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WHAT IS OUR STANDARD?

May 11, 2009
by Dr. Anne
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An issue which keeps coming up in discussions as addiction counselors become more active members of the mental health counseling arena focuses on whether or not addiction counselors should be held to a higher standard on behaviors relating substance use/abuse/dependence than professionals in other mental health disciplines. Many addiction professionals have experienced their own addiction problems and are now working as addiction professionals who counsel persons in addiction treatment. For many years, recovering persons were required to document five of more years of sobriety prior to working as addiction counselors. However, a psychologist who has a history of substance dependence might not be required to demonstrate abstinence from the substance of choice for more than a year prior to counseling substance abuse clients. As the qualifications of new persons entering the profession are reviewed, there has been discussion of certifying persons who have at least a year of sobriety prior to beginning work towards certification. During the time prior to working in an agency, an individual can complete the required training. Some treatment agencies mandate a specific period of sobriety (typically 3 years) before they allow a recovering person to work with clients and to obtain experiential hours towards state and/or national certification. Please use this site to discuss the pros and cons of establishing a specific number of years of sobriety to be eligible for certification.

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First, thank you for allowing I as well others to discuss the pros and cons surrounding the number of years of sobriety required in order for one or prospective recovering individual to become eligible for certification and or licensure. In my opinion, this can be a complex issue as well as one where it seems to, in some way, discriminate against those wanting to give back to addiction in helping others to know that...recovery is possible through treatment for addiction. For those who may not have been in recovery, this raises the question of "how long" has a person been in recovery as oppossed to they themselves (other professionals) providing treatment services to clients but yet, living a "secret" life of using or abusing some type or form of substance. So...my question is, if one is in this profession and questions or stands on the belief that former addicts (yes, people can recover and not take on the life-labeling of "once and addict, always addict") need to demonstrate a certain number of years of abstinence from substance abuse...then this should be across the board in terms of all professions working with substance abuse and addiction as well as psychiatric disorders, or both (co-occurring disorders) in terms of accountability, meeting the clients needs, and offering the most effective type of treatment servcies and or methods. We live in a society where one system or belief questions the other about what is ethical and what is right? This can absolutely create conflict and division amongst professions which in turn will filter on down to the clients themselves and thus, doing more harm than good. On the other hand, I can see that a system is needed to carefully screen out those in recovery who still need time to deal with their own recovery process (which shoudl be understood in terms of "first things first").

So essentially, what does it say for a psychologist and the helping field of profession if he/she is struggling with an addiction problem and yet allowed to practice or provide services to a client/patient dealing and struggling with such a dangerous and devestating problem? Addiction does not discriminate in who or what professions is okay to provide counseling or services...the professional him/herself should know and practice what they preach or counsel and not live a life of denial that he or she does not have a problem and or occassionally uses but yet, still believe they are provding the most, safe, and effective treatment to addicts or psychiatric patients or client? If you are not true to yourself and your profession...that what makes you think you will be true to the client. So, again, this to can be a complex issue, depending upon how you view it and your beliefs, and it can discourage those in recovery from being able to help those in need while at the same time still being active in their own recovery program but, being cognizant and deligent to understand and know that this is a ethical boundary that is not to be crossed...where with the psychololgist...it is being crossed but being allowed and or tolerated with out any type of drug screening or testing mechanism in place to prevent such "getting away with a dandgerous and unethical way practice or delivery of care" so to speak...it does not have to be (made) complicated but, as professionals...we have to be careful in what we pracrtice, preach, and demonstrative in our own living and perspectives.

Thank you for allowing me to share and participate in regards to the issue of "what is our standard?"

John

After reading some of the comments again, it became apparent that persons involved in this discussion favor continued counseling for addiction professionals working in the field. However, some counselors will not pursue their own work with a therapist duet to concern that the person consulted will breach confidentiality. There is a gossip network between addiction counselors that is alive and well. A counselor who needs help in working on his/her own issues might be afraid that gossip will result in loss of income. We are not large in numbers and word of mouth about a counselor having problems travels fast. How do we support each other's continued growth and development in such a setting?

