Should You Become A Substance Abuse Counselor| Case Study 1

Should you be a Substance Abuse Counselor?| Case Study 1

Should you be a Substance Abuse Counselor?| Case Study 1 

She was about 5’5 inches had milky white skin, and beautiful blond hair. Her eyes were a shade of blue I had only seen in movies. Brilliant like a piece of jewelry. She always wore pearls and a cute sweater with her pants or a skirt. Very neat and professional looking. 

The first time I met her I was interviewing her for the job as substance abuse counselor in a medicated assisted treatment out patient program. In other words a Methadone clinic for opiate addiction. The interview went well the only concern I had was that she had a Masters in pastoral counseling.  That may seem great to you considering the population we worked with at the clinic but from experience, my mind screamed “oh hello no.”  


However, she was so nice I hired her and her work experience fit the organizations’ criteria. I regretted it by the second week.

Here is where things went wrong.

1. Whenever this counselor could not understand what was being taught in training or if she did not get an assignment right she would come into my office crying.  “Oh Shit” I thought and began a silent prayer. I spent the next few weeks telling her over and over how she had potential, try this strategy, or that technique. As her supervisor I would read the regulations and policy and procedure with her and the sessions would appear to go well. One day she said  “I don’t want to make you unhappy.”  

Look I will tell you that is scary. Her job is to take care of her case load, learn her job not please me.  Having been a counselor I understand all too well wanting to make your supervisor happy to have you around and trust you but this was different.  This woman lived in fear. That is dangerous for a supervisor. If she considers herself a failure on the job, in the end, she will blame the supervisor. She did just that turned herself into a victim by entering and leaving my office crying.  

Major size tear drops like I never saw before. If I had been working in another environment I would have thought I was being punked. She would share about everything in her gut that disturbed her.  

Should You Be A Substance Abuse Counselor?| Case Study 1

It is important for counselors and the supervisor to know that the supervisor is not the therapist.  We have empathy but bottom line can you do the job?  When something like this happens suggestions and referrals for assistance are given, but it only works if the person really wants to learn the job. Sadly, in this case, this woman was full of excuses with the intent to have her way as you feel sorry for her.

2. Opiate treatment programs dispense the medication methadone and sometimes Suboxone.  This means the clinics are highly regulated by the DEA, local, state, and federal regulations, and in many states the board of pharmacies. Let’s not leave out the State Methadone Authority. 

What this counselor did because she thought she knew better was turn her clients against the company and her peers. She told them things like we didn’t care about them and only she did. She would advocate for them which is our job but not to violate regulations.  Sometimes we can be flexible in treatment but when it comes to the medication it is very rare.   She would make promises to the client that the clinic could not go along with and then tell the client it was the teams’ fault.  

3. When she quit and moved on to another job it took her clients a few months to bond with his/her new counselor because they were told not to trust us. That created a barrier to treatment which we should avoid. Building the treatment plan with the client is about identifying and removing barriers not creating them.  

Code of Ethics

There is a Code of Ethics that substance abuse counselors commit to prior to getting certified. You sign it when you start your job with most organizations. you sign it again when you apply to get certified.

 Here are a few code of ethics this counselor did not take serious:

The addiction professional will provide the client and/or guardian with accurate and complete information regarding the extent of the potential professional relationship, including the Code of Ethics and documentation regarding professional loyalties and responsibilities.


The counselor set her clients up to believe that she could move the moon for them and when and if she failed it would be the fault of the team and/or program director. 

The addiction professional will foster self-sufficiency and healthy self-esteem in others.

The counselor enabled her clients. She did not encourage them to have a plan “B”, and that the counselor and clinic could not be plan “A” all of the time.


The addiction professional encourages self-sufficiency among clients in making daily choices related to the recovery process and self care. 

This counselor believed the clinic should stay open late for her clients that refused to get up and attend treatment on time.  It was the responsibility of the clinic to make last minute arrangements for the client repeatedly. She shared those views with the client. No regard for her co-workers, the risk that comes from breaking rules. No understanding that when you break the rules for one client they brag to the other clients who expect the same or accuse the staff of favoritism. When clients yell favoritism they tend to call state authorities. Not a good day for those unannounced visits. 

Addiction professionals will maintain respect for institutional policies and management functions of the agencies and institutions within which the services are being performed, but will take initiative toward improving such policies when it will better serve the interest of the client.

The counselor never came to supervision or treatment team with solutions only request for the team to violate regulations and organization policies.


