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A Day in The Life of a Substance Abuse Counselor

Substance abuse counseling has never been in greater demand than it is today. From medical and doctorate level professionals to certificate level counselors, we need licensed clinicians to make a dent in the addiction epidemic that has only gotten worse over the past decade. While addiction counseling represents an amazing opportunity to help hundreds, if not thousands, of people over the course of your career, it also comes with some very particular challenges. In today’s blog post, we discuss an addiction counselor’s typical day – what to expect when treating others for behavioral health disorders including mental health and substance abuse.

Before we get started, it is important to recognize that substance abuse and mental health counseling will vary dramatically between facilities and even more so if you decide to enter private practice, where you will have the ultimate in flexibility. For the purposes of this blog post, we will limit our discussion to substance abuse and mental health counselors employed by an addiction treatment facility or hospital.

Individual and Group Therapy

On the surface, a typical day for a counselor will include individual and group therapy. Individual therapy involves one-on-one discussion and talk therapy such as Cognitive Behavioral Therapy, or CBT, directly with the client. Group therapy will consist of approximately one-hour long sessions with multiple clients who discuss their lives, prior drug use, goals and more in a support style setting. Individual sessions are critically important because they build rapport between the counselor and client that will define the course of treatment. Excellent counselors are able to use empathy, active listening and concise communication to allow their clients to open up and discuss their very deepest thoughts, feelings and concerns. During the group session, counselors will excel by promoting open and honest discussion between clients, allowing them to learn from each other and limiting their own role to that of a moderator rather than a dictator. The number of clients that each counselor will work with largely depends on the facility and their policies.


What is less visible, but just as important, is the counselor’s responsibility to document client progress, clinical notes and thoughts. Documenting how a client progresses is very important considering that mental health and addiction issues are chronic – meaning they stay with a client for their entire life. Mental health and substance abuse patients may relapse requiring treatment, potentially, from other clinicians. Further, during their initial recovery, the counselor may have to refer the client to a medical specialist or to another specialized facility. Having strong documentation is critical to ensuring the continuity of care and advising other clinicians on issues that may be important to the client’s course of treatment.

This documentation also serves two very important purposes beyond interaction with other clinicians. First, the treatment plan is very fluid. It can and will change over the course of a client’s stay at the facility. However, to objectively and appropriately modify the treatment plan, the documentation from every clinician must be collected and analyzed. Poor documentation only makes it more difficult to modify the treatment plan and ultimately hurts both the clinician and client. Further, most patients will be seeking treatment with the help of their insurance. Insurance companies require appropriate documentation of progress and treatment in order to approve further care. This is known as utilization review and the counselor plays a significant role in this process. Utilization review specialists within the facility consult with the counselor to procure appropriate and complete documentation to the insurance company. With appropriate documentation of the client’s progress through treatment, the goal is for the insurance company to approve necessary care, ultimately benefiting the patient.

Counselor Self-Care

Also overlooked is the effect that counseling has on the counselor themselves. On the surface, it feels like counselors are doing great work and helping hundreds of people, but their own mental health is often set aside. Counselor self-care is of paramount importance. This is especially true for those who are new to the field. As gratifying as helping others may be, it is imperative that counselors help themselves as well. Most counselors benefit from regular counseling sessions of their own. During these sessions, they are able to discuss their emotional well-being and the effects of the counseling has on them. Think of how an argument or problem with a friend or relative affects you. Now multiply that by dozens or even hundreds of people over the course of the year. Counselors truly see the most difficult of human situations on a daily basis. Even more frustrating is the fact that we simply cannot help everyone. There are some cases where a client is not ready to recover and the course of recovery fails. A client may end up relapsing, which the counselor often takes upon himself or herself as a personal failure. Some may experience a client passing away – an absolutely devastating potential consequence of drug abuse and mental illness. Having a supports system around them allows the counselor to cope with these inevitabilities more effectively and direct their attention toward those whom they can help.

Ultimately, addiction counseling often proves to be a worthwhile and gratifying career opportunity which, rather unfortunately, has a great deal of growth potential due to the current state of drug abuse in the United States. However, aspiring counselors must be aware of the pitfalls that include the risk of burnout and the emotional stress that they will experience every single day at work. Many aspiring counselors begin at lower career levels, including as a recovery support specialists or behavioral health technicians, so they can learn more about the field as well as the strains and stresses that they will experience. This can be excellent foundational experience, even for those that have an advanced degree. We always recommend that those pursuing their counseling license, certificate or degree speak with and even shadow existing counselors to understand more fully what their career path will entail. Further, there are so many sub-specialties within counseling; it can be beneficial to consider a specialization in the field.

In the meantime, The Academy for Addiction Professionals is always available to help with counselor education and continuing education needs. Contact us for more information.