Anne Hatcher

I entered treatment for my addictions at a VA Medical Center in 1982. After 30 days of treatment, I went to a half-way house for the following year. While there I attended mandatory AA/NA meetings 5 times weekly. I was also required to attend a weekly domestic violence group to begin addressing this and other emotional aspects of my many failed relationships with women and employers. After 2 years, I accepted a job working in the half-way house as a cook / counselor-in-training. My employer and training supervisor suggested that I remain in therapy as long as I continued to work with others as a new counselor. I took that recommendation to heart. I am convinced that anyone working as a counselor has a moral and ethical obligation to address their own therapeutic issues for as long as they work with others. Sobriety does not equal sound emotional health. I regret that anyone working as a counselor / therapist (not just those with a history of substance abuse or dependence) believes they are exempt from dealing with their own issues. All too often as a clinical supervisor I hear from new counselors " I took some group sessions in my Masters program and believe they are now good to go. My standard is "if your working as a counselor in any setting, you should be healthy enough to seek out and attend ongoing treatment / therapy and clinical supervision. Those we serve deserve our best and most of all so do we. There is no shame in receiving assistance. The shame is in refusing the need and blindly passing on the pain and hurt to those we serve. I look forward to comments.

Everyones comments are right on point. In my opinion, counselor of all types and personal issues should be in treatment to resolve personal issues. We cant help out clients if we dont help ourselves and hide our personal issue working as a therapist. I believe there is a personal moral reposonsibiility to that client on behave of the profession.
The guidelines should also be the same across the board-PhD, LCSW, LMHC, CASAC etc. anyone in the helping profession. The longer the timeperiod clean and having worked on issues the better off for the career.
thank you.

My feelings on this topic are somewhat torn. I believe there is certainly a need for some standard that can be applied to determine whether an individual is sufficiently recovered from the effects of a substance dependence to be able to, in turn, serve others. Length of abstinence is indicative solely of length of abstinence, and not one's ability to provide competent treatment. Whether a person is in a degree-seeking program or some other training program for CAC Certification, I believe that it is incumbent upon the educational venue to track both the progress toward certification AND the student's appropriateness to be a practitioner in the field. This would, in the case of "training programs" require a significant revamping of the system, but I believe that it is needed.

For instance, in the Master's Counseling program that I am currently in at the University of Colorado, Denver, each instructor not only gives a course grade, but also rates each student on a 5-point scale as to their possession of personal traits/skills/general fitness to work in the field. Students rated 3 or lower are met with and concerns are discussed and addressed. Individuals with consistently low ratings may be asked to leave the program.

A similar system for individuals seeking CAC Certification might in addition to a period of at least one year of abstinence would, I believe, serve the public, the profession, and potential counselors in good stead.

Throughout my 20+ years of professional and personal experience with addictions, I would like to say a couple of things about this issue:

1. I have worked with therapists with many years of sobriety who are not good therapists
2. I have worked with therapists who are not addicted (or it is unknown) to anything but are excellent addictions counselors.
3. Usually when a therapist relapses on substances it eventually shows up in his/her work. And if it doesn't, what is the point?

Whether someone uses a substance or not should not be the grounds for firing them, any more than arresting them (if we believe this is a relapse-remitting disease). It is only when such use interferes with their (or someone else's) life/job that it should be a concern of the employer. Otherwise, it should strictly be a personal concern. Above all, an employed counselor should always be offered treatment before being let go, unless there are serious ethical breaches or number of failed attempts to get help. I'm not a fan of arbitrary abstinence limits but I do believe that 3-5 years of working on personal issues, whether involving addiction or any other mental health problem is a good boundary for someone to become a licensed practitioner. Of course, it is tricky for the employer to ask about personal life anyway, but in the field of substance abuse recovering people have historically had an edge in hiring. This is changing somewhat simply because licensure standards have increased in most states, making the old way of hiring recovering people with no clinical training to perform tasks requiring strict adherence to accreditation standards more difficult (this is not to mean someone like this couldn't become a good therapist with proper training).

