Why Addiction Counselors Go by So Many Names

addiction counselor in his office Substance use disorder treatment and counseling is part of an ever-evolving field. New social norms, new research revealing all-new insights into the disorder, and a more clinical and inclusive approach to addiction treatment have resulted in new and shifting terminology and titles.

For the uninitiated, this can make things a bit confusing, but we’re to help you sift through it all.

Substance abuse counselor, addiction counselor, chemical dependency counselor, addiction therapist, alcohol and drug counselor—these are just some of the titles that state jurisdictions use to describe what are essentially the same type of credentialed professionals providing the same type of counseling, education, and advocacy services in the addiction recovery field.

Despite differences in titles, addiction counselor roles are largely similar, regardless of the state in which you’re credentialed.

Titles largely reflect jurisdictional preferences and which national standards-setting organization the state credentialing agency aligns with. And, of course, most states have a variety of different titles for professionals with different levels of education and expertise along the credentialing hierarchy.

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How the NAADAC Ushered In a New Era and New Terminology in the Addiction Counseling Field

In 2015, NAADAC began a major push toward state licensure for substance abuse counselors, a level of credentialing beyond the type that comes from nongovernmental professional associations.

State licensure comes with an official legislative practice act, a legal framework in which counselors operate, and a clearly defined scope of practice. It also comes with title protections. With state government involved in regulating the profession, there would be strict penalties for anybody without proper training and licensure trying to pass themselves off as a substance abuse counselor. This helps uphold the integrity of the profession while ensuring the safety of the public.

Before the 2015 push, just a handful of states had a concrete licensing process already on the books (Indiana, Arizona, Connecticut, South Dakota, and Kansas).

Indiana, in particular, was the first to put forward a clear path to licensure similar to that of other counseling roles. Like mental health counselors, marriage and family therapists, social workers, and psychologists, Indiana recognized addiction counselors as needing a graduate level education for licensure and a solid licensing blueprint. Thanks to Indiana’s trailblazing efforts, the “Indiana Model” took hold and other states quickly began using it as framework for their licensing legislation.

NAADAC is clear — in order to protect the role of addiction counseling, clear legislation and licensure standards must be established; otherwise, it’s at risk of being taken over by other allied counseling fields and losing its standing as a truly specialized area of practice. When addiction counselors are licensed, addiction-specific coursework and training requirements are built into the vetting process, ensuring consistent methods and standards of practice.

According to the NAADAC, while state certification through a nongovernmental professional association involves meeting education, service hour, and exam requirements, and is recognized by employers and insurers, licensure surpasses certification in its rigor and standards. And just as importantly, NAADAC views licensure as crucial to the profession because of the title and practice protections it ensures.

In recent years, significant state efforts have been underway to transition the field of addiction counseling into a clinical profession. Many states have consolidated multiple state certification boards, linked degree programs to credentialing requirements, and ushered in state licensing.

A Changing Mindset and Evolving Terminology in Addiction Counseling

In the 50 years since the National Institute of Drug Abuse (NIDA) first came on the scene, research into addiction and the policy changes that resulted have brought about shifts in state credentialing, insurance laws around coverage, advances in treatment and wider use of harm reduction efforts.

The opioid crisis of the late 1990s ignited even more significant changes to the field and created a whole new level of understanding and insight that resulted in, among many other things, changes to addiction terminology.

For example, the term substance abuse has been largely replaced by substance use disorder (SUD) to shift from a term that describes a potential moral failing or behavioral issue to one that better describes addiction as a medical condition.

While the term “substance abuse” described addiction as merely a harmful relationship with drugs or alcohol, “substance use disorder” more accurately describes it as a medical condition that calls for a science-based approach to treatment and, as NIDA puts it, a condition that is deserving of compassion and support.

It’s this changing mindset that has brought about the transformation of professional titles to better reflect the evidence-based, compassionate care provided by the addiction prevention, treatment, and recovery community. Some states have already moved on this, officially shifting their official credential titles to substance use disorder counselor.

What About a National Standard in Addiction Credentialing?

Substance abuse counseling is now largely recognized as being similar to other clinical professions in terms of the use of evidence-based practices, treatment models, and continuous improvement, leading many to wonder how national standards could bring much-needed consistency in qualifications, practice and, of course, professional titles.

Efforts to establish a national standard for the substance abuse counseling profession have been introduced by organizations like the Human Services Research Institute and NAADAC, the Association for Addiction Professionals in recent years but have yet to materialize in any form.

Both organizations argue that standardized credentials would help substance abuse counselors work across state lines – an important topic considering the rise of telehealth services – and eliminate many of the barriers associated with interstate credentialing and insurance reimbursement policies.

