Substance abuse treatment programs and clinical counseling approaches are designed to treat a variety of substance use disorders (SUDs). Treatment approaches may include a combination of medical (e.g., pharmacotherapy) and psychosocial approaches. Counselors apply a variety of evidence-based treatments, counseling theories, and approaches to substance abuse problems. With continued care, successive treatments, and continual monitorng, individuals with SUDs can increase the interval between abusive episodes until the individual achieves either full abstinence or more responsible substance use, as well as a more stable life-fulfilling recovery. Successful long-term recovery requires the adoption of a healthy lifestyle and continued mindfulness that SUDs can rear their ugly heads if one becomes distressed or negligent in maintaining life-enhancing attitudes, beliefs, and behaviors. With patience, persistence, tolerance, empathy, and compassion, counselors can help individuals and their families successfully recover from this devastating and potentially life-threatening disorder.

The chapter explores the history from the middle ages to the present day, noting the trials and tribulations of a population that continues to remain poorly understood and misperceived by the general public. Conditions for people with psychiatric disabilities did not fare much better in the American colonies. Similar to the circumstances during the Middle Ages, care for this population was the family’s responsibility if they had a family to care for them. Moral treatments began to decline in the second half of the 19th century in favor of somatic therapies and behavioral control techniques. Although psychiatrists initially scoffed at the notion that the quality of the care they provided in mental hospitals was subpar, research was conducted in the treatment of mental illness that brought about improvements. Physicians continued to develop and work toward improvement of somatic treatments for psychiatric disabilities in the early part of the 20th century.