The NCSL Blog


By Sydne Enlund

Lack of access to behavioral health providers in rural areas affects millions of Americans.

Pile of pillsState policymakers continue to look for innovative ways to address this workforce shortage. Using addiction counselors to provide services in areas that lack behavioral health providers is one strategy states are increasingly examining.

Addiction counselors, also known as substance use disorder counselors, work with people who suffer from a range of substance use disorders (SUDs). A SUD can involve addiction to alcohol, opioids and/or other substances. Addiction counselors work in a variety of settings, including inpatient and outpatient facilities, sober living homes, hospitals or various community organizations.  

An individual can enter the field of addiction counseling through multiple means, ranging from earning a certification with a high school diploma to becoming a licensed addition counselor through a behavioral health graduate or doctorate degree with an addiction treatment focus. The state where individuals earn their certification or license affects what treatments they can provide and to whom. The scope of practice for addiction counselors and the licensing and certification standards vary from state to state, as does the terminology.

To receive a credential (i.e., certificate or license), a person needs to complete certain education requirements, either through a degree program or relevant subject matter classes, and complete a specified number of hours of field experience. Once the credential is received, a state can authorize the addiction counselor to provide specific services under the credential.

Many states offer multiple paths to the same credential. The credential can be obtained by earning either a master’s, bachelor’s or associate degree or a high school diploma. The greater level of education achieved may be substituted for some of the required practice. For example, a high school graduate may need six years of experience to receive the credential, while someone with a graduate degree only needs one year of experience. In addition, individuals who have received a graduate degree are more likely to be authorized to diagnose and practice independently.

Some credentials can also be obtained by licensed professional counselors, licensed clinical social workers or other behavioral health providers. In these cases, the provider receives further education and training in a specific SUD field to obtain the credential.

There are complexities around reimbursement for addiction counselor services:

  • A person without a graduate degree but with a certification may or may not be able to bill Medicaid, depending on whether a state decides to cover SUD services under its Medicaid program.
  • The person with a graduate degree and a certification may bill Medicaid, depending on whether a state decides to cover SUD services under its Medicaid program.

As states continue to look for ways to address the shortage of behavioral health providers, policymakers will continue to examine using non-physician providers in rural and underserved areas. For more information on addiction counselors and other behavioral health providers, please visit NCSL’s new website

Note: For the purposes of this blog, the term addiction counselor is a general term for an individual assisting those struggling with SUD, encompassing a broad range of educational and professional backgrounds, and is not synonymous with a licensed professional counselor.

Sydne Enlund is a policy specialist in NCSL’s Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.