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Is the field’s passion disappearing?

February 21, 2012
by Dan Cain
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Some signs of concern amid a more highly credentialed addiction workforce

What is the life cycle of a movement? When does it go from being a movement to being mainstream? What are the benefits/consequences when it does? Is there a way to avoid sacrificing passion for professionalism?

When I started in this business nearly 40 years ago, most people working in direct care were also in recovery themselves. In fact, it was not uncommon to find that their own long-term recovery constituted the primary quantifiable qualification they brought to the table. Oh, they brought charisma, and counseling skills, and they could satisfy the rudimentary paperwork requirements of the times. But the main thing they brought to the job was their passion.

Alcoholics Anonymous (AA) was barely 35 years old, President Nixon had just “declared war” on drugs, therapeutic communities were starting to gain traction, and methadone programs had been around for just under a decade. Most programs (except methadone) were residential. Many had administrators (hospital) who weren’t in recovery. But members of the front-line staff believed in their work, mostly because they lived it.

Today we have made it much more difficult for people in recovery to enter the recovery field. First off, we now have regulation that demands a certain level of qualification—either a higher education degree or licensure that has a significant education component. People entering recovery often do so in middle age, and with responsibilities they had avoided in their period of insanity, such as families and jobs. Going back to school, particularly full-time, proves difficult.

In addition, we’ve excluded many people from eligibility as a result of past behavior and criminal records—in some cases systematically disqualifying them for life, depending on their crime.

Many of the pioneers in our field would be barred from working in it under today’s rules.

Why the change?

Expectations and qualifications for this field changed. Why? Well, mistakes certainly had been made. Some people went right from treatment to working in treatment, and there were instances of insufficient supervision, client abuse, questionable tactics and counselor instability.

Like we do in response to so many problems, we addressed those issues with more regulation, supposedly to prevent them from recurring. We changed things systematically and effectively punished the good with the bad, because the system was too overworked, too lazy or too inept to go after the actual offenders.

Another factor that contributed was that many individuals in recovery supported enhanced qualifications and regulation. Some went on to get advanced degrees and essentially became “Judases” for arguing that everyone should do what they did. Perhaps this occurred because these individuals believed the additional education really did increase their competence and professionalism. Perhaps it was because they thought it would result in higher pay, or possibly they did it simply to justify the expense.

Others supported licensure and similar initiatives because they saw the handwriting on the wall, believing that if they didn’t participate in the process, someone else would enact it without their input. Many times these processes included a “grandparenting” provision to preserve the employment of good counselors too old to go back to school. But eventually those people all retire or die, and access to their ilk becomes severely restricted. 

It’s about quality

Your credentials don’t legitimize you—your clients do. The best counselor I ever had had dyslexia and barely finished high school. It’s not about how many books you write or how much you earn in speaking fees. It’s about how many people credit you for positively influencing their recovery.

I’m not one to believe that you need to be in recovery to provide high-quality recovery services. But it does strike me that those who are in recovery believe much more in the efficacy of what they are doing. For them it’s not abstract.

I haven’t done the research, but I’m guessing that the degree to which we are adapting to the ideas and whims of those outside our field directly correlates to the reduction of recovering people in it. It is much easier to buy into the concept of “harm reduction” if you’ve never experienced the varying levels of harm and come out the other side. It is much easier to buy into the efficacy of medication-assisted recovery if you’ve never experienced it and later achieved abstinence. It is much easier to see dual diagnosis less as an anomaly and more of the norm if you’ve never seen addiction and/or mental illness, either individually or together from the inside.

And it is much easier to rely on the quantitative aspects of the research, if you’ve never experienced the qualitative.

When we professionalize the field to the point where the passion is gone, we’re in trouble. I don’t support a return to days gone by, but I do think we are dangerously close to moving too far in the other direction. 


