Course Introduction: Counseling People Who Use Substances
Welcome to the Counseling People Who Use Substances course. In this course you will learn about commonly used substances, how substances impact people's physiology, how to assess, diagnose, and treat substance use, and so much more. This information is designed for all counselors in training, and all counselors will likely encounter clients who use substances or clients who are in systems that are impacted by substances.
Recommended Readings & Resources
To get the most out of this unit, please review the following:
- Kelly & Saitz, 2015
Course Introduction Video
Playback problems? This video is available on YouTube: youtu.be/rRnWkRlzZpw
A transcript of this video is available as a .pdf file as well as a plain (.txt) file.
Language & Perception
Research has demonstrated that language significantly impacts one's perceptions and behaviors. It is crucial that counselors be aware of how their language impacts their clients. Often, clients with substance use disorders experience substantial stigma, including some counselors who use stigmatizing terms. Shaming is not an effective way to treat substance use disorders, and counselors should practice using the less stigmatizing terms in the below table.
Some counselors in training worry that using destigmatizing language takes away responsibility. Effective substance use treatment is about identifying and remedying underlying causes such as low social support or a need to fit in, physiological predispositions and changes, problematic patterns within families, and many other potential factors. Treatment progresses more smoothly and is more effective when the counselor engages in a warm, genuine, empathetic relationship (similar to that described by Rogers). While well intentioned, counselors who shame or otherwise stigmatize their clients are more likely to perpetuate the problematic behaviors their clients seek to change, rather than actually helping their clients.
| Preferred Term | Stigmatizing Term |
|---|---|
| "Person with a substance use disorder" OR "Person who uses substances" |
"Addict" OR "Substance abuser" |
| "Person with an alcohol use disorder" | "Alcoholic" |
| "Tested [positive/negative] for [substance]" | "Clean/dirty" |
| "Substance" | "Drug" |
| "Intoxicated" | "High" |
| "Person without housing" | "Homeless person" |
Read through this article before considering the following reflection prompts.
- Kelly, J. F., Wakeman, S. E., & Saitz, R. (2015). Stop talking 'dirty': Clinicians, language, and quality of care for the leading cause of preventable death in the United States. The American Journal of Medicine, 128(1), 8-9. doi: 10.1016/j.amjmed.2014.07.043
Language & Perception Exploration Questions
- What are your values, biases, & beliefs regarding people who use substances?
- Kelly, et al., 2015 cite research that found that when mental health professionals are told that a client is a "substance abuser" they are more likely to respond punitively than when they are told the client has a "substance use disorder". How does your language and the language of others impact the way that you view clients who use substances?
- How can you become aware of when you are using stigmatizing language?
- What are your views regarding the importance of using culturally sensitive language?
- What changes might you make in your language to reduce stigma for people who use substances?
- How do you feel about the white house moving away from the "War on Drugs" and toward a "broader health approach" (Kelly et al., 2015, p. 8)?
- What do you think the authors meant by a "broader health approach"?
Course Resources
During this course, we will routinely use several external resources. Familiarizing yourself with these resources early and referring to them during other units will make the course easier.
- List of Commonly Used Substances
- From the National Institute on Drug Abuse
- The Erowid Center
- Information on drugs, drug culture, and drug users' experiences. The information on this website may be out of date or inaccurate, as it is not peer reviewed.
- The Diagnostic & Statistical Manual (DSM-5)
- The International Classification of Diseases
- ICD-10 diagnostic criteria for substance use can be found here
- The Drug Enforcement Administration's Drug Schedules
- SAMHSA's Evidence Based Practices Resource Center
- Alcoholics Anonymous (AA)
- AA "is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem" (AA). AA uses a twelve step program, and they believe that, for their "group purposes, there is but one ultimate authority-a loving God as He may express Himself in our group conscious" (The Twelve Traditions, p. 189). The organization has a page targeted toward professionals, including counselors, here.
- Narcotics Anonymous (NA)
- NA developed out of the 12 step tradition, with the aim of helping people who use any drug, including alcohol. NA has a Resources for Professionals page.
Initial Exploration Questions
Everyone develops their own values, biases, and beliefs. Psychoactive substances can be a particularly loaded topic, with some condemning all people who use substances, while others advocate for complete decriminalization and acceptance of substances. One of our aims in developing this course is to structure activities that encourage you to explore the ways in which your personal values, biases, beliefs, & culture intersect with your identity as a counselor and your professional work with people who use substances.
Before beginning this course, please reflect on the following:
- What drew you to the counseling profession?
- What do you think of when you think of drugs and illegal substances?
- What type of person comes to mind when you think of someone who uses substances?
- What are you hoping to learn during this course?
- What experiences and knowledge do you bring to this course?