Substance Use Disorder Counseling

Medically reviewed by Audrey Kelly, LMFT
Updated June 17, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

Substance-Related and Addictive Disorders is a category of mental health disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that encompasses a number of different disorders, including alcohol use disorder (also known as alcohol addiction) and opioid use disorder. Substance use counseling (previously called substance abuse counseling) can help individuals with these mental health conditions address their symptoms and foster emotional wellness.  

Substance use counselors, addiction counselors, and mental health centers provide treatment for those experiencing substance use disorder. Professionals like substance use disorder counselors work to develop individualized treatment plans and treatment goals to address issues related to drugs and alcohol, address substance use disorder, and prevent relapse.

Substance use disorders can be difficult to manage on your own

Understanding substance use disorder 

Substance use disorders (SUDs) are not a choice, but recovery is possible, and various research-supported treatment options (including substance use counseling, previously called substance abuse counseling) and treatment centers are available. Often, underlying concerns and comorbid conditions, like anxiety disorders, environment, family history, and trauma, play a role in developing or affecting a person living with a SUD. Licensed counselors and substance abuse treatment centers can help people manage any comorbid mental health conditions in clinical settings with individualized treatment plans.

SUDs can affect all areas of a person’s life, including social relationships, family and love life, work, education, physical health, and mental health. 

Substance use disorder can escalate into dependence and addiction. These two words are often used interchangeably, but they both pertain to aspects of substance reliance. Substance abuse treatment and related mental health counseling can address all aspects of substance use and related behavioral disorders, helping individuals overcome addiction and avoid relapse. 

You’re also not alone. According to the Substance Abuse and Mental Health Services Administration, more than 40 million Americans lived with an SUD in 2020, including 14.5 million who lived with alcohol use disorders. While studies indicate that over 50% of those living with substance use disorder maintain full-time jobs, the U.S. Bureau of Labor Statistics reports that unintentional drug overdoses are steadily rising in the workplace.  

The hopeful news is that recovery is possible, and there is help, including in-person and online therapy, for those living with substance-related and other addictive disorders. Substance use counselors work to provide support in all areas of a person’s life to assist in managing substance use disorder.

Potential symptoms

Everyone experiences symptoms differently. Understanding the possible symptoms of a substance use disorder may help you identify if you need care.

Here are some potential symptoms and signs of SUDs:

  • Difficulty cutting down on or quitting a substance despite wanting to do so
  • Changes in performance at work or school
  • Withdrawal symptoms upon attempting to discontinue the use of a substance
  • Personality changes, such as secretiveness, irritability, or agitation
  • Changes in sleep patterns (IE, difficulty sleeping, or oversleeping)
  • Mood swings
  • Outwardly visible symptoms, such as trembling or shaking, bloodshot eyes, and difficulty with personal hygiene
  • Slurred speech
  • Unexplained financial problems or needs due to spending money on substances
  • Legal problems related to the use of substances
  • Social changes due to the use of substances (IE, social isolation, or changing friend groups and hangout spots based on to substances)
  • Difficulty or problems in interpersonal relationships related to the use of substances
  • Cravings for the substance

The truth is that it’s never too soon to ask for help or start the recovery process. If you notice these symptoms in yourself, it may be time to reach out and ask for help.

What are some addiction treatment options?

There are several different treatments available for SUDs, including substance abuse counseling services, and combined approaches are used frequently. Some people go to detox first to prepare themselves for treatment. In detox, counselors work to help clients discontinue the use of substances safely. After detox, a person may enter residential or inpatient treatment, followed by outpatient treatment and ongoing support groups or therapy. Substance abuse counselors and addiction counselors, often working in an independent practice, provide addiction counseling and additional resources and counseling services to ensure a comprehensive recovery process.

Some common complementary therapies to used effectively treat substance use disorder include:

  • Motivational interviewing (MI) — Also known as Motivational Enhancement Therapy, MI is a counseling approach that seeks to alleviate any doubts an addicted person may have about pursuing therapy. It’s listed as an evidence-based therapy by the National Institute on Drug Abuse.

  • The Matrix Model —The Matrix Model combines the principles behind various therapeutic techniques, such as CBT, MI, and CM, implementing them in a mixture of individual and group therapy sessions. It’s especially useful for treatment of alcohol abuse.
  • Step Facilitation Therapy —STP is a type of behavioral therapy intended to promote engagement with 12-step programs.

  • Contingency Management — Contingency management is a type of cognitive-behavioral therapy. It involves using tangible rewards to incentivize treatment engagement on the part of the patient. These rewards may involve gift vouchers or small cash prizes in exchange for meeting small and achievable treatment milestones (ex: attending sessions every day for a month). It’s been successfully used to treat opioid use disorder.

  • Rational Emotive Behavior Therapy (REBT) — Another form of behavioral therapy, REBT aims to replace irrational or limiting beliefs with more positive thought patterns. It’s an effective treatment for a large variety of co-occurring disorders, such as depression, anxiety, as well as various phobias and sleep issues.

In treatment, you often learn about and create a plan for relapse prevention, work on problem-solving skills and interpersonal relationships, address any legal or social issues that may be prevalent, address comorbid or co-occurring concerns and conditions, such as gambling addiction), and more. Family therapy sessions and emotional support for families and family members may also be provided. There is no shame in seeking care, for problem behaviors associated with SUDs, and it is important to destigmatize these issues so that more people can get the life-saving support they need.

