Debunking Myths and Misconceptions About Addiction Counselling

Addiction counselling is a talking treatment for people whose drinking, drug use or other compulsive habit has become a problem in their life. The American Psychiatric Association describes addiction counsellors as treating people with addictions, typically substance use disorders, and also gambling problems.¹ Six beliefs about this work come up again and again, and each one can delay somebody from asking for help. This page checks all six against published clinical sources. Where the sources run out, it says so rather than filling the gap with reassurance.

If you are in immediate danger or thinking about harming yourself, contact a local emergency service now, or one of these helplines and suicide hotlines worldwide.

Belief 1: addiction is simply a choice

The US National Institute on Drug Abuse defines addiction as a chronic, relapsing disorder in which drug seeking and use become compulsive despite adverse consequences.² It treats addiction as a brain disorder, because circuits for reward, stress and self-control change with it.² Those brain changes in addiction can last a long time after a person stops taking drugs.²

That evidence on its own is incomplete, so the other half of the clinical literature matters. Kaplan and Sadock's chapter on neurocentrism holds that data consistently demonstrate that quitting is the rule rather than the exception.³ That chapter also reports that people addicted to nicotine, alcohol, cocaine or heroin change behaviour in response to rewards or sanctions, which is why it treats quitting as ordinary.³

Both things hold at once. Substance use gets much harder to stop than it was to start, and most people do eventually stop. Willpower is a poor description of what changes in between, because what changes is usually the person's reasons, their circumstances and the help around them.

The belief persists for a reason that is worth naming. Kaplan and Sadock's Synopsis reports that weak public support for treating substance dependence suggests these problems are still viewed partly as moral failings rather than as medical disorders.⁴ In a consulting room that shows up as shame. People apologise for taking up the appointment, and families may arrive angry with the person and with themselves. Neither is a reason to stay away, and both are ordinary opening material for a first session.

Belief 2: counselling is only for severe addiction

Diagnosis is not a threshold you have either crossed or not crossed. Kaplan and Sadock's textbook notes that DSM-5 combines the older abuse and dependence diagnoses into a single disorder measured on a continuum from mild to severe.⁵ A problem sits somewhere on that line long before anyone would call it severe.

Plenty of people sit below the diagnostic line and are still at risk. The same textbook records that 10 to 20 percent of older adults are drinking above recommended limits and are at risk of problems even if they do not meet criteria for a use disorder.⁵ Older adults are the group that chapter reviews. The pattern is not unique to them.

Length of treatment tracks severity too, which is useful if you are weighing up one appointment. Kaplan and Sadock's Synopsis reports that for alcohol, tobacco or cannabis problems uncomplicated by heavy illicit drug use, relatively brief individual or group counselling can produce long-lasting reductions in drug use.⁴ Trying a short course early is a reasonable thing to do.

Belief 3: every addiction counsellor does the same thing

Methods do differ, and the honest finding is that several of them work. Wenzel, Brown and Beck report that cognitive behavioural approaches are effective in reducing alcohol and drug use, and that 12-step facilitation, motivational interviewing and nondirective interactional therapies are equally effective.⁶

Matching still counts. One trial summarised on the US National Library of Medicine's bookshelf worked with opiate-dependent clients in a methadone maintenance programme.⁷ Adding professional psychotherapy to standard drug counselling benefited clients with higher levels of psychopathology, while drug counselling alone helped clients with lower levels.⁷ So the useful question to put to a counsellor is what they would do with a situation like yours, and why.

Motivational interviewing comes up often in this field, and it helps to know what it is before you meet it. Miller and Rollnick write that motivational interviewing is about mobilising a person's own motivations, not installing different ones.⁸ A counsellor working that way offers a menu of options and asks which ones fit your own priorities, rather than installing a plan of their own.⁸

Belief 4: counselling is only for the person using

Family members are often the first to go looking for help, and there is clinical work built for exactly that. SAMHSA’s treatment protocol on family therapy in substance use disorder asks counsellors to link family members directly to community-based family recovery supports such as Al-Anon.⁹

The same protocol treats the family as a whole, and works on the quality of the relationships inside it rather than on the substance use alone.⁹ Both people in the couple usually feel resentment about the past and worry about the next few months. None of this makes family involvement a requirement, and none of it says the family caused the problem.

Where the person using is not ready to go, family work has a route of its own. Miller and Rollnick point to community reinforcement and family training, known as CRAFT, as a way of engaging unmotivated drug users in treatment through their family members.¹⁰ Your own counselling remains worth having whether or not they ever come.

Belief 5: counselling is a quick fix

It is not quick, and the timescales are published. Kaplan and Sadock's Synopsis reports that substantial reductions in illicit drug use and related psychiatric problems are much more likely following treatment lasting at least three months.⁴ That pattern held across very different kinds of programme.

