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Are drug and alcohol counselors effective?

One of the questions we're asked most often is, does drug and alcohol counseling make a difference? Since many with alcoholism and addiction get sober without seeking professional help, is treatment from an substance abuse counselor really needed? And what is the best way to determine if a substance abuse counselor will be helpful.

Don’t be surprised if you can’t get a clear answer to this question. Although the efficacy of addiction treatment has been established, there are many competing interests that will attempt to steer you to this or that brand of drug and alcohol counseling. For one thing, there are so many different types of treatment centers and all of them claim to offer the superior approach. Some are 12-step based, others are more behavioral or more cognitively oriented, but most generally involve drug and alcohol counselors. Confounding the issue further is that most places now describe themselves as “holistic”, a term that has essentially become meaningless because many programs use it to mean different things.

Website claims about rehab efficacy are also frequently grossly distorted. The best evidence to date suggests that residential addiction treatment for 1-3 months in duration does not produce sobriety rates in excess of 60% at one year. These programs general employ drug and alcohol counselors. This number can be tweaked upwards with ongoing treatment, recovery management and some contingency management (like urine drug screening and treatment modification in response to stressors and early warning signs of relapse). Some groups that combine best practices and work with clients over longer periods of time can achieve higher rates of success.

Whatever approach is used, generally, substance abuse counselors are involved. There is no “typical” program (if you’ve seen one rehab, you’ve seen one rehab). But a common residential treatment scenario involves medical evaluation, psychological or psychiatric evaluation if indicated, detox as needed, and then group therapy led by a drug and alcohol counselor. Individual therapy with the same substance abuse counselor is often also built in.

The programs then typically bolt on other services in an effort to round out the schedule and address various deficits in the psychosocial functioning of the addict or alcoholic. These might include evidence –based approaches like mindfulness meditation and relapse prevention therapies to approaches with less solid evidence (art therapy, experiential therapies, equine –assisted therapies, etc). These more experiential therapies are rather controversial; substance abuse counselors often swear by them, but the research definitely is not yet there to support their use. They are, however, attractive to clients, and for that reason (among others) are often included in treatment programs. They are often attractive to drug and alcohol counselors as well, as they approach the patient who is struggling from an entirely different angle than the counseling itself.

Many people with addiction can get well without formal treatment; i.e. simply by accessing community based resources. But many cannot. Despite ongoing efforts to understand who needs treatment and who doesn’t (including, for example, patient placement criteria), the reality is that by and large, we don’t know. And since treatment does substantially increase the probability of improved life and sobriety, it's generally recommended. Most of the daily work with patients in these treatment programs is delivered by drug and alcohol counselors; in many ways its fair to say that their work forms a significant part of the engine behind the effectiveness of treatment.

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