What Is Substance Abuse Counseling and How Does it Intersect with Applied Behavior Analysis?

We are in the midst of an opioid epidemic, and the statistics are bleak.

Each and every day, more than 130 people in the U.S. die from an opioid overdose, according to the National Institute of Drug Abuse. In 2017, the total number of Americans who died as a result of overdosing on opioids reached 47,000. To fully understand the extent of this crisis, it’s important to recognize that there are still an estimated 1.7 million Americans addicted to opioids and another 652,000 addicted to heroin.

But it doesn’t end there. According to a 2017 National Survey on Drug Use and Health, about 14.4 million adults ages 18 and older have alcohol use disorder (AUD) and nearly 21 million Americans have some type of substance addiction.

Now more than ever, the United States needs an army of qualified professionals who can help those suffering from addiction achieve a life free of drug and alcohol abuse. Counseling plays an important role in beating addiction, and is proven to be a key element for maintaining sobriety for any length of time.

Substance abuse counseling, when combined with other forms of treatment and services, helps those suffering from addiction—and the people who love them—recover and heal.

One of the most interesting additions to addiction counseling in recent years is behavior therapy. When addiction is viewed as both a neurological disease and a learned behavior, a number of treatments emerge, including cognitive behavior therapy (CBT) and applied behavior analysis (ABA). Focusing on the negative behaviors that support addiction, substance abuse counselors can utilize a variety of therapies, including positive and negative reinforcement, motivation for change, and delayed discounting, to introduce or encourage (reinforce) positive behaviors that replace negative, addictive behaviors.

What is Substance Abuse Counseling? Understanding Addiction and How it is Treated

Substance abuse counseling, also often referred to as addiction counseling, is a course of education, coaching, and support designed to help those recovering from addiction better understand the root of their addiction as they adopt new lifestyles changes, practices, and coping skills.

Substance abuse counseling is just one part of the recovery process and is often used in conjunction with other forms of psychotherapy, medical treatments, and medications provided by other members of the healthcare community.

Emotional support is one of the most important facets of substance abuse counseling. While the goal of this type of counseling is to help addicts better understand the behaviors, attitudes, and feelings that fuel their addiction and then to help them implement positive changes designed to break those unhealthy cycles, it’s often the supportive nature of this type of counseling that makes it a valuable and unique addition to any recovery plan.

The Role of Counseling in the Treatment of Addiction

According to the American Society of Addiction Medicine (ASAM), alcohol and drug dependence/addiction is now recognized as a “primary, chronic disease of brain reward, motivation, memory and related circuitry” which, like other chronic diseases such as hypertension, asthma, or diabetes, may involve periods of remission – this is essentially what substance abuse counselors call relapse. As such, substance abuse is not viewed as something that can be cured; rather, it can be successfully managed through a number of proven interventions and therapies.

What causes some people to become addicts and others to not is still not fully understood; however, the environment, psychological traits, stress levels, and genetics all play a part. The use of drugs and alcohol actually changes the brain in profound and lasting ways, making recovery a complex and often difficult process.

Most recovery programs are multi-faceted, involving a team of medical and mental health practitioners (including social workers, doctors, nurses, psychologists, psychiatrists, and more) and treatments that often occur both on an inpatient and outpatient basis.

Substance abuse counseling in the recovery process can prove extremely valuable because addiction is far more than a physical compulsion; it’s one that is often influenced by psychological and mental health issues, maladaptive behaviors, negative attitudes, destructive lifestyle choices, and poor coping skills.

The Use of Behavior Therapy in Addiction Treatment

Utilizing behavior therapies in substance abuse counseling allows patients to explore their feelings and negative thoughts, come to terms with the effects of their addiction, improve their awareness of undesirable thoughts and behaviors, and actively engage in a long-term, individualized plan of recovery.

The use of behavior therapy in substance abuse counseling looks something like this: If a number of negative behaviors resulted in addiction, then a number of positive behaviors can replace the negative, addictive behaviors.

CBT was originally developed to prevent relapse among alcoholics and cocaine addicts, and this therapy, along with ABA therapy, focuses on eliminating the negative learning processes that tend to form poor behavioral patterns like addiction.

Through a number of behavior therapy techniques, substance abuse counselors help addicts identify the negative behaviors leading to substance abuse and then replace them with reinforcing behaviors.

Behavior therapy in addiction counseling may also include providing incentives for maintaining sobriety, learning positive life skills, and developing strategies for better handling stressful situations or triggers.

Substance Abuse Counselor Job Description

Substance abuse counselors work with addicts, recovering addicts, and their loved ones throughout every stage of the recovery process. Counseling is often a long-term process that may be conducted privately, in group settings, or with families.

Substance abuse counselors first begin the treatment program by assessing the patient, both clinically and personally as to develop an appropriate course of treatment, which includes goals and the steps to be taken to meet those goals.