Dan Cain is President of RS Eden, a Minneapolis-based agency that operates chemical dependency treatment programs, correctional halfway houses and a drug testing lab among its services. He has 39 years of experience in the chemical dependency field as a counselor, clinical supervisor and administrator. In 2007 he received Hazelden’s C.A.R.E. Award for continuous service to the recovery community. His e-mail address is dcain@rseden.org.
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Comments

When reading the article, please know that I did not use the word Judases in writing it. I used the term Judas goat. A Judas goat is one that leads the others into a situation they might now willingly go to on their own. But they do so because they trust in the goat leading them. Judas is widely heralded as a traitor of the highest order. In no way to I intend to imply anyone who got a higher educstion, and then lobbied for it as a requirement for everyone, is a traitor.

One problem that comes about is, as things evolve, we are continually creating the "new normal". Many of the people in the field today have no frame of reference for the early days, other than to know they existed. Not a good situation.

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Dan Cain is a pioneer in the field of addictions. He has been the director of RS Eden in Minnesota for over 40 years and has kept that program on the cutting edge of what should be offered to chemically dependent persons and their families. Seeing the remarkable changes he has made to that program makes me have a tremendous amount of respect for him and his ideas.

Sadly, I have seen many of the things that he talks about in this article. I have been in the field of treating addictions for 34 years and have seen the counselors of today coming out of college with their MSW's, LPC's, LLP's, etc. and they have absolutely no emotional connection to what it truly means to be an addict. This makes some of them extremely judgmental and leads to counselor burnout, high turnover and ineffectiveness with their clients. Sadly, many people coming out of treatment today still have difficulty in obtaining employment because of the criminality that was associated with their addictive disorder. We could kill two birds with one stone by allowing ex-clients to become a part of the field that helped them get sober. This could be accomplished by having programs available for ex-cons and addicts who want to go to school for counseling. It would have to be an on-the-job training program, along with education, so that they would have the experience as well as a degree upon completion. Our field needed to advance so that we could compare our credentials to the community mental health counselors and psychologists that used to look at us as para-professionals. We needed the skills to work with a higher degree of mental health disorders but, by requiring a degree, without offering assistance has led to the sterile or, book-learned counselor; lacking passion that Dan refers to. Provided that The Affordable Care Act goes through it's constitutional challenge, Medicaid will make many more people eligible for substance abuse treatment, causing a shortage in qualified addictions counselors. We continue to have record high unemployment? Are you listening Washington?

I love your idea of "on the job training" along with education. You are correct in that there are usually some criminal backgrounds as a direct result of using, that bar a lot of potentially great counselors from working. This type of program would be a blessing for many people. They would be able to become productive members of society and give back what was given to them in a spirit of compassion. Maybe one day this wont be just an idea!

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I don't see myself as being less passionate about addiction treatment. What I do see is a lack of recognition by health care agencies, hospitals and the like of recognizing addiction as a health care priority. Several physicians in our area try to take care of addicts as best we can, but treatment options are very slim, mainly due to funding priorities of larger health care organizations. As we all know, treating addicted people would untimately save society a lot of money in so many ways, but trying to get people in powerful places to understand that and make something happen is a different matter.
Joe Troncale, MD

Dan,
I truly appreciate your point of view and your dedication to the field, however, I think you are creating a false dichotomy of passion vs. professionalism. I know a great many passionate professionals. They may not all be self-professed consumers, but a great many have the type of life experince that you describe as important (and I agree by the way). Some got it from their own "lived experience", some got it from growing up in a family system which included a person or persons with co-occuring disorders, and yet others got it from field placements or early job experience.

With regard to Harm Reduction, (as well as Motivational Interviewing, Stage- Based assessment and other evidence based practices), I can tell you this: they sure beat the tools we had in 1977. That's what was burning me out!

To me, the ideal of a true "helper" is one who, in addition to understanding recovery principles, has empathy, genuineness and unconditional positive regard for the consumer - regardless of his or her "lived experience".

Gordon Reiher, MA, LCPC Chicago, IL

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As a SA counselor and in recovery myself since 1982, I wholeheartedly agree. It was and is still very difficult to work in MAT, which is where I am now. What do you suggest we do to influence the tides?

I entered the field in 1990 and in the same spirit as Dan and the retired/retiring colleagues of our generation.

I also wrote an article for this same publication about our vanishing workforce entitled "A Profession in Peril", in which I discussed that I have hired and supervised countless interns of all degrees and years of experience, from the college intern to the licensed mental health professional.

