Tools for the new generation

June 30, 2007
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Clinicians must be prepared to offer appropriate care for co-occurring disorders

Since the Substance Abuse and Mental Health Services Administration's National Treatment Plan effort of 2000, SAMHSA's Center for Substance Abuse Treatment (CSAT) has worked with the substance use disorder treatment field to address the needs of the next generation of clinical professionals. SAMHSA has continued to recognize the importance of workforce issues. There is one particular area of emphasis that SAMHSA believes should be of concern to the next generation of clinical professionals: co-occurring disorders.

H. westley clark, md, jd, mph

H. Westley Clark, MD, JD, MPH


The co-occurrence of substance use and mental disorders within one individual presents a unique set of challenges for consideration by our next generation of clinical professionals. The behavioral health workforce must have a unique set of skills and training that demonstrates their working knowledge of mental health and substance use disorders as well as the interactions among those disorders and the ways in which each condition may affect the other. Data trends suggest that the existing behavioral health workforce is not prepared to meet the needs of persons in recovery with both substance abuse and mental health disorders.

SAMHSA recognizes that individuals enter the behavioral health field with different levels of expertise and experiences; however, it is imperative to establish a baseline of core competencies that addresses the unique needs of people with (and at risk for) co-occurring disorders. These competencies are needed to ensure that regardless of where an individual enters the behavioral health continuum of care (prevention/promotion/treatment), core standards of care are available within a substance abuse prevention/mental health promotion, substance abuse/mental health treatment, or relapse/recovery context.

Of the 5.2 million adults with both serious psychological disturbance and substance dependence or abuse (i.e., a substance use disorder), about half (47%) received mental health treatment or substance use treatment at a specialty facility in 2005. Of this group, approximately 8.5% received specialty treatment for both mental health and substance use disorders, indicating that more than 90% of all individuals needing treatment for a co-occurring disorder received either no treatment or inappropriate treatment. This highlights the compelling need for core competencies for addressing co-occurring disorders within the behavioral workforce.

Recruitment needs

In addition, it has been well documented that members of ethnic/racial groups are underrepresented in the workforce compared to the numbers of minorities needing services. Strengthening Professional Identity: Challenges of the Addictions Treatment Workforce, a December 2006 federal publication (available at http://www.nattc.org/resPubs/tap21/StrengtheningProfessionalIdentity.html), indicates the need to recruit members of racial/ethnic minority groups into the workforce. Moreover, peer and faith-based providers play a key role in the workforce by offering behavioral health recovery support services.

Vernard jones, lcmht, ccap, mac, cps, icadc, president of the mississippi association of addiction professionals (l), barrett weir, and h. westley clark, director of the center for substance abuse treatment (csat), chat at the 2006 naadac annual conference in burbank, calif

Vernard Jones, LCMHT, CCAP, MAC, CPS, ICADC, President of the Mississippi Association of Addiction Professionals (l), Barrett Weir, and H. Westley Clark, Director of the Center for Substance Abuse Treatment (CSAT), chat at the 2006 NAADAC Annual Conference in Burbank, Calif. Photo by Kevin Large

With respect to behavioral health promotion and substance abuse prevention, community coalitions and state prevention professionals are critical to improving the capacity of an effective workforce. Expanding the role and capacity of community coalitions and state/tribal prevention professionals to promote positive behavioral health and wellness is also a core strategic goal identified in the Federal Mental Health Action Agenda (http://www.samhsa.gov/Federalactionagenda/NFC_execsum.aspx), part of the President's New Freedom Commission on Mental Health initiative designed to promote full access to community life for people with disabilities.

Since before 2004, SAMHSA has worked hard to develop strategies to enhance workforce development. To further its efforts, SAMHSA in fiscal year 2007 began surveying the field to identify core competencies that have been developed for different behavioral health professions.

Role of associations

CSAT has worked closely with state authorities and professional organizations such as NAADAC, The Association for Addiction Professionals in order to synthesize the critical components of the core competencies necessary for the adequate treatment of co-occurring disorders. Organizations such as NAADAC can assist those affected by co-occurring depression, anxiety disorders, and post-traumatic stress disorder by facilitating the cross-training of clinicians and by joining in efforts to promote such training.

Given the prevalence of conditions such as PTSD among men and women who present for treatment for substance use disorders, it is of critical importance that an adequately trained workforce be prepared to offer appropriate care. The beneficiaries of appropriate treatment for co-occurring disorders will be not only patients, but also their families, neighbors, and communities.

H. Westley Clark, MD, JD, MPH, is Director of the federal Center for Substance Abuse Treatment in the Substance Abuse and Mental Health Services Administration.
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