Substance abuse counselors may work in a variety of settings, including:

  • Hospitals
  • Prisons
  • Probation and parole agencies
  • Detox centers
  • Private practice
  • Juvenile detention facilities

Counselors may often recommend outside medical care to patients, particularly if they have a history of medical problems, mental health conditions, or if they are going through active withdrawal. Counselors may refer patients to inpatient detox treatment centers, hospitals, or outpatient facilities that can better address their needs and ensure their safety.

In addition to therapy sessions, substance abuse counselors may ask patients to complete written assignments, read specific literature, and keep track of their progress in between sessions. Part of substance abuse treatment involves educating people on the effects of drugs and alcohol on their bodies, their brains, their relationships, and their lives, so it is important to make sure patients actively participate in their own recovery.

Substance abuse counselors also provide drug testing, relapse prevention training, and sober life skills training, and they may oversee support groups. Substance abuse counselors may even provide services through online programs.

While twelve-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are run by recovering addicts, substance abuse counselors may help start or organize these groups.

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How to Become a Substance Abuse Counselor

While many mental health providers must meet specific education, certification, and state licensure requirements to practice, substance abuse counselors can become certified or licensed to practice by meeting any number of requirements depending on the specific role they will fill and the license required for that role.

Consider What You Want to Achieve

Associate’s degree…bachelor’s degree…master’s degree…or a basic course of training beyond a high school diploma? Which is right for you?

Because most states have credentialing options for substance abuse counselors at a number of levels, you may be at a loss regarding which type of degree (if any) you should pursue.

A smart first step is to visit your state’s licensing board website to learn about how the certification/licensure process works and what type of education and experience is required for all levels. Some states have a dedicated substance abuse/addiction counseling board, while other states certify and license substance abuse counselors through the board of health or department of human services.

Then, you’ll want to explore the profession in your area. Check out recent job postings and talk to addiction counselors where you live. What type of education do they have? What credentials are employers looking for? What credentials do you need to run your own practice or supervise/manage a practice? Can you increase your earning potential and/or employment prospects by earning a higher degree?

You’ll also want to keep the following in mind:

  • While substance abuse counselors in many states may be credentialed with just a high school diploma and the completion of a specific course of training, a master’s degree is the minimum requirement to earn licensure as a mental health counselor or clinical social worker.
  • Degrees in substance abuse counseling are offered at the associate’s, bachelor’s, and master’s level. However, many employers require a minimum of a bachelor’s degree.
  • Earning a bachelor’s or master’s degrees may shorten the amount of time it takes to earn certification or licensure. This is because while states require a specific number of hours of work experience to qualify for certification or licensure, you may be able to substitute your degree for part of the work experience requirement, which may shorten the time it takes to achieve certification or licensure.
  • Voluntary professional designations through national certification bodies also often demand higher degrees. For example, the Master Addiction Counselor (MAC) through the NAADAC, the Association for Addiction Professionals requires a minimum of a master’s degree.

Choose a Program That Best Fits Your Professional Goals

There is a myriad of degree programs at the associate’s, bachelor’s, and master’s level in substance abuse counseling. These degrees may be offered online, on-campus or through a blended mode of delivery, and they are often offered as both part- and full-time programs.

Associate’s Degrees

Associate’s degrees are often two-year (60-credit) degrees offered through junior or technical colleges. These programs often qualify students to earn entry-level state certification in substance abuse counseling. A high school diploma or GED is the typical requirement for entry into these programs. Some of these programs include:

  • AS in Alcohol and Other Drug Abuse
  • AAS in Chemical Dependency
  • AAS in Substance Abuse Counseling
  • AS in Substance Use Disorder Counselor
  • AAS in Addictions and Substance Abuse

Bachelor’s Degrees

Often viewed as the ideal degree for an entry-level career in substance abuse counseling, bachelor’s degrees provide a clear and expedited path to state certification in the field and are valued among many employers. Usually consisting of about four years of study (120 credits), these programs often culminate in a practical experience (internship), and they offer options for specialization within the field.

A high school diploma or GED, along with specific entrance examinations (usually SAT or ACT), are typical requirements for entry into a bachelor’s degree program.

Bachelor’s degrees also offer excellent preparation for future graduate education in substance abuse counseling.

Some of these programs include:

  • BS in Substance Abuse Counseling
  • BS in Psychology, specialization in Addictions
  • BS in Psychology – Addictions and Recovery
  • BS in Substance Abuse Studies
  • Bachelor’s in Addiction Counseling

Master’s Degrees

Master’s degrees offer the most options when it comes to working as an addictions counselor. A master’s degree comes with a variety of professional benefits, including the opportunity to earn state licensure and to sit for the Advanced Alcohol and Drug Counselor (AADC) or Master Addiction Counselor (MAC) certification exams, two of the most esteemed designations in the industry.

