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What challenges can be encountered being a substance abuse counselor?

Junior in high-school interested in counseling

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Michelle’s Answer

Hello, Julianna !

As a substance abuse counselor or addiction counselor (CASAC) you will never have the same day twice. It is one of those "every day is different" careers. You would need to have a profound understanding of human behavior, mental illness and addiction issues. You would be working with individuals that have been rehabbed, active users and people who have had multiple rehabs and continue to resume using substance who appear non-rehabable. You will see these clients while they are not using as well as during their affect as well as in pain. You are there to help them and meet them "where they're at".

It can be very sad, especially seeing someone in pain and sick. While you are in your office, you can't be surprised if someone has a seizure, gets sick or passes out. A lot of mental health clinics or outpatient programs supply staff with oxygen and/or Narcan in case a client has an emergency at the office while with their counselor. You would be trained in the use of Narcan to revive people experiencing the effects of an opioid overdose, but you will learn that you have to be 100% sure the person is overdosed on an opioid.

You can't go into it thinking you'll save the world. You will have some success stories, but it can be sad and hopeful at the same time. You just have to know that just being there makes a difference. Another challenge is navigating through what some clients tell you. You will not always get a clear picture from the client and that is challenging because in order to help someone you need to know the true situation. You're not always going to get the truth from a client unless you also speak with family members or friends to hear their side of the story.

As a case manager, I had many dually diagnosed clients who had a mental illness and substance abuse. I wasn't their rehab counselor, but a general overall service provider. As a person who doesn't have a personal background in it, I was able to approach these clients neutrally. As a person first. You will see that many who do go into specific CASAC work are former addicts and many employers strongly believe that hiring people who used to have an addiction will work better with addicts. So many of your co-workers will have that background and if you do have that background, you would be desired as an employee. Some people think that being a former addict helps addicts better than not having had the experience.

The instances where it is challenging can be very upsetting but you have to be able to keep emotion out of it. It's a difficult job. You'd have a wide range of people you'd serve, from disheveled, unclean, unable to talk logically to business suit professionals - and it will depend on what city you work in, too.

I hope that this somewhat gives you a small idea of what it's like. It's great that you are exploring possible careers and I wish you all the best !
Thank you comment icon Thank you for your honesty it is very appreciated I grew up in a home with someone who used substances, it was very hard for me! I also thank you for a realistic answer to my question !! Julissa
Thank you comment icon Thank you for your insight, Michelle! I do want to make sure Julissa is clear and emphasize that you do not have to a have experience with substance abuse. While people who have gone through that experience can relate more to someone they are helping, with the proper training and passion for helping people, someone without that background can still be effective and desired for such roles. I have a friend who has gone through training and helped many people without having had a substance abuse background himself. Again, thank you for your insight Michelle! Sharyn Grose, Admin
Thank you comment icon Sharyn, thank you so much for your words because it's nice to know that others who do not have the first hand experience are doing it as well, and that people realize that. Yes, I had enormous trainings, very frequently and felt that what I did mattered. I worked in a very large city and had experience with all types of colleagues and I feel that dynamic was a big part of it many times. My clients never complained and my approach was different than others, but the clients' trust and interaction with their worker is the most important element and the thing that matters. Thanks for confirming it and stating clearly the concept and adding to what I said. Appreciation from afar ~ Michelle Michelle M.
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Chinyere’s Answer

Hello Julissa,


Being a counselor can present various challenges. However, some of the challenges that may be encountered as a substance abuse counselor include:

1. Emotional strain: Substance abuse counselors often hear traumatic stories and witness the negative impacts of addiction, which can take a toll on their mental well-being. Dealing with clients who are struggling with addiction can be emotionally draining.

2. Resistance to change: A good number of individuals struggling with substance abuse may not be willing or ready initially to make changes in their lives. Motivating and engaging these individuals in treatment can be challenging for counselors.

3. Relapse: Occurrences of relapse are common in the recovery process. Witnessing clients relapse after making progress can be discouraging for counselors, as they invest time and effort into helping individuals achieve sobriety.

4. Limited resources: Substance abuse counseling often takes place within a healthcare system that may have limited resources for treatment options, funding, or access to specialized services such as detoxification facilities or residential treatment programs.

5. Ethical dilemmas: Counselors may encounter ethical dilemmas related to confidentiality when working with clients who pose risks to themselves or others due to their substance abuse. Balancing client privacy rights while ensuring safety and appropriate interventions can present challenges.

6. Work-related stressors: The nature of this job involves dealing with crises, managing caseloads, meeting deadlines, and navigating paperwork requirements for documentation purposes—all of which contribute to work-related stress.

7. Stigma and burnout: There is still some stigma surrounding addiction and seeking help for it; this stigma might impact both clients' willingness to seek help and the counselor's own feelings about their work in this field.

8. Cultural competence: Substance abuse counselors need cultural competence skills because they work with diverse populations from different backgrounds that require understanding various cultures' nuances related to addiction treatment approaches.

9. Self-care needs: Providing support for individuals struggling with addiction requires substance abuse counselors being attentive to their own self-care needs so that they do not become overwhelmed by compassion fatigue or burnout themselves.


Lastly, it is important for substance abuse counselors to receive adequate training, supervision, support systems, self-care practices and engage in continuing education opportunities in order to effectively address these challenges.
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