Jurisdictional Title Differences for Addiction Counselors

In general, regional differences in addiction counselor titles reflect those used by the state credentialing agencies. Even in states without government-mandated licensing, an industry-regulated framework exists, with nonprofit professional associations stepping in to provide certification for addictions professionals that employers rely on when hiring.

But state to state, you will notice that there is not strict conformity to standard titles, despite the fact that most states operate as member boards affiliated with one of the two major standards-setting and professional exam agencies

International Certification & Reciprocity Consortium (IC&RC)
NAADAC—the Association for Addiction Professionals

Despite using their examinations as part of the credentialing process and maintaining some alignment with the credentialing standards they set (education + supervised experience + exam), that consistency doesn’t always extend to the titles they use.

Take neighboring states Illinois and Indiana, for example. Both are members of the IC&RC, yet their titles look nothing alike.

In Illinois, the Illinois Alcohol and Other Drug Abuse Professional Certification Association uses the term Certified Alcohol and Other Drug Abuse Counselor (CADC) to describe certified substance abuse counselors in the state. They also use the titles of Certified Reciprocal Alcohol and Other Drug Abuse Counselor (CRADC), Certified Advanced Alcohol and Other Drug Abuse Counselor (CAADC), and Certified Supervisor Alcohol and Other Drug Abuse Counselor (CSADC) to describe those with either advanced or reciprocal credentials.

But in neighboring Indiana, the Indiana Professional Licensing Agency licenses four levels of addiction counselors: Addiction Counselor Associate (LACA – bachelor’s level), Addiction Counselor (LAC – bachelor’s level with two years of experience), Clinical Addiction Counselor Associate (LCACA – master’s level) and Clinical Addiction Counselor (LCAC – master’s level with two years of experience).

In most states, you’ll find a number of similar titles used to describe addiction counseling professionals with different levels of education and training/experience in the field. But some states use just one title. For example, in Montana, the Board of Behavioral Health credentials substance abuse counselors under one title: the Licensed Addiction Counselor (LAC).

Just a small sampling of some of the addiction counselor titles you’ll come across from one state to another include:

Kentucky Board of Alcohol and Drug Counselors
Certified Alcohol and Drug Counselor (CADC)
Licensed Alcohol and Drug Counselor (LADC)
- Licensed Clinical Alcohol and Drug Counselor (LCADC)
New York State Office of Addiction Services and Supports
- Credentialed Alcoholism and Substance Abuse Counselor (CASAC)
Ohio Chemical Dependency Professionals Board
- Licensed Chemical Dependency Counselor II (LCDC II)
- Licensed Chemical Dependency Counselor III (LCDC III)
- Licensed Independent Chemical Dependency Counselor (LICDC)
Maryland Board of Professional Counselors and Therapists
- Certified Supervised Counselor – Alcohol and Drug (CSC-AD)
- Certified Associate Counselor – Alcohol and Drug (CAC-AD)
- Licensed Clinical Alcohol and Drug Counselor (LCADC)
Arizona Board of Behavioral Health Examiners
- Licensed Independent Addiction Counselor (LIAC)
- Licensed Associate Addiction Counselor (LAAC)
- Licensed Addiction Counselor Technician (LACT)
Florida Certification Board
- Certified Addiction Counselor (CAC)
- Certified Addiction Professional (CAP)
North Carolina Addictions Specialist Professional Practice Board
- Certified Alcohol and Drug Counselors (CADC)
- Licensed Clinical Addiction Specialists (LCAS – Advanced Alcohol and Drug Counselors)

Terms Describing Certified vs Licensed Addiction Counselors

To add to the general confusion of professional title differences from one state to the next, some states certify, other states license, and some states do both.

For example, in Arizona, all addiction counselors are licensed, while in Florida, they’re certified. And in Maryland, entry-level alcohol and drug counselors are certified, whereas those with advanced levels of education and training are licensed.

And referring back to Illinois and Indiana, the former certifies, while the latter licenses.

In general, the terms “certification” and “licensure” tend to algin with the state’s regulatory approach and professional standards. In jurisdictions that use both terms, certification generally refers to entry-level professionals with an associate’s or bachelor’s degree who must practice under supervision, while licensure is reserved for advanced-level (usually master’s prepared) addiction counselors who are legally permitted to practice independently.

But, of course, in some states, it’s still different. For example, the Kentucky Board of Alcohol and Drug Counselors offers the Certified Alcohol and Drug Counselor (CADC) credential for bachelor’s-prepared professionals; the Licensed Alcohol and Drug Counselor (LADC) credential for 30-credit master’s-prepared professionals; and the Licensed Clinical Alcohol and Drug Counselor (LCADC), a credential for 60-hour master’s-prepared professionals who are permitted to practice independently.

In just the last ten years, a number of states have made adjustments to their credentialing process to include licensure, though it has yet to be seen if that will bring about more consistency in the use of terms to describe professionals in the field.

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