A master’s degree in mental health counseling is often a smart choice for individuals who want to seek state licensure as a mental health counselor. These degrees are often fully customizable, allowing students to specialize in substance abuse counseling, and the majority include a practical clinical placement.

Admission into a master’s degree in substance abuse counseling or a related field usually requires a minimum undergraduate GPA, the completion of specific undergraduate courses (usually in research methods and statistics and general psychology), and minimum GRE scores.

Master’s degrees in substance abuse counseling may include:

  • MS in Addictions Studies
  • MS in Substance Abuse Counseling
  • MS in Clinical Counseling with a substance abuse focus
  • MS in Addiction Counseling
  • MS in Psychology and Addiction Counseling
  • MS in Substance Abuse Psychology
  • Master of Rehabilitation Counseling, Addiction Counseling specialization
  • MA in Mental Health Counseling
  • MS in Clinical Rehabilitation and Mental Health Counseling

Earn State Licensure

Once you’ve completed your chosen course of study, you’ll also need to complete specific experience requirements to qualify for certification/licensure, which usually involve working alongside a credentialed substance abuse counselor for a specific period of time.

After meeting the education and experience requirements for the specific certification/license in your state, you’ll need to take and pass the appropriate state board licensing examination. Many states require applicants to take and pass the National Counselor Exam (NCE).

Check with your state licensing board for more information on licensure requirements.

Professional Certification Options

Adding behavior therapy credentials to your resume will allow you to integrate effective, evidence-based therapies into your practice. This is a purely voluntary process, and the combination of ABA and substance counseling is still largely an emerging area of specialization, but one that is proving to be effective.

BCBA Certification

If you completed a master’s degree in psychology, education, or behavior analysis, you may have satisfied the educational requirements needed to earn the Board Certified Behavior Analyst (BCBA) through the Behavior Analyst Certification Board.

Or, if you hold a master’s degree in one of these three areas, you may also complete the required courses in ABA by completing a verified course sequence (VCS), which is offered by a number of schools as either a stand-alone sequence of courses or as a graduate certificate.

But even if you completed a master’s degree in another area, like counseling, you may still be able to complete a course of education in ABA. That’s because in 2022, the BACB will remove the degree restrictions, opening up the BCBA to a wide variety of practitioners in the human services field.

In anticipation of this change, many schools that offer the VCS (either as a stand-alone course sequence or as a graduate certificate) have already removed the degree restrictions, allowing master’s-prepared counselors and similar professionals to complete this comprehensive course of study in ABA.

Complete the VCS now and you can begin integrating ABA into your practice. And then in 2022, when the degree restrictions for the BCBA credential are removed, you can complete the experiential and exam requirements necessary for earning the BCBA.

The BACB also offers certification for substance abuse counselors with:

CBT Certification

The National Association of Cognitive Behavior Therapists (NACBT) offers two primary  professional certification options in cognitive behavioral therapy:

  • Diplomate in Cognitive-Behavioral Therapy
    • Requires a master’s or doctoral degree in psychology, counseling, social work, psychiatry, or a related field
    • Ten years of post-graduate experience in providing CBT
    • Three letters of recommendation from mental health professionals familiar with your CBT skills
    • Completion of a certification program in CBT recognized by the NACBT
  • Certified Cognitive-Behavioral Therapist
    • Requires a master’s or doctoral degree in psychology, counseling, social work, psychiatry or a related field
    • At least six years of post-graduate experience in providing CBT
    • Three letters of recommendation from mental health professionals who are familiar with your CBT skills
    • Completion of a primary or introductory certification program in CBT recognized by the NACBT

Salaries for Substance Abuse Counselors

According to the U.S. Bureau of Labor Statistics (BLS), substance abuse, behavioral disorder, and mental health counselors earned the following salaries at the 25th, 50th, 75th, and 90th percentiles, as of 2021:

  • 25th: $38,520
  • 50th (average): $48,520
  • 75th: $61,660
  • 90th: $77,980

The top-paying states for substance abuse counselors, according to mean salary, include:

  • Utah: $66,190
  • Alaska: $65,090
  • Washington D.C.: $64,920
  • Rhode Island: $64,640
  • New Jersey: $63,430

The top-paying metro areas for substance abuse counselors, according to mean salary include:

  • San Jose-Sunnyvale-Santa Clara, CA: $74,560
  • Carson City, NV: $73,200
  • George, UT: $70,630
  • Lewiston-Auburn, ME: $68,370
  • Albuquerque, NM: $66,090

Resources for Substance Abuse Counselors

The following organizations can provide you with a wealth of information regarding substance abuse counseling and the professionals who provide it:

Substance Abuse and Mental Health Services Administration (SAMHSA)

American Society of Addiction Medicine

NAADAC, the Association for Addiction Professionals

National Association of Addiction Treatment Providers

International Association of Addictions & Offender Counselors

National Board for Certified Counselors

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2021 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 December 2022.