Ask the substance abuse counselor

I’ve been a substance abuse counselor for 7 years. I’ve worked in outpatient and in the prison system. There are still some misconceptions about my field and thought I would offer myself up for questions…if anyone is interested.

What do you do? What’s your typical day at work like?

What is the success rate of treatment? Meaning, recovery for a year or more.
Do you only recommend 12-step programs or do you offer alternatives?
Has Suboxone/Subutex become the treatment of choice for opiate withdrawal?

Is there a “top” substance that you see abused? As in, “most people I see are addicted to meth” or “9 out of 10 of my cases are for alcohol abuse.”

Do the most-abused substances change from year to year?

How do people differ in their reactions to a particular substace?

Is it possible to have a ‘non-addictive personality’, if that’s the right way of putting it, towards some substances? (I know that there is a difference between physiological and psychological addiction, and suspect that I am thinking of the latter with this question.)

Do you only deal with illegal substances, or do you also deal with legal ones? Do you deal with addictive behaviours (Internet addiction? :wink: ) Where does addictivve behaviour shade into mere habit?

Kytheria I get work, do some notes from the day before, see a client, do some notes, call a probation officer, do a group, see a client, call a referral source, do some notes. Lots of notes.

Indygrrl Success rates tend be about 30% but that is a fuzzy number. Success rates are difficult to track because each study will define “success” differently. But abstinent for at least year comes in at about 30%.

I recommend whatever works. I’m not a 12-step fundamentalist. I recommend it because it has worked for so many people and, if nothing else, it’s a great place to meet other people who are trying to remain abstinent. Sometimes I suggest they go the meetings for this reason alone, that is, they don’t have to “work the program”, just show up and meet new people. I also recommend church (or other religious places) for those that are interested. There are also Secular Organizations for Sobriety and Rational Recovery. Sometimes I just tell them to get a new hobby (oversimplification here).
Suboxone has not become the “treatment of choice” because doctors are limited to how many patients they can have to whom they are prescribing Suboxone. It is used in the local detox center frequently but this is usually followed up with a referral to methadone clinic. Methadone is still the prefered treatment for opiate addiction, mostly because it’s cheaper, well known, and familiar.

Zipper JJ Marijuana and crack cocaine are the most common drugs used here in Kent and Sussex County, at least as I have seen. In the 7 years I’ve been in the field I’ve seen little fluctuation in the most abused substances. I suspect it has to do with cost. Pot and crack are relatively cheap. I saw a lot of heroin addiction between 2000 and 2003 with most of that coming out of New Castle County, more specifically Wilmington. They were young, in their early to mid 20’s.
Alcohol is always popular but I don’t see much of that in treatment because people are being pick up and charged with possession of alcohol. There are a lot more ways to get in trouble for drugs than for alcohol and most of my clients are mandated to treatment by Drug Court . Most of the client’s I have that are addicted to alcohol are referred from a DUI treatment program because they failed the program.

Are you in Recovery?* What percentage of substance abuse counselors are?

Do you bring in people in recovery to tell their stories, like a speaker meeting for AA? What is the efficacy of this?

*Do not answer this if you will be breaking anonymity. I understand, both personally and fundamentally.

Do you see a difference in success rates between those who are mandated to treatment and those who are not?

Is it possible to have use one substance in an addictive way and not use some other substance in a “social” way? Yes. But this doesn’t usually happen. This typically becomes a matter of preference. I’ve had many clients who met criteria for cocaine dependence that only drink occasionally but that was because they didn’t like getting drunk. However, alcohol use frequently led to cocaine use.

The only legal substance here in America is alcohol and yes, I deal with alcoholism. My agency does not treat other addictions (Gambling, Internet, Sex) as a primary condition. If someone presents with an “other addiction” we will treat it as well. I’ve only had two clients admit to sexual addiction and then I didn’t see them again after that. In Delaware, the Gambling Counsel provides 20 sessions free of charge for anyone identified as having a gambling. So I refer them out. I’ve had verrry little training in behavioral addictions so I tend to refer them out and if I can’t I seek supervision from someone who specializes in that area. Sex addiction especially, that is a tricky thing to treat because you can’t exactly tell the person to remain celibate.

I read an interview with Stephen Tyler and he mentioned a counselor he’d had who had no credibility with him because the guy had never been an addict himself. (His next counselor was more to Tyler’s specifications, down to the prison tattoos.) How much of your own drug past is fair game for clients to ask you about?

I’ll answer this the way I tell my client’s. I smoked pot everyday for 5 years, does that count? I’ve never been in treatment for addiction or used a 12-step model to recover. I managed to stop and stay stopped. Process was about the same as a 12-step model though.

My agency has brought in guest speakers occasionally. We usually do it to break the ice, so to speak. Many people are reluctant to attend community based support groups and this gives them an opportunity to see what they are likely to encounter at a meeting.

