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The idea of “counseling” or “therapy” terrifies many people. Not only do they dread having to look at aspects of their lives they’d rather deny: they picture themselves being bullied and berated, and they imagine their peers will ostracize them as “crazies.” Sadly, such fears have kept many people from getting treatment for addiction disorders.
Even though more people today are learning to see mental/behavioral illness as illness, many misconceptions still surround both illness and treatment. Many people can’t even answer the basic question: “What is a substance abuse counselor?” The first step in understanding what substance abuse counselors do is clarifying what isn’t true about them.
DISPELLING ADDICTION COUNSELOR MYTHS
Myth: Counselors are the same as psychiatrists.
Truth: Psychiatrists (who often provide the least actual counseling) are medical doctors who have completed formal degrees, internships and residencies, and who are licensed to prescribe medicine. The next level down is the licensed psychologist, who has a non-medical doctorate in psychology and is certified to diagnose mental/behavioral illnesses but not to write prescriptions.
There are many other types of counselors, from clinical social workers to Licensed Chemical Dependency Counselors: exact titles and certifications are regulated by state laws. (Some spiritual counselors receive their credentials from religious denominations.)
When being treated for addiction disorder, you will work with someone who is specifically certified as an addiction counselor: an LCDC, Certified Alcohol and Drug Abuse Counselor, certified addiction counselor, licensed substance abuse therapist or similar title. (Never accept treatment from a detox center whose counselors have no verifiable credentials.)
Myth: Counselors are out to “fix” you and will treat you like a mass-produced machine.
Truth: Counselors are very much concerned about their clients’ individual personalities and needs. And they don’t tell you what to do: like Socrates, they gently steer you toward discovering problems and solutions for yourself.
Myth: It’s the counselor’s job to make everything “all better.”
Truth: Your own part doesn’t stop at listening and following instructions. To some clients, the standard approach of helping them work out their own solutions (see previous myth) is a liability. They go in hoping for a program they can implement as easily as taking a pill, and when they realize how much real work the counselor needs them to do, they get angry. If you expect recovery to be simple or easy, no counseling will ever be good enough for you. Accept that personal responsibility is the price of a life worth living, and be prepared to work for your recovery and your future.
WHAT DOES A SUBSTANCE ABUSE COUNSELOR DO?
So if substance abuse counselors aren’t there to appease you, reprogram you or plan your life for you, what exactly should you expect?
- A good substance abuse counselor will ask you lots of questions. They’ll have been briefed on your drug abuse history by the main detox center, but they’ll want to hear the details from your point of view. And besides their asking questions to learn about you and your situation, much of the counseling will consist of questions designed to help you think: What else could you do in a situation that’s always “driven you to drink”? How do you think your family feels about this or that? Why do you feel useless, or frustrated or chronically bored?
- A good substance abuse counselor will make extra effort to understand you as an individual. Besides helping you explore your own frustrations, dreams and natural wiring, many questions you’re asked will help the counselor recognize these points as well. The better counselors know you as a person, the better equipped they are to help you in particular.
- A good substance abuse counselor will be patient and flexible. After working with a counselor for a while, you may notice subtle shifts in his or her approach: less tendency to press one line of questioning, greater persistence in another area, longer pauses waiting for you to complete your responses. This is no accident: the counselor is learning the path that best motivates you to work wholeheartedly toward your own recovery. Rather than trying to fit you into a predetermined cure-all mode, he or she is fitting the treatment template to your unique needs.
- A good substance abuse counselor will encourage you to explore unresolved issues. Being sensitive to your needs doesn’t mean the counselor will let you stay inside your easiest comfort zone. On the contrary, expect a little “tough love” and some prodding to face old pains you want desperately to avoid. Just as with physical detox, sometimes the only path to feeling better leads through a stretch of feeling much worse.
- A good substance abuse counselor will focus on stress management and coping skills. Whether you have a lot of childhood pain to pull out of the closet or are weighed down with bad habits picked up later, a vital part of recovery is learning to handle life’s inevitable struggles without running to the “easy way out.” Although therapy is frequently associated with digging into the past, its main goal is to develop coping methods for the future.
- A good substance abuse counselor will want to meet your family. Whether your therapy is individual, family or group—or a combination of all three—the household you’re going back to was affected by your addiction and should be involved in your recovery. By knowing you and your closest loved ones as a group, a counselor can help the whole family understand how to effectively communicate and work together for sobriety.
- A good substance abuse counselor will encourage you to set goals for your future. You can’t just leave detox and go back to “life as it was,” or you’ll be sucked back into the drug use that was part of that life. Your counselor will help you recognize and plan for the life you really want, the life you’ll be eager to stay sober for.
All that said, occasionally counselor and client prove a mismatch: they have a personality conflict, or they just don’t mesh for some indefinable reason. (Counselors are human too: professional degrees can’t immunize everyone against every hang-up and hot button.) Ideally, meet your future addiction counselor before you even start detox (consider it a selling point if this is a center’s official policy) and see whether you connect. And if you do find yourself paired with someone who seems a bad match, don’t hesitate to ask if you can be reassigned.
Don’t, however, demand someone else just because you’re getting impatient for results or because the counselor inadvertently pushed one of your buttons. That’s the same I’m-entitled-to-an-easy-ride attitude that gets most addictions started in the first place. And as already noted, if you expect to sit back and let a drug addiction counselor do all the work, you have only yourself to blame for lack of progress.
Which brings us to your own part in recovery counseling.
WHAT WILL THE COUNSELOR EXPECT YOU TO DO?
- Answer questions honestly. By now, you’ve probably guessed that a good bit of an addiction counselor’s effectiveness hangs on understanding your specific needs and problems. And they can’t help you if you hide those problems. So forget about guarding your pride, and don’t worry about being judged. Whatever you say will remain between you and your counselor, and they won’t label you “bad” or “hopeless” whatever you say.
- Avoid getting defensive. Since your counselor is committed to understanding your point of view, try to return the favor. Even if a question hits you in a sensitive spot, don’t fling back any “You’re deliberately picking on me” accusations. It’s fine to say you’re uncomfortable with this or that line of questioning: just don’t turn your distaste on the questioner.
- Be brave enough to face painful memories and realities. While counselors will be understanding if you ask to change the subject, they also recognize when avoiding certain subjects isn’t in your best interest. Try not to take an “I absolutely refuse to talk about that” attitude toward anything: that may be the thing you most need to talk about.
- Own up to your weak spots. The things you don’t want to face up to probably also include points where you can’t handle everything you think you should. Be willing to make “a searching and fearless moral inventory” of yourself, as they say in the Twelve Steps.
- Be willing to believe in yourself. Taking personal inventory has its pleasurable side as well: realizing that your “self” includes not only your weaknesses, but your natural strengths and talents. You don’t have to regard yourself as the lowest of the low to get permanently sober: indeed, seeing yourself as worthwhile and capable will give you hope for lasting sobriety.
- Commit yourself to long-term recovery and all it entails. As with life itself, recovery is a marathon and not a hundred-yard dash. You will face hard times and temptations to return to drugs. You also have many good times to look forward to. Have a plan for dealing with relapse temptations, expect to make the most of your life, and reinforce both those goals by staying active in a sobriety support network. Which, besides your family, recovering peers and regular doctor, should include at least one therapist certified in substance abuse treatment.
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For related information on working with substance abuse counselors, see the following articles: