This conceptual article provides a counselor-oriented overview of the origins and consequences of the current opioid epidemic in the United States. After a thorough review of Bronfenbrenner's ecological perspective on human development, this article presents a case conceptualization model aimed at providing counselors with a tool and strategy to better understand how systemic complexities impact opioid-dependent clients and their communities. A detailed composite case study is used to demonstrate the influence of multiple ecological variables on a specific client. Individual, micro-, meso-, exo-, macro-, and chronosystem stimuli are explored, and the role of advocacy as inherent in systemic conceptualization and treatment planning is discussed.