Only one of the people I've supervised decided to continue working in this field, but she never completed her national certification exam and isn't using her master's degree toward professional development.

Why is it that buzz words like ROSC [Recovery Oriented Systems of Care] seem like news in this field? It's because behavioral health-focused professionals are new to what we do and are re-creating the wheel. The IC&RC-prepared and certified counselors already knew about referring clients for mental health services, medical services, employment/training/vocational services, housing, etc. etc. We were ALREADY doing this work for years!

Now that so many states are tightening budgets and bureaucracies to pull behavioral health and substance abuse under one roof, there is an alarming assumption that there will, therefore, be hundreds of thousands of available substance abuse counselors made available by virtue of their mental health licensure scope of practice which conveys substance abuse treatment privileges.

WRONG!

What I'm sadly encountering now are people who think they want to do addictions counseling, are taking classes being taught by instructors who have never worked in the field and have never even taken the very classes that they're now being paid to teach.

The net result: we're still scrambling for qualified, competent and committed staff. Passion is certainly part of who we are and why we do what we do. But it also helps to know how to produce an evaluation that requires more skills than clicking a drop-down window, checking a box, filling in a blank, and hitting "send" -- we're more interested in data mining and research than we are about connecting with the client.

As more regulation reigns, the costs of providing treatment soars.

I'm with you, Dan. The professionalism of the field was and is a good thing, but candidates for IC&RC certification no longer have to do the oral case presentation. On-line degrees are diluting the 12 Core Functions and meaningful internships to a virtual free-fall of competency-based entry level work.

If mental health professionals want to work in our field -- and that's a huge "IF" -- then they, too, need to pay their dues by being certified like the rest of us were.

Thank you - I got in the field in 1988 - mostly through my own recovery and doors opening for me along the way.

I thought I was alone out here and I am certainly feeling overwhelmed by the lack of passion toward real recovery and the difficulties involved and the un-relenting push toward harm reduction and pharmaceutical recovery.

Thanks again.

matthias

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Hi. I have been sober for close to 11 years. SA counselor for 2 ½ years. I am what people call an "alcoholic of the worse variety." Many of the comments made in this article mirror my experience. My criminal history made it difficult and challenging to enter the field. I served as a 12-step volunteer for many years before I began practicing counseling. The agency I work for advocates a combination of AA, spirituality....I have received such feedback as "you talk about God and AA too much..." or "don't tell your story...." This feedback has been difficult to accept. I especially like the comment that my effectiveness as a counselor is based upon the clients/addicts/alcoholics I help and assist to find sobriety. Not by my credentials or "who I know." The program says "good is the enemy of the best." My sponsor sent this link to me so that I could read this message. She has been a SA counselor for over 20 years.....this article shared her experience as well. I guess I must remain vigilant, hopeful principled and above all, "do not let the life recovery got me interfere with my recovery life." Keep Coming Back it Works!!!

I had a professor once who warned us of being 'professional sponsors,' and we had to have more than our story. Is telling your story more about you, or the patient? Listen to the feedback. We should be learning everything from our patients. Just something to keep in mind.

Dan and Concerned Others,
All is not lost. I am happy to report the passion does continue. Today many in recovery have returned to, or entered higher education for the first time. Many of those students are not only of middle age but younger. From my assessment and personal experiences the new profession of addictions counseling is in the good hands of a newer,younger and yes....passionate future leadership.

As you have pointed out and concur with my previous articles and public speaking on the issue the "field" had to move to a "profession" in order to survive. Several forces have brought about change that would impact the future of addictions. Like you and others I have made comment and observation that many doing addictions counseling did not have degrees in "addictions counseling". Yet by our (addictions) failure such would continue to be the case.

To that end NAADAC in partnership with the International Coalition of Addiction Studies Educators (INCASE) with a grant from SAMSHA intiated the move toward, and culmination of, addictions counseling curriculum of associate degree thru PHD with a scope of practice and defined career ladder. This was a proactive approach by NAADAC to have a place prepared to answer the changes and challenges. For many years the profession was warned the day for degrees would come. That day is now here.

