The biopsychosocial model views substance abuse as a complex interaction of all of the other models and endorses multiple strategies for counseling from these models as appropriate. Counseling Conclusions regarding effective counseling strategies for counseling individuals with substance abuse are limited in that this counseling specialty area has been driven more by experience and clinical intuition than by research. Given this, conclusions regarding counseling and substance abuse have to come from general counseling research data. Counselors, regardless of their settings, impact as change agents within the context of therapeutic relationships with individuals. Successful relationships are facilitated by a skilled counselor who helps the client become more invested in the process and who utilizes therapeutic techniques appropriate to the client.
Counseling is a process beneficial to most clients of skilled counselors.
However, it is not always so. A significant number of clients get worse. Successful counseling has process factors which are common across the various counseling models. These factors include the counselor's establishing an open, trusting, collaborative relationship, facilitating client cognitive learning through reframing, feedback, and insight, and assisting the client in behavior changes through behavioral regulation, reality testing, and successful experiences. Successful counseling outcome is dependent on counselor therapeutic skills such as focusing conversations on life problems, addressing presenting problems directly, and providing structure for counselor-client intervention.