Lived Experience Is the Credential Nobody Gives You a Certificate For In Substance Use Counseling

July 27, 2026

John Makohen, Author and Co-Founder, Educational Enhancement CASAC

Tom O'Connor, Publisher

I counsel addiction with a resume that includes homelessness, heroin, and sex work. Here's why that history reads clients faster than any degree.

A woman sits down across from me for her first session. She hasn't said a word about her history yet. Three minutes in, her shoulders drop half an inch. She stops picking at her sleeve.

She knows. She doesn't know my file number or my old ZIP code. She knows the way I hold quiet when she says "relapse" like it's a confession. She knows because I'm not flinching. People who've never been in the room flinch. It's small. It's also everything.

I spent a third of my life homeless. A third of it strung out on heroin—years of selling my body before I was old enough to drive. 

Read: The Unhoused Encounter - Part II Significant Barriers To Accessing Quality Treatment Services

Then I became a substance use counselor. Nobody handed me that job because I have a nice face. I got it because I've sat on both sides of that desk, and clients can tell the difference between someone reciting a textbook and someone who's actually walked the block.

New research from Australia recently backed this up. A batch of interviews with workers across the drug and alcohol field, some clinicians, some peer staff, all landed on the same point. Lived experience isn't a nice extra. It's a skill set. People with it read a room. Clients spend years learning to hide from everyone else. I could've told them that for free.

What having lived experience in substance use counseling actually does.

It's not about swapping war stories. Half my job is knowing when not to share mine.

What it does is strip the room of performance. A client who's been burned by every system that was supposed to help them walks in braced for judgment.

When they get a counselor who's used, who's been arrested, who's slept under a bridge, and who is still sitting there upright and steady, something shifts. Not because I'm inspiring. Because I'm proof that the math works out, you can be a full-blown wreck and still end up okay.

That's not a slogan. That's data with a pulse.

I've walked clients into family court when I was the only person in the building who didn't flinch at the judge. I've sat in a housing office translating the same denial letter I used to get, back when I was the one holding it.

Nobody trains you to do that in grad school. You learn it in the same place I learned everything useful. On the ground, broke, scared, figuring it out because nobody was going to figure it out for me.

That's the part people miss when they talk about lived experience like it's a warm feeling you bring into the room. It's a map. I already know where the potholes are because I've broken an ankle in every one of them. The part nobody wants to talk about.

Here's where it gets ugly and where the field keeps screwing this up.

Using your own history as a clinical tool comes at a cost. Every session with a client whose story rhymes with mine, I'm managing my own stuff in real time. What do I share? What do I keep?

Is this client's spiral going to drag something loose in me that I thought I'd nailed shut?

Nobody trained me for that. I figured it out the hard way, alone, because most agencies assume that if you've lived it, you'll instinctively know how to handle hearing it reflected at you forty hours a week.

That's like handing someone a scalpel because they've been cut before.

And then there's the part that actually pisses me off. Colleagues. The ones who clock you being tired on a Tuesday and start wondering out loud if you're using again.

Not because you gave them a reason. Because you told them your history once, and they never stopped filing you under "risk" instead of "coworker."

I get why it lands: the instinct to protect the field from itself. I also think it's insulting. You don't ask the guy who broke his leg in college if his limp means he's about to break it again.

Where the field is still lying to itself.

Plenty of agencies love to put a person with lived experience on a flyer. Fewer pay them like the specialists they are. Fewer still build them a career ladder beyond "peer support," or ask them how the program should actually run rather than just handing them a caseload and a badge.

That's not respect. That's a photo op with a heartbeat. If an agency wants what people with lived experience bring, they need to build the scaffolding. Real supervision. Real guidance on disclosure, because nobody should have to improvise the moment a client asks, "Were you ever like me?"

Equal pay alongside degree-only hires. A seat at the table when decisions are made about how the whole program is built, not just a seat in the client's chair.

Not that. This.

The AA meeting version of this doesn't hold up.

Ask around, and you'll hear the party line. Lived experience means you found the program, you found your Higher Power, you found the twelve steps, and now you're qualified to pass it on. I don't buy that math. Plenty of the sharpest counselors I know never touched a Big Book. Plenty of the ones who quote it loudest couldn't sit with a client in real crisis without reaching for a script.

What actually qualifies you isn't which pathway you found. It's whether you survived long enough to know the ground is uneven, and whether you can sit still while someone else finds their own way across it.

That's not a program. That's a skill built the hard way, and it doesn't care what book you carried while you built it.

Where I land.

I still think about heroin. Not every day anymore, but often enough that I don't pretend I've graduated past it.

I respect what it did for me and to me, and I choose not to touch it, and that tension is exactly what makes me useful in that chair.

You don't need a tidy origin story to help someone else write theirs. You need to have survived the mess without lying about the mess.

That's the whole qualification.

The workers who "just get it" aren't lucky. They're specialists nobody trained on purpose.

Pay them like it.

If you're sitting on a history like mine and wondering whether it belongs in this field, it does. Educational Enhancement CASAC Online trains substance use counselors who bring more than a syllabus into the room and teaches you how to use what you survived instead of just carrying it.

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Read John's bio by clicking his icon at the start of this article.

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