Adopted persons are at a higher risk to receive mental health and substance use treatment (Behle & Pinquart, 2016; Brodzinsky, 2013) and are also at a higher risk for a lifetime prevalence of substance use disorder (Kendler et al., 2012; Yoon et al., 2012). Despite the known risks for adopted persons, there remains a gap in counselor awareness and knowledge of the unique counseling needs of adopted persons and their families seeking substance use counseling (Atkinson et al., 2013; Brodzinsky, 2013; Lancaster et al., 2017). Therefore, we provide an overview of the related substance use research, describe the counseling needs of adopted persons and their families, and offer practice implications.