Difference between Therapists & Counselors in Addiction Treatment?

As the prescription drug abuse problem grows in the United States, and many people are diagnosed with co-occurring mental health and substance use disorders, treatment to overcome addiction and substance abuse is more important than ever. Professionals who help treat substance abuse and addiction include physicians, nurses, social workers, case managers, and therapists, among numerous others. It is important that treatment focus on individual needs as much as possible, since life circumstances, personality, and health can vary greatly between each person who seeks help.

With so many involved in addiction and substance abuse treatment, there are many levels of education and different expectations placed on these people. Each person on the treatment team is important, but there are two types of addiction professionals – therapists (or psychotherapists) and counselors – who are the primary focus of treatment, especially during rehabilitation.

While different states regulate these professions differently, and the positions have overlapping duties in the life of a person overcoming addiction, therapists and counselors have distinct roles.

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What They Do


The term therapist is a regulated term in many states, and the position usually involves a clinical understanding of psychology. Therapists must become licensed professionals in order to practice, although their practice is not restricted to helping people with substance abuse; instead, therapists tend to focus on the whole person over a long period of time. Recovering from addiction may be the start of the therapist-client relationship, but a therapist will use a variety of techniques to help the individual with their mental and emotional health overall, of which overcoming substance abuse is one part.

Therapists train in many techniques, such as Cognitive Behavioral Therapy, to help their clients understand their interactions with the world around them and effect positive changes in several areas of their lives. Addiction is a chronic disease of the brain, involving genetics, family history, and environment. Understanding what triggered the addiction, and learning better ways to cope with that stress or trigger, is one way of changing a person’s life and mental health overall. By understanding the root causes of an addiction, the person can begin mending relationships with friends and family, working toward a career, and maintaining an emotionally stable life.

Therapists also treat mental health issues when they co-occur with substance abuse, such as depression, anxiety, bipolar disorder, and schizophrenia. In contrast, counselors are typically not trained to work with mental health issues directly.

Styles of therapy that work well in the context of addiction or co-occurring disorder treatment include:

  • Cognitive Behavioral Therapy: Therapists and clients work together to identify problematic behaviors and triggers for problematic behavior. The person works to change their reactions to triggers.
  • Contingency Management: Positive steps and behaviors are reinforced with rewards during therapy sessions, to help stimulate the risk/reward area of the brain that would otherwise be stimulated by intoxicating substances.
  • Motivational Enhancement: This therapy focuses on helping the client find internal motivation for their own recovery, rather than taking the person through specific steps. This type of therapy resolves ambivalence about the process, and it can involve family or friends.
  • Family behavioral therapy: This therapy addresses environmental problems connected to addiction, such as domestic violence, mental health or substance abuse issues in relatives, unemployment, or chronic illness. This therapy works particularly well for adolescents dealing with substance abuse.



Counselors can be social workers, medical professionals, or religious leaders, depending entirely on the rehabilitation setting. While many states require counselors to receive special training and licenses to provide support for those recovering from addiction, counselor is more of an umbrella term encompassing any professional who provides support to clients as they work toward sobriety and other preferred outcomes.

In general, counseling involves working on specific issues, including marriage difficulties, stress management, and substance abuse. In the context of substance abuse treatment, counselors work with their clients on understanding withdrawal symptoms and the consequences of substance abuse, and developing a plan to remain sober after treatment is over.

Counselors are often provided through a rehabilitation program, either inpatient or outpatient. For 12-Step-based programs, for example, the counselor will be trained specifically in guiding their clients through each of the 12 Steps toward recovery. In a medical setting, the counselor may focus on helping their client gather resources for medical treatment, focus on developing a routine to take medications and stay employed, and learning how to avoid ingesting intoxicating or addictive substances.



The majority of therapists have a PhD in psychology or psychiatry. They must also receive a license before practicing therapeutic techniques. Degree paths include a doctorate in clinical psychology, a doctorate in educational psychology, and a state license.



Counselors most often have master’s degrees in social work or psychology, or a combination of education, experience, and licenses allowing them to use the term counselor in their treatment work. Some of these degrees are master of social work, licensed clinical social worker, licensed professional clinical counselor, and pupil personnel services credential.



Therapists often open private practices, but they can also be found working in hospitals, rehabilitation settings, or through mental health charities. Since their scope is to work on a long-term basis with clients, they often continue their work with an individual after that person has completed a structured treatment program.



getting-helpCounselors offer many kinds of treatment styles, such as:

  • Leadership in group therapy
  • Discussion guidance in support groups
  • Family counseling to rebuild relationships
  • Individual counseling to manage symptoms, cravings, and triggers

These treatment options all focus on overcoming substance abuse and maintaining sobriety rather than larger mental health concerns that may have contributed to addiction. Counselors can be found in hospitals, inpatient and outpatient rehabilitation programs, transitional living environments such as sober living homes, and support groups.

Get Help

Regardless of whether a person works on a short-term basis with a counselor or with a therapist to overcome problematic thoughts and behaviors that lead to addiction, getting professional help is necessary to overcome addiction and substance abuse problems. People who struggle with substance abuse need social support and guidance, along with medical supervision to safely detox, in order to remain sober and focus on their long-term health.