This article reviews the emergence and expansion of addiction counselling as a specialist form of professional practice with problem drinkers and drug users in Ireland, over the past 30 years. It sees addiction counselling as having its roots in a widely shared disenchantment with the ‘medical model’ of addiction treatment, and identifies the main factors which have shaped the growth of this new profession over this period.

It is argued that statutory health authorities have largely allowed addiction counselling to evolve in an ad hoc style: ceding maximum discretion to individual counsellors and teams of counsellors, while making minimal efforts to standardize counsellor training or to integrate the counsellors’ work into a broader, coherent health service response. Reference is made to attempts currently under way to establish statutory registration systems for addiction counsellors in this country, which, if successful, should raise standards of practice and provide greater protection for members of the public availing themselves of such services.

It is also argued, however, that both statutory registration and implementation of Tiered Care models of service delivery are likely to reduce the level of autonomy which addiction counsellors have traditionally enjoyed vis-a-vis service managers.