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Alcohol and drug abuse counselors (sometimes called substance abuse counselors) work with people who abuse or are addicted to drugs or alcohol. Through individual and group counseling sessions, they help their clients understand and change their destructive substance abuse behaviors. There are about 86,000 substance abuse counselors in the United States.
Throughout history people have used drugs for a variety of purposes??”for healing, for religious ceremonies, to alter consciousness for self-understanding, to loosen inhibitions and have fun, or to dull the senses against emotional or physical pain. Alcohol and other substances were used in ancient Egypt, Greece, and India as offerings to spiritual beings, as well as to reach a higher consciousness. Many religions today, from Tibetan Buddhism and traditional Native American religions to Roman Catholicism, use alcohol and other consciousness-altering substances in traditional ceremonies.
Throughout the ages people have also abused drugs and alcohol. No matter what the purpose for the initial drug use, it becomes for some people an obsession, and then an addiction. The history of treatment for substance abuse is much shorter. In the 1800s, alcoholics and morphine addicts were placed in asylums. Treatments sometimes included miracle medicines that were supposed to be quick “cures” for addicts. In the early 1900s doctors used electro-shock therapies and psychosurgery to treat alcoholics.
In 1935, the Alcoholics Anonymous (AA) program was started by two men known as Bill and Dr. Bob. They helped each other achieve sobriety and continued to help others. This system of alcoholics helping other alcoholics grew into the AA movement, which is still strong today. AAs 12-step program has been adapted and used effectively to treat addictions of all kinds.
Today alcohol and a huge variety of dangerous drugs are readily available??”marijuana, cocaine, LSD, heroin, inhalants, amphetamines, barbiturates, and more. Fortunately, treatment programs are also readily available for those who want them. Outpatient methadone programs give heroin addicts the medication methadone to reduce cravings for heroin and block its effects. Patients are also counseled, given vocational guidance and training, and taught how to find support services. Long-term residential programs last for several months to a year. Patients live in a drug-free environment with fellow recovering addicts and counselors. Outpatient drug-free programs use such therapies as problem-solving groups, insight-oriented psychotherapy, cognitive-behavioral therapy, and 12-step programs. Short-term inpatient programs focus on stabilizing the patient, abstinence, and lifestyle changes.
The Job
Alcohol and drug abuse counselors main goal is to help patients stop their destructive behaviors. Counselors may also work with the families of clients to give them support and guidance in dealing with the problem.
Counselors begin by trying to learn about a patients general background and history of drug or alcohol use. They may review patient records, including police reports, employment records, medical records, or reports from other counselors.
Counselors also interview the patient to determine the nature and extent of substance abuse. During an interview, the counselor asks questions about what types of substances the patient uses, how often, and for how long. The counselor may also ask patients about previous attempts to stop using the substance and about how the problem has affected their lives in various respects.
Using the information they obtain from the patient and their knowledge of substance abuse patterns, counselors formulate a program for treatment and rehabilitation. A substantial part of the rehabilitation process involves individual, group, or family counseling sessions. During individual sessions, counselors do a great deal of listening, perhaps asking appropriate questions to guide patients to insights about themselves. In group therapy sessions, counselors supervise groups of several patients, helping move their discussion in positive ways. In counseling sessions, counselors also teach patients methods of overcoming their dependencies. For example, they might help a patient develop a series of goals for behavioral change.
Counselors monitor and assess the progress of their patients. In most cases, counselors deal with several different patients in various stages of recovery??”some may need help breaking the pattern of substance abuse; some may already have stopped using, but still need support; others may be recovered users who have suffered a relapse. Counselors maintain ongoing relationships with patients to help them adapt to the different recovery stages.
Working with families is another aspect of many alcohol and drug abuse counselors jobs. They may ask a patients family for insight into the patients behavior. They may also teach the patients family members how to deal with and support the patient through the recovery process.
Counselors may work with other health professionals and social agencies, including physicians, psychiatrists, psychologists, employment services, and court systems. In some cases, the counselor, with the patients permission, may serve as a spokesperson for the patient, working with corrections officers, social workers, or employers. In other cases, a patients needs might exceed the counselors abilities; when this is the case, the counselor refers the patient to an appropriate medical expert, agency, or social program.
There is a substantial amount of paperwork involved in counseling alcohol and drug abusers. Detailed records must be kept on patients in order to follow their progress. For example, a report must be written after each counseling session. Counselors who work in residential treatment settings are required to participate in regular staff meetings to develop treatment plans and review patient progress. They may also meet periodically with family members or social service agency representatives to discuss patient progress and needs.
In some cases, alcohol and drug abuse counselors specialize in working with certain groups of people. Some work only with children or teenagers; others work with businesses to counsel employees who may have problems related to drugs and alcohol. In still other cases, counselors specialize in treating people who are addicted to specific drugs, such as cocaine, heroin, or alcohol. Counselors may need special training in order to work with specific groups.
High School
High school students who are considering a career in alcohol and drug abuse counseling should choose a curriculum that meets the requirements of the college or university they hope to attend. Typically, four years of English, history, mathematics, a foreign language, and social sciences are necessary. In addition, psychology, sociology, physiology, biology, and anatomy provide a good academic background for potential counselors.
The educational requirements for alcohol and drug abuse counselors vary greatly by state and employer. A high school education may be the minimum requirement for employers who provide on-the-job training, which ranges from six weeks to two years. These jobs, however, are becoming increasingly rare as more states are leaning toward stricter requirements for counselors.
Postsecondary Training
Some employers require an associates degree in alcohol and drug technology. Most substance abuse counselors, however, have a bachelors degree in counseling, psychology, health sociology, or social work. Many two- and four-year colleges now offer specific courses for students training to be substance abuse counselors.