Addressing co-occurring concerns in treatment for SUDs

Addressing co-occurring or comorbid concerns is often a vital part of treatment for SUDs.

Common comorbidities seen in those living with SUDs may include:

  • Post-traumatic stress disorder (PTSD). It said that roughly half of those living with a SUD meet post-traumatic stress disorder or PTSD criteria.

  • Eating disorders*. People with eating disorders are five times more likely to live with a SUD when compared to the rest of the general population.

  • Anxiety disorders. Anxiety disorders are a significant risk factor for the development of a SUD, especially alcohol abuse.

  • Almost a third of those living with major depressive disorder or MDD meet the criteria for a SUD. Substance use can also pair with other types of depression, like persistent depressive disorder.

  • Attention-deficit/hyperactivity disorder (ADHD). People with ADHD are more likely to live with a SUD when compared to those without ADHD.

Other conditions can play a role in the development of SUDs for some people. In cases like these, addressing other concerns is often highly beneficial and is an important part of treatment for SUDs. Other risk factors, like environment, may also be addressed in treatment. When a person receives care that acknowledges their needs as a whole person and does not shy away from the role the substance may play in a person’s life, it means that a person can speak openly about their experiences, find healthy coping mechanisms to use when triggers arise, learn how to advocate for themselves, and gain other skills that may be beneficial for them as a unique person in recovery.

Substance use disorders can be difficult to manage on your own

How therapy can help you recover

If you’re considering SUD counseling and recovery, you might wonder how it works, what it will be like, or what the benefits of treatment might be. Counseling for a substance use disorder can help you:

1. Name and navigate triggers

Learning to name and navigate triggers is often a crucial part of relapse prevention. Your triggers might be specific feelings, specific situations (such as situations where you may be in the same room as or get offered a particular substance), or something else. Once your name or identify your triggers, you will likely make a plan for how you can navigate them, helping you engage in more rational thinking. This might be turning to a support system, leaving the room or event, finding ways to cope after the fact, or something else.

2. Work on life goals

A big part of counseling or treatment for SUDs is thinking about what you want your future to look like. This could include learning skills that’ll help you build and maintain healthy friendships, job or work-related skills and goals, and implementing positive daily routines into your life.

3. Challenge negative thoughts

It’s very common to experience depression, negative thoughts, and other challenges when new to sobriety. Learning to challenge negative thoughts effectively is something that we can all benefit from, and in time, your general thought patterns can become more positive and balanced if this is something you’re working on.

4. Improve your overall mental health

Because mental illness often coincides with substance abuse, one of the key principles of substance use counseling is addressing mental health holistically. In other words, most often, you will address everything – or most things – that is impacting your mental health rather than the SUD diagnosis and the behaviors that might come with it alone. Many patients learn coping skills, communication skills, and so on that positively impact their lives and well-being overall.

Sarah Claridge, LISW

Sarah has helped me work through some challenges I was experiencing. Her nonjudgmental approach to substance use and finding healthier coping skills was a huge asset for my healing. Highly recommend.”

5. Find solidarity and fight stigma

You will likely come to find a sense of solidarity in SUD counseling or treatment. Whether that is from the healthcare professionals you work with, of a support group, a sponsor, or someone else, finding people who take away the stigma of SUDs and provide solidarity for your recovery is something everyone who gets care deserves. 

That said, this is by no means an extensive list. Counseling for a SUD can help you in many different ways, and it is the start of what truly feels like a new life for many people.

Where to find treatment near you

  • Ask a professional. You can ask a general doctor or call area hospitals for treatment information, you can also ask a substance abuse counselor, therapist, social worker, or psychiatrist you already work with. 

  • Use a treatment locator such as

  • Call a resource hotline such as the 211 hotlines. 211 is available in most areas in the United States. Dial “211” using any landline or cell phone, and you’ll be connected with an operator.

If you have health insurance, you can also contact your health insurance company directly to see what treatment resources they cover. 

Tips for supporting your loved ones

If you live with a SUD and want to show someone in your life how to support or better understand what you’re going through, you may send online resources and other sources of information their way. SUD treatment often encourages the involvement of loved ones.

Alternatively, if you’re the loved one of a person with a SUD, you may want to find support for yourself. There are many support groups for loved ones of those with SUDs, including family and romantic partners. 

Therapy and additional support options

Individual therapy with a licensed mental health professional may also be advantageous if you are the loved one of someone living with a SUD. It can be challenging to watch someone you care about face a SUD or another similar condition. Among the many other reasons people might seek therapy, therapy is a safe space to talk about your feelings and help you cope with or manage stress when times are hard. In time, you can learn to replace the negative habits and thought patterns that lead to substance abuse with more positive behaviors.

Online therapy is a viable option if an individual doesn’t want to meet in person. Individuals can connect with a licensed professional from their home without a commute, often at a more affordable price than in-person treatment. 

Many halfway houses and correctional facilities are willing to accept proof of substance use counseling with an online provider who has a Master’s degree or Bachelor’s degree in their field.


To find a therapist, you can get in contact with your doctor or insurance company, search the web for someone in your area, or sign up for a platform that offers remote therapy. Make sure to find someone that is licensed, with relevant supervised clinical experience in their field. Beyond education, it is important to find someone with good listening skills and the ability to offer you a variety of treatment options.

Whether you have a loved one with a SUD or want to talk about something else that’s on your mind, seeing a mental health professional can support you in finding clarity and confidence as you move forward.

Receive evidence-based counseling
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
Get the support you need from one of our therapistsGet started