The field of Substance Abuse Counseling Substance abuse counselors often have to deal with the most difficult problems faced by people, for these issues are not, by their very definition, limited to the psychological. And when problems are brought on by the use of addictive and mind-altering substances, the counselor must be able to not only work with the mental issues themselves facing the patient, but also the physical and physiological problems that arise, as well. A background in therapy, mental health, and sociology is necessary, and as such, the education required of practitioners is difficult but also quite fascinating.