The creation of the National Addiction Studies Accreditation Commission (NASAC) will ensure the historical and contemporary quality of addictions counseling. The new curriculum also includes process addictions as well as the historial aspects of AA/12 step. In this way we have moved from a field to a profession. NAADAC has made sure that the historical door to the profession remains open, yet there is a reality it is not as wide and has limitations. Thus NAADAC's and twenty addiction stakeholders move toward taking control of the profession for "our degree" programs in higher education.

I would be happy to share with you that many new and current students along with alumni of the programs,have extended their appreciation for the opportunity for addiction degrees in higher education. Yes they also bring the passion you speak of, because of their own experiences and recovery. From what I see the sun is shining brighter on the addictions profession than ever before. I have faith and trust in both students in recovery and those who are not. Your concerns and others have been answered.

Lets Build Upon a Heritage and Leave a Legacy,
Don P. Osborn
President of NAADAC

Dear Dan,

I just read your article in Addiction Professional, March/April 2012 issue. In response to the question, NO. It is because of the expectations and requirements of this field that services for people with the disease of addiction that they are receiving a higher standard of care. As substance abuse counselors we set the bar higher for our clients, why should we as professionals expect that the bar should be set lower for us?

I am in recovery, 4 years, 10 months, and 18 days since the last time I injected poison into my own veins. I get what you are saying, my passion comes from my experience as an addict, living in the process of recovery, and wanting to help others end the cycle of self-destruction. My inspiration to enter this field came from my counselor in my third, and prayerfully last, long term residential rehab. She is in recovery as well. I am now working as a chemical dependency counselor intern in the criminal justice system. About half of the counselors I work with are in recovery, the other half are not. My mentor is one that is not in recovery. Her experience as a mental health professional has helped make me a far better counselor than I ever could have been without her advice, admonishment, encouragement, instruction, role modeling, and a few good kicks in my ass when I screwed up. These have all helped me to become a clinician and professional in this field.

Counseling is not the same as chairing a meeting, or sponsoring a fellow addict. Just because a person in recovery is an excellent sponsor or speaker does not necessarily mean they would make a good counselor. I have a Associate’s degree in addiction counseling and a bachelor’s in social psychology. This does not make me more or less qualified as a counselor, however it did give me a basis in theory and practice. In fact I have complained to the dean of my college that they would better serve students and in turn ultimately clients if the education was more “real world” focused.

All that said, the short answer to the question is: I believe there is still a lot of passion but the educational requirements help those of us entering this field approach the problem with real solutions rather than just ideals.

...Bo

I would like you to send me the 101 booklet i do get them on my phone as emlias but the person i need it for is about to come out from prison and i would lime her to read the booklet i did call round agost to see what ki d of help there was for her but its very expansive and she has no insuranse i dont know how celan she would come out but i would like her to stay that way and she wants help but i dont know where to turn for help she should be out by the end of noviembre pls help me look for help if you guys cant help me

I really appreciate this article. I love what you said about credentials not being the marker of great counseling but the number of people who credit you with a positive influence on their recovery, and also that for counselors in recovery the efficacy is personal, not abstract.

However, I'm in long term recovery and I always took issue when people claimed that being in recovery was somehow a barrier to higher education. I have two young children (middle aged people tend to have older kids, so they have an advantage actually), work full time, and also am in the process of earning my CSAC and starting my MFT in two months. It can be done. Being in recovery doesn't mean you can't go back to school. Being in recovery is not mutually exclusive to higher education, and what's the underlying message that it is? That said, the real issue is reforming, or eradicating, the federal student loan policy that prohibits monies going to individuals with drug charges. THAT is where we need to start because that is a real barrier. Additionally, if we let people enter into the field with no higher education, can we trust supervisors will hire "just the really good ones?" We need an equalizer that 'attempts' to ensure quality care. The Wild West of addiction services is over. Is that good? I don't know. But overall probably.

To answer your question - yes, I am extremely passionate about this field, and I do think the level has dropped off. This forum is not a great sample though, because clearly the people reading and commenting are not the lackluster of the bunch - quite the opposite, actually. We showed up.