While laws, regulations and laws might not provide a specified length of sobriety before certification or licensure, employers may or may not have published their standards. In a number of treatment agencies, a person with less than 3 years of sobriety will not be hired. A few agencies want employees who have 5 or more years of sobriety. Should agencies with such policies publish them as part of the application packet or refuse to consider applicants and not inform the applicant as to the reason for not being considered for the position? Since agencies are discriminating on the basis of length of sobriety, will this impact laws and state rules?

My feelings on this topic are somewhat torn. I believe there is certainly a need for some standard that can be applied to determine whether an individual is sufficiently recovered from the effects of a substance dependence to be able to, in turn, serve others. Length of abstinence is indicative solely of length of abstinence, and not one's ability to provide competent treatment. Whether a person is in a degree-seeking program or some other training program for CAC Certification, I believe that it is incumbent upon the educational venue to track both the progress toward certification AND the student's appropriateness to be a practitioner in the field. This would, in the case of "training programs" require a significant revamping of the system, but I believe that it is needed.

For instance, in the Master's Counseling program that I am currently in at the University of Colorado, Denver, each instructor not only gives a course grade, but also rates each student on a 5-point scale as to their possession of personal traits/skills/general fitness to work in the field. Students rated 3 or lower are met with and concerns are discussed and addressed. Individuals with consistently low ratings may be asked to leave the program.

A similar system for individuals seeking CAC Certification might in addition to a period of at least one year of abstinence would, I believe, serve the public, the profession, and potential counselors in good stead.

Welcome to the AP blog community, Anne! It's great to have you, and I think the interactivity and back-and-forth of blogging makes it a particularly appropriate way to talk about ethical issues.

Reflecting on the comments to this topic so far has led to a lot of discussion and consideration among students. One observation to add to the mix is that a person who is new in recovery tends to have a different approach to working with others than someone who has a year or more of recovery time. Along with that observation , one has to consider the difference between the recovering person who has a strong support system and peers with whom to consult and the recovering person who decides to not include support persons in recovery. Persons approaching addiction counseling from the different perspectives might work with clients differently even if they have good counseling skills.

Anne Hatcher

Although I am not a legal professional I do have a strong opinion on this topic & would like to write a book on it but. for the sake of the readers here, I will make every attempt to be succinct in my comments. It is my understanding & belief that substance use disorders should be treated like any other medical condition. This is what I understand the Americans with Disabilities Act (ADA) requires (with a few caveats). I cannot imagine requiring a pregnant woman to remain off work for a specified & specific period of time before returning to work after delievering her baby(ies). Almost every company/organization has a policiy that simply states, for pregnancy or any other medical condition, that the employee who takes medical leave must provide proper documentation & demonstrate a "fitness for duty" in order to return to work. This is my passionate plea for substance use disorders & mental health disorders. It is my STRONG belief that any other practice is discriminatory. I think those of us who have worked in the addictions and/or mental health arena for any length of time can attest to counselors in recovery who claim M-A-N-Y years of sobriety but who should never counsel another individual, couple or family. I have also observed the opposite. When we talk about requiring a minimum number of years that a new employee should have before beginning work as a counselor, is there a magic number? My years of experience have taught me that the answer to this question is "NO". I have found the ability & preparation to counsel to be highly (pun intended) individualized with or without the element of the individual being in recovery. Although I want to continue writing & sharing my thoughts in this area, I am going to stop here as I believe that the readers that have progressed this far understand my point & have formed their own opinion. Thank you for reading my thoughts! I am interested to read yours.

This is an on going issue and will continue to be so as long as persons in recovery seek certification as addiction counselors. One advisory board was hesitant to make a rule. However having a guideline would provide a basis for evaluating an applicant seeking certification.

Anne Hatcher

Dr. Anne

Anne S. Hatcher, EdD, CAC III, NCAC II, is Co-Director of the Center for Addiction Studies at...