Percentage of substance abuse counselors in recovery? Good question. I think the percentage is shrinking because recovery is not just about preventing relapse, that is simply changing a bad behavior. It is about a personal and fundamental change. It’s about the person. This requires skilled therapy, which is a teachable skill. I’ve met many peers who are great at recovery and would probably make a great sponsor but are not-so-good counselors.
Being a grassroots movement in the early days, this field did not get a lot of respect. The movement is towards educated (college), certified, and licensed professionals.

No, I see no difference. Well, maybe a slight difference, but only slight. Those who are mandated have a higher power (no pun intended) to answer to and so I have a little more leverage when it comes to exploring motivations for abstinence versus motivations for continued use. Kind of like a stick and a carrot. The stick keeps you from moving backwards while the carrot entices you to move forward.

I agree, I have met both counselors who are in recovery, and counselors who are not. Addiction research and understanding has come eons from where it once was, and the very definition of an alcoholic is changing. Soccer Mom’s, Mr.Mom’s and the everyday family man/woman are now fitting the bill of functional addicts.

Back when Bill W. and his buddy were forming AA, it was the wives and family who were being hurt, now it’s the whole kit and kabootle.

As much as is necessary to benefit the client and move them along. Obviously, some of the more personal stuff is excluded. To comment on Mr. Tyler. This is a common sentiment among people with addiction. It seems to be rooted in the belief that “you’ve been there you can’t feel me”. This is not true, at least not for a good therapist. There is also the fear of being judged. A good therapist does not judge his/her patient. I’ve never done heroin but I know what it feels like to be desperate. A good therapist listens to the client and lets the client tell him/her what it was like for them. I don’t suscribe to the confrontation style of addiction treatment. I’ve found it to be distasteful, disrespectful, and ineffective. Therapy is about the relationship. I have managed to help many people who believed the same thing Steven Tyler did. My job is help people live without drugs and alcohol, not share in war stories. If a person has managed to live life without drugs and alcohol, who better to teach you how to do it?

In fact, it is moving away (albeit only slightly) from the disease model. In my opinion it is a brain disorder. Once it is understood from the perspective, it is easier to see why you need to remain abstinent and “only a little” or “just once” will never work.
I use the diabetes analogy: No amount of will power, “right living”, soul searching, or “being strong” is going to fix your diabetes. You have to change your eating habits and the way you think about food. You have to change your lifestyle, take your medication, and follow the doctors orders to manage your diabetes.

What is meant by a substance though - coffee? tobacco? Gambling treatments? Do you have any people seek treatment who have won hundreds of millions of dollars? Hm. Gambling seems to be a counterproductive thing for the government to be in the business of providing while simultaneously offering “the cure”.

We don’t treat addiction to nicotine. I’ve never seen anybody for a coffee addiction. I think I would just look at them funny if they did :smiley:
Gambling was allowed in our State with the condition that the company provide for the treatment. In Nebraska (?) or a neighboring State the condition for allowing slot machines was that the casino provide 1% of its profits to treat gambling addiction. So much money was generated for treatment that the State put a cap on the contributions :eek:
No, I’ve had anybody present for treatment because they won a million bucks but I have had a couple of millonaire customers. Nobody famous though. I did have a professional actor in my DUI education group (he does commercials and magazine ads). I also had a column writer from the Washington Post in my DUI education group.
That is one of the things I really like about my job, I meet lots of interesting people.

I have a friend who seems to be of the opinion that any drug use, no matter how occasional, is abuse and addiction. So, for example, if one occasionally smokes pot, or occasionally smokes cigarettes, with no habitual or consistent use, she labels them as addicts and says there’s no way to use tobacco or any other drug without chemical dependency.
I smoke here and there mostly because I like sitting out on my porch in the evenings and having a smoke. I may run out and not pick up a pack for five months not feeling any qualms about it, or may smoke a couple cigarettes a day–a pack every couple weeks–for a few months running. It’s the same with pot. I may smoke sometimes and may not. I say I enjoy these things the same way anyone else may enjoy having a beer sometimes or any other diversion, but that I never feel a craving or “need” to use either substance. I don’t spend inordinate amounts of money or make poor decisions based on my need to purchase said products. I just enjoy them once in a while. For background, I used heavier drugs occasionally in my exciting but misspent youth, again with no habitual pattern, no regrets, and no bad consequences.
She claims these are “classic defense/justifications of addicts everywhere” and the fact that I don’t see problems in any of this means I’m an addict in denial. What say you? Is she full of crap like I think she is? Is it possible to use recreationally without being an addict, the same way millions of people occasionally visit casinos without having gambling addictions?

Do you ever recommend other models for recovery like SMART or Rational Recovery? How do you deal with clients who reject the 12-step model of AA?


Yes, she is full of crap and your pattern of use does not indicate any abuse or addiction problems. The Diagnostic and Statistical Manual 4th edition has clear cut criteria for abuse and dependence (2 seperate diagnoses) and the way you have described your use, you don’t appear to have a problem. However, use of illegal substances is, well, illegal. Just nod your head, say “okay” and enjoy :wink: