Learn about North Carolina Licensure

Mental Health and Substance Abuse

Written by Jack Levinson

getting help

As the discourse around mental health and substance abuse has become more transparent, we have begun to learn about how many individuals are in need of support. This has led to a pronounced increase in mental health services, and in turn, an increase in job offerings for mental health and substance abuse social workers.

Mental health social work is a quickly growing field ripe with opportunities for those who are interested in supporting those who are struggling.

Most social workers are motivated to enter the profession because they feel called to assist others. The promising job outlook, then, is the icing on the cake. But the numbers are nothing to sniff at: according to the Bureau of Labor Statistics, substance abuse, behavioral disorder, and mental health counselors can anticipate a job growth rate of 18% by 2032, greatly exceeding overall averages for opportunity increases in the U.S. This makes becoming a mental health and substance abuse counselor an especially enticing path through the social work profession.

Because there is so much change taking place as a result of major developments in mental health research and treatment methodologies, social workers in the field have to stay up to date on important findings in real time. This article will provide a primer on current issues in mental health social work, including new approaches to therapy and counseling, ethical issues in mental health social work, and more. It will also provide detail on how to become a mental health social worker and salary data for social workers in the mental health arena.

The Role of a Mental Health and Substance Abuse Social Worker

When individuals are struggling with mental health concerns, including mental illness, addiction, and emotional-behavioral issues, the guidance of a trained professional can make all the difference in creating positive change. For the disadvantaged, for whom access to mental health treatment is far more limited than privileged communities, social services are nothing short of game-changing, offering services that can help people turn their lives around.

Mental health social workers are typically Licensed Clinical Social Workers (LCSWs) who have extensive training in their chosen therapeutic modality.

This allows them to perform therapy and counseling in individual, couple, family, and group settings, providing an empathetic and insightful ear to those who feel unheard.

Many social workers choose a particular mental health struggle to focus on, gaining expertise that makes them especially effective at providing counseling to people in need. As new therapeutic methods are developed, some mental health counselors gravitate toward the approaches that most correspond to their goals and perspectives.

Some mental health social workers can be deployed for immediate crisis interventions, while others are focused on providing long-term care for those with addictions or mental health needs. They can also provide assessments that are valuable for individuals as well as other social work organizations that rely on these evaluations.

Places That Employ Mental Health Counselors

A wide variety of institutions and organizations benefit from having mental health counselors on staff. These can include:

In short, the mental health social work field is expansive, accommodating the many mental health issues we know can arise for all types of people.

group psychotherapy session

Becoming a Mental Health and Substance Abuse Counselor

Providing mental health services is a tremendous responsibility, and consequently there are strict eligibility requirements in order to earn the position. If your goal is to have the full-fledged role of a mental health social worker, the following guidelines are not optional but strictly mandatory for anyone hoping to work in the field in North Carolina.

Mental Health Social Worker Education Requirements

Like all other social workers, those in the mental health and substance abuse sector must complete a Master of Social Work (MSW) program in order to become eligible for licensing. During your program (which typically lasts two years when completed on a full-time schedule), you will get the opportunity to complete a significant amount of field work hours getting your first exposure to the mental health counseling profession. This preliminary work experience will give you a grounded expectation for your future career and fuller perspective to guide your future ambitions.

Mental Health Social Worker License Requirements

Counseling and therapeutic services are known in the social work world as clinical practice. Those who make their careers as mental health and substance abuse counselors are therefore expected to hold clinical licenses, becoming Licensed Clinical Social Workers (LCSWs).

The process of becoming an LCSW is a bit more time-intensive than the other most popular form of social work license (which is called a Licensed Master of Social Work), but it also is a more specialized form of license. To become an LCSW, one must complete an additional two years of supervised field work, as well as passing board examinations. In North Carolina, licensing and tests are administered by the North Carolina Social Work Certification and Licensing Board (NCSWCLB).

Your licensing field work hours will give you a significant amount of experience in mental health counseling, building the skills you need to start a thriving counseling practice.

The Connection Between Mental Health and Substance Abuse

Mental health social work and substance abuse counseling are always grouped together, even though some mental health specialists are exclusively focused on substance abuse, and some counseling practices are not suitable for those struggling with addiction.

What’s the connection? Conventional wisdom about substance dependence is that it is inextricably linked to mental health. Most addiction programs start by targeting the addiction itself, as it is a destructive behavior that poses the most immediate risk to those who are struggling. However, addiction is understood to be a result of other types of mental unrest, meaning it cannot simply be dealt with in isolation.

