Skip to content Skip to navigation

Counselor education embracing broader base of learning

February 11, 2015
by Gary A. Enos, Editor
| Reprints

The addiction treatment community increasingly acknowledges the many diverse paths to illness and recovery, but is the academic world keeping up in the way it educates and trains the clinicians of the future?

Some counselor education programs appear to be making a concerted effort to broaden their students' understanding of both the causes of addiction and the diverse avenues to a better life for their patients. At Adler University in Chicago, leaders recently reworked course syllabi to ensure that harm reduction approaches to addressing addiction are incorporated in some way into all courses.

Geoff Bathje, PhD, a member of the school's core faculty for the M.A. in Counseling Program, says individual instructors have leeway to determine how much harm reduction information is included in each course. But he believes that with an increasing emphasis on harm reduction approaches in research, clinicians should be armed with more information for their patients in this area.

“Even if a patient comes in wanting complete abstinence, regardless of what their goals are, there should be some harm reduction information available,” says Bathje, who teaches an Introduction to Addiction Counseling course to master's students who are preparing to become licensed behavioral health counselors.

Application of knowledge

In one particularly timely component of Bathje's instruction, he has invited into his classes individuals who conduct trainings in drug overdose prevention using the medication naloxone (Narcan). Students then have the opportunity to apply their knowledge about the medication in their work in the community.

“There have been five or six treatment sites where students in one of my classes have been able to convince leaders to train staff at a program where they have been working,” says Bathje.

He believes that at a minimum, students should have knowledge of the basic concepts of overdose prevention and needle exchange programs, for example. Yet he says harm reduction also applies to the overall therapeutic approach to working with the patient, and that has become more apparent as Motivational Interviewing (MI) strategies have received more attention in practice.

“The idea of harm reduction counseling as a model is still early in its development,” says Bathje. “It fits well with MI, which is about meeting clients where they're at.”

He adds, “The definition of harm reduction that I really like is 'any positive change.'” Therefore, if an individual who enters treatment with poly-substance issues is able to eliminate use of one substance at the outset, that is harm reduction, he says. Maintaining a positive therapeutic relationship in the face of challenges also constitutes harm reduction, he adds.

Bathje understands that the vast majority of treatment programs consider themselves abstinence-based and still would find at least some harm reduction approaches not to be a fit. “There's the reality,” he says. But with government officials starting to move away from the drug war references of the past and becoming more open to public health strategies such as overdose prevention, he believes students should be prepared for what might become a future need in treatment programs.

“There's still a lot of work to be done to refine what harm reduction counseling means,” says Bathje. “To some, all it means is the public health stuff. But there are broader goals that counselors can achieve with clients.”

Other trends that he sees as becoming more prominent include an incorporation of more non-Western healing techniques in healthcare generally, which inevitably will lead to more acceptance of alternative therapies as a potential component of substance use treatment.

Bathje writes on the school's website, “My overarching goals in teaching are to promote multicultural competence, awareness of contextual/environmental issues, critical thinking, and self-reflective thought in all areas of training and practice.”

Inclusivity in training

For the exclusively online-based counselor training programs at California Southern University, the addictions curriculum has expanded from a single-course approach to a track structure, says curriculum developer Robert Weathers, PhD. Even for clinicians-in-training who expect to practice in a mental health-focused setting, they will find that “one in two clients coming into therapy presents with a substance use disorder,” says Weathers, a former clinical director at Passages Malibu. “Having one course in addictions doesn't square with this.”

Weathers believes students need to be exposed to a broader range of topics relative to addictions. “There needs to be more inclusivity in training,” he says. “It is no longer enough to specialize in one domain of addiction.”

Many programs do a good job of training in therapeutic technique, he says, but don't focus enough on findings in neuroscience that are leading to a greater understanding of addiction, optimal treatment, and recovery.

“In teaching marriage and family therapy courses, I see that there is a naïvete in understanding the complexities of working with a couple in active addiction or recovery,” says Weathers. He adds, “We try to emphasize what goes on in the brain and the impact it has on the addict.”

Weathers also believes bridges need to be built between a 12-Step community that knows addiction and a treatment community that knows therapy. Many still see 12-Step approaches that are rooted in spiritual terminology as antithetical to the academic world, he says, and that is part of the reason why it often seems that there is little to no common ground between the 12-Step and therapy communities.

Topics

Comments

I began the development of the New Concept Model in Addictions Treatment in 1983, using genetics and the neurosciences, along with a standard psychosocial adaptation of the "Minnesota Model". I, along with a group of other science minded addiction professionals, initiated the founding of the Neuroscience and Addictions Research Foundation 1n 1986. This effort was supported by the late James Eads, the then Director of the then "National council on Alcoholism" and the local meetings and public policy development was conducted there. There were close to 100 members including those working in addiction related research and other related professional settings. We were involved with NIDA and NIAAA at that time and the result of our public policy efforts was SAMHSA, CSAT, and CSAP, followed by the NATTC. Our goal was to provide a science based access to training and when I had CSAT contact Sue Giles, Director of the UMKC substance abuse training program, and they agreed to put the pilot Addiction Technology Transfer Center here in Kansas City at the University. NATTC, the outcome of the pilot model remains here with 15 regional centers across the nation. They have done well, considering the ever prominent problem of lack of funding. At least the NARF efforts got some higher technology available to those who wish to avail themselves of some more advanced learning in the alcohol and drug addictions field, (not to exclude the epigenetic field of behavioral addictions).

It is a sad commentary on this profession that it has been so reluctant to move into the only thing that provides an opportunity at long-term recovery and movement into a solid state of functional independence. I know and understand full well why. The "War on Drugs" helped establish a huge "Money-go-Round" that you may or may not be aware of. I have dug into the details, of how it works its corruption and destroys lives and families, along with and as a part of the profiteering. As my series of ebooks reaches the general public, the truth will come out and positive change will be the intended result. No guarantees here, but it will tend to blow the lid off a lot of things that have demanded change for a long time.

Science based, highly individualized, assessment, intervention, and treatment is the only real answer to the problems of chemical misuse, dependencies, and genetic/epigenetic based addictions. When I say "highly individualized" I mean exactly that. Each individual is so totally unique, the only way to effectively deal with that uniqueness is one-on-one, science based care, tailored to that individual. That is where the "Money-go-Round" stops.

Am I way ahead of the game? Not really, because research continues to breed more research as it always has and should. I have to keep up with the latest and see how in-depth it becomes. One study does not make the case for change, but 20 can come up with some very responsible, new tools to use. As a Professional Addictions Futurist, I see the year 2025 as being a banner year for solid recovery using the only thing that works, sound science.

When I was thinking who can do my college assignment for me, the same idea was on my mind for the final paper. However, I have never finished it so far.