The present study is a qualitative exploration of the conceptualizations of substance use, abuse, dependence, and treatment from the perspectives of Italian and American counselors-in-training. The researcher conducted semi-structured interviews with two Italian and two American graduate-level counseling students. Thematic elements identified based upon collected data include differential attitudes toward alcohol and marijuana compared to illicit drug use in both Italy and the United States, consequences experienced as a result of problematic substance use, and the impact of stigma on opportunities following treatment. Differences in treatment practices and standards and differences in vocational opportunities following treatment in Italy and the United States were reported by participants. Implications for practice and recommendations for future research are provided based upon findings.