For this reason, many who undergo addiction treatment go on to participate in therapy for months or years to come. This can be an opportunity to continue the healing process, identifying and tending to the underlying factors that led to addictive behaviors in the first place. In this way, substance abuse-focused counseling is an entry point into a longer mental health journey. By linking the two areas of specialty, counselors can better understand their patients’ needs and create a streamlined support process to make their practices as effective and impactful as possible.

Current Issues in Mental Health Social Work

The flood of recent developments in the field of mental health social work are exciting, but they also require orientation for those who work as counselors and therapists. Some of these developments have made certain aspects of the counseling profession easier, while others pose new challenges for mental health social workers to take on. In any case, mental health counselors can rest easy knowing their efforts to acclimate to evolving standards of care are toward the end of helping more people more effectively.

One of the most prominent current issues in mental health social work is the growing need for counselors in the wake of the COVID-19 pandemic. The stresses of lockdown, social isolation, and the economic uncertainties that accompanied the pandemic meant the need for mental health services saw a huge spike. Initially, this saw mental health and substance abuse counselors stretched to their maximum, taking on the often taxing labor of working with as many patients as possible. Fortunately, their jobs were made easier by another important development in the mental health social work field…

Technology. Indeed, the pandemic also ushered in a greatly increased use of teleconferencing in the therapeutic setting, a change many therapists have not shifted away from. While some therapists and counselors bemoan the loss of in-person interactions, which can provide insights that remote counseling cannot, the benefits of online therapy are tremendous, especially when it comes to access. Scheduling remote counseling is significantly easier for patients and therapists alike, making it possible for counselors to work with more people and making it possible for those who would not have time to commute to therapy to attend counseling wherever they are.

However, ensuring that these remote sessions achieve the same level of quality as in-person ones is an important challenge that current counselors will have to address and develop moving forward. Remote counseling also raises new ethical issues in mental health social work, as therapists now must work to maintain the privacy of their patients and make efforts to make their services available to those who don’t have access to computers.

Finally, another major development in the mental health social work field is a newfound engagement of intersectionality. This framework acknowledges the intersecting impacts of one’s demographic positions (such as race, gender, sexual orientation, religion, and more) on mental health. Previous therapeutic approaches had treated all individuals as though they were coming from the same background, one implicitly informed by a white male perspective. Therapists all over are understanding that this approach can be downright harmful for patients from different demographics, causing alienation that goes directly against the goals of counseling.

These emerging developments are part of what makes the counseling field an engaging, intellectually rich arena to join. Those who are just beginning their educational journey will benefit from learning about these phenomena in advance of launching their careers, and will be better able to support their patients in the future as a result.

working online

Mental Health and Substance Abuse Counselor Salary

According to the BLS, substance abuse, behavioral disorder, and mental health counselors in the state of North Carolina earn a mean annual wage of $55,350. This breaks down to an hourly rate of $26.70.

Where one works as a mental health counselor can impact their salary. While the BLS does not report mental health counselor salaries in North Carolina by industry, it does provide national data that can provide a general guideline for aspiring social workers in the state. According to the BLS, the top-paying industries for mental health counselors pay the following:

Further, as one gains expertise in the field, they will be able to take on more specialized work, which is often matched by an increased salary level. The BLS reports that mental health counselors earning in the top 90th percentile nationally earn a mean annual salary of $82,710 or more. This is a reason for those pursuing mental health social work to feel hopeful about their financial prospects in the long term.


What level of education does a mental health or substance abuse counselor need?

In order to become a mental health and substance abuse social worker, one must hold a Master of Social Work (MSW) degree. This is mandatory in order to be eligible for North Carolina state licensing.

Can I become a mental health social worker if I am not an LCSW?

While it is possible to take on lower-ranking administrative roles in mental health social work organizations, one cannot become a full fledged mental health or addiction counselor without the extensive training of an LCSW. This is because mental health counselors are tasked with helping individuals who are sometimes in critical crisis, posing an immediate threat to themselves or others. They are also expected to provide evaluations that can form the basis of other major considerations for their patients. Managing these responsibilities effectively requires great training and education, which is why this license level is mandatory.

Do all mental health counselors offer the same services?

No. Mental health and substance abuse counselors can be trained in a wide range of therapeutic modalities suited to different populations, mental health diagnoses, and philosophies of care. Mental health counselors are encouraged to find the arena that most speaks to them, as this will fuel their engagement in the long run and is likely to be the area most suited to your perspective and skills.

How do mental health counselors help underserved communities?

Many mental health counselors work for organizations that are specifically focused on offering their services in low-income or otherwise under-resourced communities. In most cases, these services are offered free of charge to patients, making them as available as possible to those who would otherwise have barriers to access. If it’s important to you to provide counseling for those who cannot afford it otherwise, you are certain to find an organization that will make this goal possible.