Most people who end up in substance use counseling did not see it coming.
They were not trying to develop a problem. They were trying to feel better, or function, or get through something hard. The substance worked, for a while. And then it stopped working the way it used to, and stopping became its own problem.
That is not a character flaw. That is how this works.
If you are here because something has shifted, and you are not sure what to do about it, that is enough of a starting point. You do not need to have hit rock bottom. You do not need a diagnosis. You just need to be honest with yourself that something is worth looking at.
Who Does Substance Use Counseling?
Substance use counseling at VCS is led by John-Mike Nelson, PhD, LPC, LSATP, MAC.
Dr. Nelson is a Licensed Substance Abuse Treatment Practitioner and a Master Addiction Counselor, which puts him in a small group of clinicians with genuine specialty-level training in this area. Not a general counselor who also sees substance use. Someone whose clinical focus is built around it.
His approach is direct without being confrontational. Conversational without being passive. He is not going to hand you a checklist and a pamphlet. He is going to talk with you honestly about what is happening, what is underneath it, and what actually tends to help.
He sees adults in Virginia and Washington D.C., both in-person at the Burke office and virtually.
Meet Dr. Nelson | Contact VCS to Get Started
What VCS Treats
Substance use exists on a spectrum. VCS works across it.
That includes people who are:
- Drinking more than they intended, more often than they planned
- Using substances to manage anxiety, sleep, or stress, and noticing it is not optional anymore
- Concerned about their use but not sure if it is “bad enough” to call it a problem
- Navigating early recovery and looking for outpatient support alongside it
- Managing a co-occurring mental health condition alongside substance use
- A family member who is watching someone they love change and not knowing what to do
If you have been going back and forth about whether what you are doing counts as a problem, that back-and-forth is worth paying attention to. The question itself is usually telling you something.
How Dr. Nelson Works
Substance use is almost never the whole story.
It is usually a symptom of something else: stress that has nowhere to go, anxiety that needs to quiet down, experiences that never got processed, or a gap in the way someone is coping with what their life actually looks like. Treating the substance without understanding what is underneath it tends to produce short-term results at best.
Dr. Nelson’s approach is to work at both levels. What is happening with the use, and what is driving it. That means the work is not a protocol you run through. It is a real conversation about your specific situation, what has worked, what has not, and what actually makes sense to try next.
His sessions are conversational by design. There is no script. No worksheet assigned before you have had a chance to just talk. You lead. He listens. When he sees something worth exploring or challenging, he will say so, directly and without making it heavier than it needs to be.
FAQ: COMMON QUESTIONS
Do I have to call it addiction to come here?
No.
The word “addiction” carries a lot of weight, and plenty of people who would benefit from substance use counseling are not sure it applies to them. That uncertainty is not a barrier to getting started. Dr. Nelson works with people across the full spectrum of substance use, from “I am worried this is becoming a habit” to “I know I have a serious problem and I need help.” You do not need a label to walk in the door.
What if I am not ready to stop?
That is a more common starting point than most people realize.
Ambivalence about change is not a disqualifier. It is actually one of the most clinically significant things Dr. Nelson works with. Understanding your own ambivalence, where it comes from and what it is protecting, is often more useful than someone telling you to just make a decision.
If you are not sure you want to stop, that is worth exploring. You do not have to arrive with a commitment to sobriety to start a conversation.
What about co-occurring mental health issues?
Dr. Nelson specializes specifically in co-occurring disorders, which means substance use alongside anxiety, depression, trauma, or other mental health concerns.
This is more common than most people expect. And it matters clinically, because treating one without addressing the other usually does not work. If your substance use and your mental health feel tangled together, that is not a complication. It is something Dr. Nelson is specifically trained to work with.
Will this show up on my insurance or medical records?
Confidentiality in substance use treatment is protected under federal law, specifically 42 CFR Part 2, which provides stronger privacy protections than standard HIPAA rules. Your treatment records cannot be shared with employers, family members, or most outside parties without your written consent.
If you have specific concerns about how billing or records might appear, that is worth discussing before your first session. Dr. Nelson can walk you through what applies to your situation specifically.
Is this outpatient? What if I need something more intensive?
VCS is an outpatient practice. Dr. Nelson works with people in individual counseling sessions, not in intensive outpatient programs (IOP) or residential treatment.
For many people, outpatient individual counseling is the right level of care, particularly for those in early stages of concern, people stepping down from a higher level of care, or those in recovery who want ongoing clinical support.
If a higher level of care is clinically appropriate, Dr. Nelson will tell you that directly and help you figure out what the right next step looks like. He is not going to keep you in a setting that is not the right fit for where you are.
Do you work with families?
Yes. Substance use does not happen in isolation, and families are often deeply affected by it.
Dr. Nelson works with family members who are navigating a loved one’s use, whether that person is in treatment or not. Understanding what is happening clinically, how to respond rather than react, and how to take care of yourself in the middle of it is its own kind of work. You do not have to wait for your loved one to be ready before you start.
Ready to start?
Substance use counseling at VCS is available in-person in Burke, Virginia and virtually across Virginia and Washington D.C.
Getting started does not require a long intake process. Reach out through the form below or contact us directly. The first step is just a conversation.
Call: (202) 630-1765
Or use the form below to contact us immediately: