How to Choose The Right Addiction Counselor

Choosing an effective addictions counselor is a bit like choosing a good undertaker: nobody wants to need one and by the time you do; you’re probably in no shape to go shopping for one.

The process can be confusing and draining. There are a lot of options and simply navigating the alphabet soup of professional credentials can be overwhelming. It’s helpful to understand the different types of addiction professionals, your options for types of treatment, and strategies to ensure that the clinician you’ve chosen is a good fit for you.

Types of Professionals

People commonly confuse psychiatrists with psychologists and counselors with therapists. In the simplest terms:

1. Psychiatrists prescribe medications and it’s rare for these folks to spend any significant time face to face with clients.
2. Psychologists are considered experts in human behavior and cognition (thought processes). They provide testing for any number of conditions (processing challenges, learning disabilities and extensive psychological assessments). Most provide counseling services that tend to focus primarily on changing behavior without a lot of emphasis on emotion.
3. Therapists are an eclectic group of professionals who take a holistic view to treatment. They have earned a masters degree in a variety of studies (psychology, social work, education, and others). There are a lot of variations from state to state but they’re usually either a Licensed Clinical Social Worker (LCSW), Licensed Clinical Professional Counselor (LCPC) or Licensed Marriage and Family Therapist (LMFT).
4. Substance abuse counselors (CADC, LADC) also come from very eclectic backgrounds. They most often have either an associates degree or bachelors degree, though in many states it’s possible to attain licensure with no post secondary education at all. The majority of substance abuse counselors are recovering addicts and alcoholics.

Counseling vs. Therapy

Unfortunately, these terms are often used interchangeably. Counseling is best conceptualized as focusing on change from today forward; whereas therapy incorporates examination of how past experiences continue to affect current perspective and behavior.

In the context of early addiction recovery, I urge folks to avoid looking at the past unless there is a compelling reason to go there (example – chronic PTSD). I strongly suggest that stability and sobriety have to come long before mental health concerns. This is especially true because attaining sobriety almost always has a huge impact on mental health.

How Do We Know Who Gets It & Who’s a Quack?

Quite often folks choose counselors by the same means that they locate a plumber. They find us in the phone book and through internet searches. They look for who’s in their neighborhood or close by to work. Some get referred by their primary care physician and others by their health insurance provider. 

My experience is that the very best recommendations come from the real experts – the men and women of AA and NA. More so than any other group, these folks have a strong awareness of local resources. They know which providers “get” addiction and which do more harm than good.

The importance of this point cannot be overstated. There are plenty of professionals who are very effective in mental health and very ineffective with substance abuse. Worse, just because a clinician accepts clients who are seeking recovery from addiction, that doesn’t mean they have any experience, training, or education in substance abuse. Health insurance companies generally contract with any clinician that has a master’s degree or higher with little or no regard to their areas of expertise.

If you’re connected to people in the know you can feel assured that the clinician you’re going to see was effective for them. The more you know about what you need and what works for you, the easier it will be to ensure that your clinician will work for you.

Interview Your Clinician

Counselors are like shoes – sometimes you have to try on a few to find a good fit. Please keep in mind that your clinician’s job is to be of service to you.

I very much appreciate it when potential clients interview me. They don’t want to waste their time or mine. The types of questions they ask usually go to the heart of the matter:

• Are you a recovering addict or alcoholic?
• Did you grow up in a family of addiction?
• Do you believe that addiction is a disease?
• How much experience do you have in working with addicts/alcoholics?
• Do you judge people based on what they did while active in addiction?
• Are you comfortable incorporating my spiritual (and/or) religious beliefs in counseling?

These are standard and straightforward questions that any clinician should be willing to answer. I encourage folks to ask what they really want to know and those types of questions usually show past negative experiences in counseling.

• Will you judge me for my sexuality?
• Will you change the subject if I talk about really bad things that happened to me?
• Will you give me direct feedback and not just say things like, “Uh huh, Hmm, and I see”?
• Will you answer my questions with questions?
• If you think I’m kidding myself will you tell me?
• Will you tell me how I should feel or how I should live my life?
• Can we just talk sometimes or do I have to stay with what you think is important?

Listen to your intuition. If you feel uncomfortable with the clinician you’re seeing, tell them. If something can be changed, great! If not, consider asking them to recommend someone who has the style/attributes you’re looking for. Meeting with someone you know you can’t be open with doesn’t make sense. Please remember that we work for you.