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Substance Abuse Counselor Duties in a Hospital Based Environment

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Substance abuse counselors are mental health professionals who specialize in helping people struggling with addictions. They provide counseling and support as their clients begin the road to recovery. Substance abuse counselors work in a variety of settings, including hospitals. Hospital-based substance abuse counselors may work on detox units, inpatient intensive treatment units or outpatient departments.

Assessment and Diagnosis

Substance abuse counselors who work in hospitals generally meet with clients the moment they are admitted, and they perform screenings and psychosocial evaluations. Psychosocial evaluations are used to assess the client's psychological, social, mental and physical health. Counselors gather information regarding a patient's current and past history of use, withdrawal symptoms, health problems, concurrent psychiatric disorders, family history of substance abuse and previous attempts at treatment. Based on this information, they may make a substance abuse disorder diagnosis, which is needed for insurance reimbursement and admission to treatment.

Treatment Planning

Treatment planning is another important component of a hospital substance abuse counselor's duties. The treatment planning process begins after the evaluation has been completed. The counselor must determine what type and form of treatment is needed, including deciding whether a patient needs detox, inpatient or outpatient treatment. They formulate actionable treatment plans that include specific steps the client needs to take to begin the recovery process. This usually includes discharge within a specific time frame, as may be required by managed care guidelines.


Substance abuse counselors are also responsible for implementing treatment plans. The structure and type of counseling they provide largely depends on the unit in which they work. They might provide individual counseling, group therapy or a combination of both. Counselors who work on inpatient units have more frequent contact with their patients, while counselors who work on outpatient units might only see their patients a few times per week. Regardless of the setting, the counselor continually assesses the patients' progress and makes adjustments to treatment plans, if necessary.


Substance abuse counselors plan for aftercare before a patient is discharged from the hospital. They evaluate the patient's progress and make an appropriate referral for continuing treatment, if necessary. For example, patients from inpatient units may be discharged to less-intensive outpatient units or outpatient substance abuse counseling centers in the community. Patients who successfully complete outpatient treatment may not require further care. Substance abuse counselors may also provide referrals to additional services, such as social services or employment agencies.