Many counselors have a masters degree in counseling with a specialization in substance abuse counseling. Accredited graduate programs in substance abuse counseling are composed of a supervised internship as well as regular class work.
Certification or Licensing
Certification in this field, which is mandatory in some states, is available through state accreditation boards. Currently, 47 states and the District of Columbia have credentialing laws for alcohol and drug abuse counselors. These laws typically require that counselors have a minimum of a masters degree and two to three years of postacademic supervised counseling experience. Candidates must also have passed a written test.
NAADAC, the National Association for Addiction Professionals, also offers a national certified addiction counselor (NCAC) certification.
Other Requirements
In order to be successful in this job, prospective counselors should enjoy working with people. They must have compassion, good communication and listening skills, and a desire to help others. They should also be emotionally stable and able to deal with the frustrations and failures that are often a part of the job.
Students interested in this career can find a great deal of information on substance abuse and substance abuse counseling at any local library. In addition, by contacting a local hospital, mental health clinic, or treatment center, it might be possible to talk with a counselor about the details of his or her job.
Volunteer work or a part-time job at a residential facility such as a hospital or treatment center is another good way of gaining experience and exploring an aptitude for counseling work. Finally, the professional and government organizations listed at the end of this article can provide information on alcohol and drug abuse counseling.
Counselors are hired by hospitals, private and public treatment centers, government agencies, prisons, public school systems, colleges and universities, health maintenance organizations (HMOs), crisis centers, and mental health centers. More and more frequently, large companies are hiring alcohol and drug abuse counselors as well, to deal with employee substance abuse problems.
Starting Out
Counselors who have completed a two- or four-year college degree might start a job search by checking with the career placement office of their college or university. Those who plan to look for a position without first attending college might want to start by getting an entry-level or volunteer position in a treatment center or related agency. In this way, they can obtain practical experience and also make connections that might lead to full-time employment as a counselor.
Job seekers should also watch the classified advertisements in local newspapers. Job openings for counselors are often listed under “alcohol and drug counselor,” “substance abuse counselor,” or “mental health counselor.” Finally, one might consider applying directly to the personnel department of various facilities and agencies that treat alcohol and drug abusers.
Counselors in this field often advance initially by taking on more responsibilities and earning a higher wage. They may also better themselves by taking a similar position in a more prestigious facility, such as an upscale private treatment center.
As they obtain more experience and perhaps more education, counselors sometimes move into supervisory or administrative positions. They might become directors of substance abuse programs in mental health facilities or executive directors of agencies or clinics.
Career options are more diverse for those counselors who continue their education. They may move into research, consulting, or teaching at the college level.
Salaries of alcohol and drug abuse counselors depend on education level, amount of experience, and place of employment. Generally, the more education and experience a counselor has, the higher his or her earnings will be. Counselors who work in private treatment centers also tend to earn more than their public sector counterparts.
Alcohol and drug abuse counselors earned a median annual salary of $37,030 in 2008, according to the U.S. Department of Labor. The lowest 10 percent earned less than $24,240. The highest 10 percent earned $59,460 or more. Median annual wages were highest ($44,130) for counselors working in general medical and surgical hospitals. Directors of treatment programs or centers could earn considerably more that the national median salary. Almost all treatment centers provide employee benefits to their full-time counselors. Benefits usually include paid vacations and sick days, insurance, and pension plans.
Work Environment
The hours that an alcohol and drug abuse counselor works depend upon where he or she is employed. Many residential treatment facilities and mental health centers??”and all crisis centers??”have counselors on duty during evening and weekend hours. Other employers, such as government agencies and universities, are likely to have more conventional working hours.
Work settings for counselors also vary by employer. Counselors may work in private offices, in the rooms or homes of patients, in classrooms, or in meeting rooms. In some cases, they conduct support group sessions in churches, community centers, or schools. For the most part, however, counselors work at the same work site or sites on a daily basis.
The bulk of a counselors day is spent dealing with various people??”patients, families, social workers, and health care professionals. There may be very little time during a workday for quiet reflection or organization.
Working with alcohol and drug abusers can be an emotionally draining experience. Overcoming addiction is a very hard battle, and patients respond to it in various ways. They may be resentful, angry, discouraged, or profoundly depressed. They may talk candidly with their counselors about tragic and upsetting events in their lives. Counselors spend much of their time listening to and dealing with very strong, usually negative, emotions.
This work can also be discouraging, due to a high failure rate. Many alcoholics and drug addicts do not respond to treatment and return immediately to their addictions. Even after months and sometimes years of recovery, many substance abusers suffer relapses. The counselor must learn to cope with the frustration of having his or her patients fail, perhaps repeatedly.
There is a very positive side to drug and alcohol abuse counseling, however. When it is successful, counselors have the satisfaction of knowing that they had a positive effect on someones life. They have the reward of seeing some patients return to happy family lives and productive careers.
Employment of alcohol and drug abuse counselors is projected to grow much faster than the average for all occupations through 2018, according to the U.S. Department of Labor. There are more than 20 million alcoholics in the United States and an equal, if not greater, number of drug abusers. Because no successful method to significantly reduce drug and alcohol abuse has emerged, these numbers are not likely to decrease. As people become more informed about the benefits and options available to them through counseling, this career should be in high demand. Overall population growth will also lead to a need for more substance abuse counselors. Finally, many states are shifting away from criminalizing drug use, seeing it as a mental-health problem that should be treated through the medical system, not the criminal-justice system.
Another reason for the expected growth in counselors jobs is that an increasing number of employers are offering employee assistance programs that provide counseling services for mental health and alcohol and drug abuse.
Finally, many job openings will arise as a result of job turnover. Because of the stress levels and the emotional demands involved in this career, there is a high burnout rate. As alcohol and drug abuse counselors leave the field, new counselors are needed to replace them.