Relapse is the part most people are frightened of, and the figures need reading carefully. The neurocentrism chapter reports NIDA's estimate that relapse rates among treated patients run from 40 to 60 percent, while holding that the data consistently show quitting to be the more usual long-run outcome.³ It also warns that clinicians meet the hardest cases most often and can mistake them for the rule rather than the exception.³

A lapse gives you information about what set it off, and a good counsellor will use it that way. Bandura's review found that perceived self-regulatory efficacy partly determines success in altering addictive habits and in keeping to altered habits over the long term.¹¹ Bandura also holds that recovery efficacy, the belief that you can regain control after a lapse, is what carries a habit change forward.¹¹

That has a plain consequence. Bandura puts it plainly: a therapist can provide guidance, but you serve as the main agent of your own change in these habits.¹¹ A counsellor who promises to do the changing for you is promising something no one can deliver.

Belief 6: it costs too much to be worth asking about

This page will not tell you what addiction counselling costs where you live. We hold no verified fee or public-funding figures for the countries this site serves, and a page that guesses at them is worse than a page that says so. Any page quoting one global answer, or assuming an insurance system you may not have, is guessing.

Cost is a real barrier, and it sits alongside several others. Kaplan and Sadock's textbook lists shame, denial and pessimism about treatment and recovery among the barriers that keep older adults from seeking help for a substance use disorder.⁵ Money is often the reason people give when one of the other barriers is the real obstacle.

Public agencies publish these corrections themselves, and their pages are worth reading with their country in mind. SAMHSA lists therapy and self-help being a waste of time among the myths it answers, replying that treatment varies by individual and may include medication, therapy, or both.¹² That is a United States agency writing for a United States reader, so treat the fee and service parts of any national page as local to that country.

What the title "addiction counsellor" requires of a person also differs by place, which is worth checking before you pay anyone. New York State's licence requirements for mental health counsellors say a programme accepted as substantially equivalent must include at least 60 semester hours, or the equivalent, of graduate study.¹³ A review of US counsellor licensing found that all 50 US states and the District of Columbia had laws in 2021 on post-graduate supervised experience and portability, with definitions and minimums varying across jurisdictions.¹⁴ If one country varies that much inside its own borders, the rules where you live are worth reading rather than assuming.

What a first session usually involves, and what to ask

A first appointment is mostly assessment and a conversation about what you want. Expect questions about how much you use and how often, what happens when you try to stop, what else is going on around you, and what you would like to be different in six months. Nothing is settled for you in that hour.

Miller and Rollnick's account of focusing shows the counsellor asking what you want for yourself, then working from your own reasons rather than the ones they would choose.⁸ If a first session instead tells you what your goal is, that is worth noticing.

Finding an addiction counsellor

Search the TherapyRoute directory for a counsellor in your city, then use the questions above at first contact. Our guide to how to find the right therapist covers what to look for and how to judge whether someone is a fit. TherapyRoute also carries a fuller guide to addiction counselling and recovery, a page on addiction counselling approaches, and a page on coping skills.

Team TherapyRoute

References

• [1] American Psychiatric Association. What is psychiatry? psychiatry.org/patients-families/what-is-psychiatry.
• [2] National Institute on Drug Abuse. Drugs, brains, and behavior: drug misuse and addiction. nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction.
• [3] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2). Neurocentrism: implications for addiction and the courtroom (pp 2052-2059).
• [4] Kaplan & Sadock's Synopsis of Psychiatry, 11th ed (2014). Substance-related disorders, chapter 20 (pp 34-34).
• [5] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2). Alcohol and substance abuse in older adults (pp 10449-10456).
• [6] Wenzel, Brown & Beck - Cognitive Therapy for Suicidal Patients (2009). 2008-18315-013. (pp 286-293).
• [7] US National Library of Medicine. Psychotherapy in substance abuse treatment, Bookshelf record NBK64952. ncbi.nlm.nih.gov/books/NBK64952.
• [8] Miller & Rollnick - Motivational Interviewing (4th ed, 2023). 5. Focusing: “Where Are We Going?”. (pp 94-99).
• [9] Substance Abuse and Mental Health Services Administration. (2020). Substance Use Disorder Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series, No. 39. SAMHSA. ncbi.nlm.nih.gov/books/NBK571080.
• [10] Miller & Rollnick - Motivational Interviewing (4th ed, 2023). 7. Planning: “How Will You Get There?”. (pp 155-157).
• [11] Bandura - Self-Efficacy: The Exercise of Control (1997). pages 381-390. (pp 381-388).
• [12] Substance Abuse and Mental Health Services Administration. Mental health myths and facts. samhsa.gov/mental-health/what-is-mental-health/facts.
• [13] New York State Education Department, Office of the Professions. Mental health counselors: license requirements. op.nysed.gov/professions/mental-health-counselors/license-requirements.
• [14] Review of state licensure policies for behavioural health counsellors, PMC11366493. pmc.ncbi.nlm.nih.gov/articles/PMC11366493.