Substance Abuse Counseling vs. Therapy: How to Choose

Substance abuse counseling is a skilled profession practiced by substance abuse treatment specialists. Substance abuse counselors have a somewhat different skillset than therapists, but their skills overlap in many ways:

• Both types of professionals are trained to assess, diagnose, and treat behavioral health conditions. 
• Both are required to study and gain proficiency in one or more therapy or counseling methods. 
• Both are trained in clinical techniques—such as different types of cognitive behavioral therapy (CBT)—that would be familiar to members of the other profession.

However, substance abuse counselors specialize in treating substance use disorders, while therapists specialize in treating mental health conditions. These specialties require diff

Substance abuse counseling developed within the substance abuse treatment field as a practical and effective method to help clients recover from substance use disorders. It incorporates a mix of clinical techniques, 12-step philosophy, and practical problem-solving methods.

Substance abuse counseling requires a specific skillset to be successful. In some ways, it’s similar to therapy, but in some ways it’s radically different. Those differences can confuse therapists who don’t have training or experience in substance abuse counseling.

When a therapist uses their standard approach with clients who have substance use disorders, it can sometimes result in poor outcomes for those clients, despite that therapist’s best intentions. This is why it’s important to make sure you see someone who is specifically trained to treat substance use disorders.

Substance abuse counseling tends to work a little differently than therapy does. It tends to be immediate and practical in its approach. Unlike therapy, which takes some time to explore what a particular client might want or need to do, substance abuse counseling usually hits the ground running and starts helping you solve practical problems right away.

Substance abuse counselors already know one of the things you want to change: your substance use. They also know the risks and complications that often come with substance use disorders. They know that without immediate action to curb your substance use, you could be in serious legal, financial, or medical trouble, especially if your substance use disorder has already progressed to a high level of severity.

So, they usually save the “getting to know all of the nuances of your situation” part for a little later in treatment. In the beginning, they focus on helping you gain the knowledge and skills you need to prevent relapse. They talk to you about your life circumstances and immediately start problem-solving with you to get you out of toxic situations that threaten your recovery.

On the other hand, therapy for mental health rarely starts with the same kind of laser focus. It takes a therapist a little more time to figure out which problems you’re trying to solve and what approach will work best.

It’s important to note that the extent of these differences depends on what method a therapist uses. Cognitive behavioral therapy is used in both mental health and substance use disorder treatment, and in CBT, you don’t have to delve into your past at all. Instead, you can just focus on the present-moment connection between certain thoughts, feelings, and behaviors and work on changing the thinking that leads to negative experiences.

The most basic difference between a therapist and a licensed substance abuse counselor is which license a person holds.

Some states license substance abuse counselors as well, while some states only certify them. In response to professional advocacy and increasing demand for substance abuse treatment, a growing number of states are licensing substance abuse counselors for independent practice.

Like therapists, licensed independent substance abuse counselors can provide services outside of an agency. However, each type of professional is authorized to do something different in a private practice setting. Put simply, therapists are licensed to treat mental health conditions and substance abuse counselors (when licensed) are licensed to treat substance use disorders.

While it’s actually a little more complicated than that—some therapists have the training and skills to treat substance use disorders; some substance abuse counselors have the training and skills to treat co-occurring mental health conditions; and some people are cross-licensed as both—that’s the main difference.

(Note that while the terms “substance abuse counseling” and “therapy” refer to different professional practices, the terms “counseling” and “therapy” are generally used interchangeably in substance abuse treatment to refer to what you do in individual and group sessions.)

Whether a therapist is qualified to treat substance use disorders depends on that therapist’s particular background.

It’s important to know that while all licensed substance abuse counselors are educated and trained to treat substance use disorders, not all therapists are. Courses on substance use and substance abuse treatment are often electives for therapists instead of required courses.

Unfortunately, many therapists who lack education or training in substance abuse treatment will still try to treat substance use disorders. Many are well-meaning and assume their knowledge and skills are transferable to any behavioral health condition or issue.

So, if you’re going to see a therapist to address issues related to a substance use disorder, make sure the therapist is properly educated and trained to provide substance use disorder treatment.

Either therapy or substance abuse counseling can help you address issues in your life related to a substance use disorder. 

The most important thing is to make sure that the therapist or counselor you want to see is qualified to treat what you want them to treat. 

Note that licensed substance abuse counselors must meet similar professional standards as therapists. According to DHHS, most states that offer substance abuse counseling licenses require licensed counselors to have a master’s degree—the same level of education as many therapists. Both therapists and licensed substance abuse counselors must study and learn effective clinical methods and prove they know them to get licensed.

So, both types of professionals are highly trained and qualified. Which to choose depends on what you need. While there is no hard and fast rule, this is a good general rule of thumb:

In other words, if you need to brush up on or develop relapse prevention skills, or you need some guidance on how to build a life that supports recovery, substance abuse counseling is probably the best fit for your needs.

If you are maintaining sobriety and effectively using relapse prevention skills, but you want to address anxiety, depression, or mental health issues that are keeping you from having the life you want, therapy is likely to be a better fit.

Again, the most important thing is to make sure that the professional you are going to see is qualified to treat substance use disorders.

Substance abuse counselors are trained to treat substance use disorders by default. Some therapists indicate in their profile or bio whether they are, but if you’re not sure, ask. Here are some sample questions you can use.

Their answers should give you the impression that they have experience treating substance use disorders and that they’re the right fit. Their approach or methods shouldn’t sound confused, awkward, or like they don’t fit with treatment you’ve already had that has worked for you.

Keep in mind that what you should look for (and the questions you should ask) should be different if you’re not primarily wanting to address substance use but are primarily wanting to address an underlying mental health condition or symptoms. Substance abuse counselors aren’t licensed to provide primary treatment for mental health conditions.

If you’re looking for a therapist to treat a mental health condition, it’s equally important to make sure they’re qualified to treat you. Check and see if they have experience treating clients with similar concerns, backgrounds, and personal characteristics. You can read our article on how to do a background check on your therapist for a step-by-step guide on how to research a therapist, what traits to look for, and what questions to ask.

Substance abuse counselors are specialists who bring valuable expertise to the behavioral health field. Licensed substance abuse counselors can offer individual substance abuse counseling in a private practice setting, and they are a great choice if that’s what you’re looking for.

Individual substance abuse counseling is not always a high enough level of care in early stages of recovery from a substance use disorder, but it can be in some cases. More often, individual substance abuse counseling serves a vital role later in treatment.

To find out whether individual substance abuse counseling might be the right level of care for you, and to learn how it fits into the substance abuse treatment continuum, you can read our other articles in this series.

If you’re not sure what to choose, don’t worry. There are people who can help. You can call and ask someone who works at a local substance abuse program, peers in support groups, your primary care doctor, or a local therapist or counselor. You can also call a behavioral health crisis or information line for more help and guidance. These hotlines are free to use and are set up specifically to help you find the right level of care.

Just remember that the particular door you come through doesn’t matter as much as walking through the door in the first place. Any treatment program or professional can help you find the right level of care. The important thing is taking those first steps toward a different life. Recovery—and all of the amazing ways it can change your life—might be only a call or click away.