detoxification (detox) centers, therapeutic communities or half-way houses, correctional facilities, and mental health agencies. The pay for substance abuse counselors tends to be fairly low, usually depending on their level of education, and the time commitment tends to be in the range of 40 hours per week.

The daily work of a substance abuse therapist depends on the demographic the counselor is working with and the place of employment. Generally, the counselor will begin by evaluating the client’s history and level of addiction, from which point the counselor can decide on a level of treatment or refer the client to another care provider, if necessary. The substance abuse therapist may also conduct follow-up care, as addicts often suffer from recidivism, and help the client get or keep his or her job.

During the evaluation, the counselor will establish the level of addiction. The substance abuse therapist will try to find out how deeply the addiction is affecting the client’s ability to function and live a healthy life, whether the client is aware of or in denial of the addiction, what sort of problematic behavior is associated with the substance abuse. When the client cannot or will not admit to misusing drugs, the therapist may use the evaluation to establish the addiction and figure out what sort of substance the client is abusing. With this information, the substance abuse therapist can then decide which treatment to pursue.

The treatment choice depends heavily on the type and level of substance abuse, the attitude of the client, and the training of the therapist. Some common treatments include community reinforcement approach (CRA), cognitive behavioral therapy (CBT), motivational interviewing (MI), and developing coping skills. Community reinforcement approach gets the client involved in a club that removes support for harmful behavior and rewards sobriety.

Counselors may also get clients to talk through their dysfunctions using CBT, or try to influence their clients to come to their own decision to change their lives with motivational interviewing. The substance abuse therapist may also help the client identify high-risk situations that might encourage backsliding, such as loneliness, going to the bar, or being around a certain group of friends, so that the client can avoid these situations. This is one coping skill, along with learning to relax, or take up other activities that help take the client’s mind off the drug.

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