Observations on the recent history of drug user counseling

The drug user counselor role is explored in terms of its changing nature over the course of the past 25 years. Initially, the drug user counselor could be characterized as a professional based on his or her experience, or as an ex-addict paraprofessional in the language of that time. Working very largely with a heroin-using clientele, the counselor was the advisor and role model who could not be conned and, thereby, the essential counterpart to the mental health professionals who were entering the drug misuse field. Over time, these latter professionals based on education have become increasingly evident and the "professionals of experience" have become less so in accord with changes in the demography, drug-using characteristics, and psychological functioning of drug user clients. Nonetheless, studies that support the particular efficacy of counselors of education for all but drug user clients with significant psychopathology are lacking. Moreover, aspects of therapeutic interaction that are more largely engaged in by "professionals of experience" are threatened by the diminution in that group's numbers and the credentialing out of nontraditional job functions. Over the past few years, awareness of the significance of the contributions of "professionals of experience" has been reawakened by the threat of AIDS and the recognition of counselors' contributions to outreach and AIDS prevention counseling.