  • The counselor clearly had boundary issues. There was unhealthy countertransference taking place. So back to why I was concerned about hiring a counselor with a degree in pastoral counseling.  Well, for one thing, it has never worked out well in this clinical environment regardless if the counselor was a male or female.  That’s my experience may have just been my luck. So,  like the others, this counselor was stuck in advocate role.  As substance abuse counselors we wear many hats and advocate is one of them.  However, we learn as we develop our skills to exchange one hat for another.  
  • When you advocate for a client you can ask for exceptions to the policies as long as it doesn’t require violating regulations. Advocating to make ongoing allowances for your clients making them an exception to the rules instead of helping he/she grow is not doing your job as a substance abuse counselor.  Enabling sets the client up for failure in the recovery journey.
  • This type of counselor made the other counselors uncomfortable. However, peers stick together when it comes to management.   The other counselors took her side every time she played victim crying, literally when redirected by the program director or executives of the company.
  • This counselor received the same training as all the other counselors as required by the organization and regulatory governance and more. She insisted on doing things her way.
  • Everyone with a helping heart does not belong in every treatment modality. I believe this woman would be the perfect family counselor, youth counselor, even a court advocate.  The stringent policies and regulations that must be adhered to with a methadone clinic did not sit well with her and she did not take the time to understand why they existed and how they protected the client, staff, and community.

If you have a desire to become a substance abuse counselor it will take more than the following:

  • Your direct personal experience with alcohol and drug addiction
  • Your friend or family members experience with alcohol and drug addiction
  • Your favorite character  in a movie or tv show compelled you to become a counselor
  • The fact that your family has told you since you were five you should be a counselor because you made everyone on the block feel so good
What does it take to become a Substance Abuse counselor?
  • There are specific course and work experience requirements you need to check your state
  • A willingness to do the job as you are trained trusting in the experience of others. There is a reason for the regulations we need to adhere to. The more organizations and counselors don’t comply the more stringent the regulations become.
  • Be willing to learn the job on your own Read, Read, Read, Implement
  • Accept the fact the client comes first not you, your supervisor, nor your peers.  If there is something unethical going on it is your job to report. This is not a “none of my business” kind of job
  • Be willing to change and grow in other words, “walk the talk.” Role model the growth you would like to see in your clients. 
  • If a treatment modality is not for you do yourself and the clients a favor find another job as fast as you can.  

So the question still is “Should you be a Substance Abuse Counselor?” In order to answer that question do your research about this position.

  1.  Research and compare the duties to that of a counselor in another field, ie. advocate, inpatient, faith-based, etc.  
  2. The code of ethics are the same so read them and ask yourself can you comply, are you willing to learn how?
  3. Talk to people who work in the field already. Ask about the day in the life of a counselor, in fact, ask about Monday in the life of a counselor. 

Check your motives for wanting to work with this type of client. Your “why” is only a stepping stone. What comes next in your training and as you gain experience is the foundation to providing quality care to those who need it.

“Do No Harm” remember this you will hear it a lot!

I hope you found this post helpful. We need more counselors who are interested in becoming certified and truly want to help by putting the well being of others first in an ethical and professional manner. 

Check out Resources for the Professionals in the Field


**If you enjoyed this post and found it helpful Comment below and Share on your favorite social media site.**

Lydia Brown




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Lydia Brown

Lydia Brown, MS, MAC, CSAC, CADAC Editor ATN, Home Business Owner Advocate for Alcohol and Substance Abuse Treatment CARF Surveyor

6 thoughts on “Should You Become A Substance Abuse Counselor| Case Study 1

  • October 16, 2016 at 11:11 pm

    Hi Lydia
    I think the most important factor for someone to be a drug/alcohol counselor is
    – direct personal experience with alcohol and drug addiction. My ex-husband was an alcoholic and I never thought that he would stop drinking. Years later he trained to be a drug/alcohol counselor and saved many lives. He had no degrees or special training, only a wish to help others like himself.

    • October 16, 2016 at 11:29 pm

      Hi Kathryn, thank you for your comment. Direct personal experience is a great place to start but there needs to be a willingness to learn
      about alcohol and addiction. Learning about the personality and thinking of an addict. I can personally tell you that when you are in the field and learn from your leaders, peers, and medical profession you find that what you knew about the disease is minimal. You realize that what you did know is how to use. On the job as you stated your husband was taught what he needed to learn. An organization would have done your husband and the client a disservice if they did not provide that training. Now as a trainer, program director, and clinical supervisor that not every recovering person in recovery can be a counselor. There are some who think it is all about his/her using and recovery. However, it is about the using and recovery process of the client who may not want to use the same help you used. Therefore, the counselor needs to be ready to disseminate information beyond his/her personal experience. I can also tell you that some of the best counselors I have had the pleasure to supervise and train have been in recovery and those who have never had the problem.

  • October 10, 2016 at 8:55 am

    We under estimate the potential positive impact counselors and therapists have upon people. Let alone the specific skills and experience they require for each of the different specialties of the role. A clear message here from you Lydia is that a Substance Abuse Counselor job is not something you can decide to take on over night. A lot of thinking, research and education is required. Thank you for the insight to such an important job.

    • October 11, 2016 at 4:32 am

      Hi Gil, Thank you for your comment. I am glad my message was clear. Like any other job some people are not appropriate for this line of work.


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