What to Expect from Drug and Alcohol Counselling
If you have been thinking about talking to someone about your drinking or drug use, you might be wondering what actually happens in counselling. What will you be asked? Will you be expected to stop drinking or using drugs altogether? What if you want to stop using one drug but not another? And how do you know whether a counsellor is right for you?
Drug and alcohol counselling can vary in style. Counsellors have different backgrounds, approaches and areas of expertise, but having a sense of what to expect can help you find someone who is a good fit.
What does a drug and alcohol counsellor do?
A drug and alcohol counsellor works with people who have concerns about their drinking or drug use. Some counsellors also support people affected by someone else's substance use.
Counselling involves more than just talking about how much you are drinking or using. It is about understanding the role alcohol or drugs play in your life, what might be contributing to patterns that concern you, and what makes changing those patterns difficult or doable.
Specialist drug and alcohol counsellors understand how alcohol and drugs affect the brain, body and behaviour, why change can be difficult, and how substance use can interact with mental health. They can help you work through barriers to change and develop strategies that are right for your circumstances. They can also provide advice about other treatment options, including withdrawal support and residential rehabilitation, when appropriate.
Do I have to stop drinking or using drugs?
No. You don't necessarily need to commit to stopping alcohol or drug use to begin counselling.
Some counsellors work primarily from an abstinence-based approach, where the focus is on stopping substance use altogether. Others use a harm reduction approach, which aims to reduce the negative effects of substance use without requiring abstinence.
These approaches aren't always mutually exclusive. Harm reduction principles can also inform counselling with someone whose goal is to stop altogether.
What is important is that your counsellor is open about their approach and works with you to establish goals that reflect your circumstances, preferences and needs.
In my practice, harm reduction principles underpin my work, but the direction of counselling is guided by you. I support people who want to stop, who want to reduce, and who aren't sure yet. You might also want to stop using one substance while continuing to use another. I will talk through your goals without assuming there's a one-size-fits-all approach.
What should happen in the first counselling session?
Your first appointment should be an opportunity for you and your counsellor to get to know each other, discuss what has brought you to counselling and begin figuring out a direction for therapy.
Your counsellor will generally ask about your drinking or drug use, physical and mental health, personal history, relationships and other aspects of your life. They may begin to explore how different experiences and circumstances are connected to what is happening for you. A good counsellor will ask about the whole you, not just about the drugs, and not just about the problems.
You can also expect your therapist to explain confidentiality, including its limits (when they might need to share information about you with other people), and give you opportunities to ask questions.
You shouldn't be expected to tell your whole life story in one appointment or have all your goals worked out beforehand, or even by the end of the first session.
In my practice, I take a relaxed but thorough approach. I will ask questions, listen carefully and share my initial thoughts and observations – it will be a conversation rather than just a barrage of questions. By the end of the appointment, I want you to feel that you have been taken seriously, that I have begun to understand your concerns, and that we have a starting point for working together.
What approaches are used in drug and alcohol counselling?
Drug and alcohol counsellors use a range of approaches, depending on their training and the needs of the person they are working with. There is a strong evidence base for several approaches to addressing alcohol and drug problems.
Two commonly used therapeutic approaches are:
Motivational interviewing (MI): Helps you explore any mixed feelings about changing your drinking or drug use, work out what matters to you and strengthen your confidence to make changes.
Cognitive behavioural therapy (CBT): Helps you recognise patterns in your thoughts, feelings and behaviour, and develop practical strategies to manage cravings, respond to situations that might lead to substance use and maintain changes over time. (This approach also has a strong evidence base for anxiety and depression).
Other approaches can also be used, and counsellors often combine different methods depending on the person's needs. Your counsellor should be able to explain the approach they are using and why they think it might be helpful to you.
In my own practice, I use motivational interviewing and CBT, alongside other approaches that can help with difficulties connected to substance use. These include dialectical behaviour therapy (DBT) skills for managing emotions and distress, and compassion-focused therapy (CFT) for working with shame and self-criticism. I also use relaxation and mindfulness techniques.
Will I be judged for my drinking or drug use?
If you feel judged by your counsellor, that is a good reason to question whether they are the right person for you.
Talking openly about alcohol or drug use can be hard, particularly if you have experienced judgement, stigma or shame, either from yourself or other people. This is why it is so important to have a respectful, non-judgemental counsellor.
That doesn't mean your therapist should avoid difficult conversations or agree with everything you say. A good counsellor should be able to discuss difficult issues and challenge you without shaming you or making you feel bad about yourself.
You should also feel able to disagree, ask questions or say when something doesn't feel helpful.
What if I also have mental health concerns?
Mental health concerns such as anxiety, depression, grief and difficulties managing emotions often overlap with alcohol and drug use.
If this is the case for you, it is important that your counsellor has experience working with both. You shouldn't necessarily have to address your substance use before getting help with your mental health, or vice versa.
As a specialist drug and alcohol counsellor, I work with substance and mental health concerns together, while recognising when additional support from other professionals may be helpful.
How do I know if a drug and alcohol counsellor is right for me?
Finding the right counsellor isn't just about qualifications and experience, although these are important. It is also about finding someone you feel comfortable talking to and whose approach makes sense to you.
Many counsellors offer an introductory phone call before booking a first appointment. This is a chance to get a first impression, ask questions, get a sense of how the counsellor works and see how comfortable you feel talking to them.
Some questions you might like to ask are:
What experience do you have working with alcohol and drug concerns?
What counselling approaches do you use, and what do they involve?
What can I expect from our first appointment?
Having said that, you don't need to have a bunch of questions prepared. What matters most is how you feel during the conversation. Does the counsellor seem approachable? Do they answer your questions clearly and openly? Do you feel comfortable talking with them?
You won't necessarily know whether a therapist is right for you after one short conversation, but it can definitely help you decide whether you want to book an appointment.
Written by Marney King, Accredited Social Worker and specialist drug and alcohol counsellor based in Melbourne, offering counselling in Coburg and online across Australia.
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