Substance Abuse Counseling (often called Addiction Counseling or Substance Use Disorder treatment) is a therapeutic approach that helps people change their relationship with substances while addressing the underlying reasons the use developed in the first place.
Here’s a clean, structured overview
What it is
Substance abuse counseling supports people who:
- Are using alcohol or drugs in ways that cause harm
- Feel out of control with substances
- Use substances to cope with emotional pain, trauma, anxiety, shame, or identity distress
- Are in recovery and want relapse prevention support
It treats substance use as a learned coping strategy, not a moral failure.
Core goals
- Reduce or stop harmful substance use
- Understand why the substance became necessary
- Build safer coping and regulation skills
- Repair relationships and self-trust
- Support identity reconstruction beyond “the addiction”
Common approaches used
Motivational Interviewing (MI)
- Helps resolve ambivalence (“part of me wants to stop, part of me doesn’t”)
- Non-confrontational, autonomy-respecting
- Especially effective early in treatment
Cognitive Behavioral Therapy (CBT)
- Identifies triggers, thought loops, and behavioral patterns
- Builds relapse-prevention plans
- Teaches urge management and alternative coping
Trauma-informed therapy
- Addresses attachment injuries, chronic shame, or developmental trauma
- Recognizes substance use as nervous-system regulation
Harm Reduction
- Focuses on safer use if abstinence isn’t immediately possible
- Meets people where they are, not where they “should be”
Group therapy / 12-step or alternatives
- Provides belonging, accountability, and shared meaning
- Alternatives include SMART Recovery, Refuge Recovery, etc.
What happens in sessions
- Assessment of substance patterns and risks
- Exploring emotional, relational, and somatic triggers
- Learning skills for craving management and regulation
- Planning for high-risk situations
- Strengthening identity, purpose, and values
Who it’s for
- People questioning their use (“Is this becoming a problem?”)
- People with diagnosed Substance Use Disorders
- People in early recovery or long-term maintenance
- People whose substance use is tied to trauma, shame, or existential distress
Important reframe
Substance use is often:
An attempt to regulate pain, not a desire to self-destruct.
Effective counseling treats the function of the substance, not just the substance itself.
Shervan K Shahhian
LIBERTY PSYCHOLOGICAL ASSOCIATION 