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Turnover, inadequate training continue to plague substance use disorder workforce

October 15, 2014
by Rebecca Flood
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The substance use disorder profession suffers from what we call “The Graying Out of Leadership.” We currently have a great number of executive-level leaders who will be retired over the next five to ten years. Our profession has very few identified, effective leadership training programs that will take the workforce to the next level. Even though most recent studies show that there is an influx of young people coming through the clinical ranks, there is not enough capacity to compensate for those that are aging out of the profession.

So what are some of the critical issues and trends that impact the workforce? In large part, prevention and treatment services have been driven more by tradition than science over the last few decades. Most recently, this profession has talked more about evidence-based best practices. Oftentimes it can take more than a decade to get evidence-based best practices out into the general population. We found that it takes five years of a demonstration project to show what is qualified as a best practice, and it takes another five years to write it, document it, disseminate information, train people, and incorporate these practices into services. Because of this time frame, our field has begun to look at what are called “Promising Practices.” Here is how it works: While practices are being researched, clinicians have begun to implement the new models of care based on what we believe to be good results. These practices are not evidence-based but are in the process of being researched and documented. Why is this helpful? It allows for practices to be utilized in a more timely manner.

In part one of this blog, we explored how more people than ever are receiving higher degrees within the substance use disorder field. But what we haven’t answered yet is this: How many are still not required to have a degree? At present, the skill set needed to treat our populations is rapidly changing. People in need of care are experiencing more co-occurring disorders. Clinical staff in our profession are not trained well enough to deal with the severity of illness that the populations are presenting with. Let’s take, for example, the state of California. California’s facility licensing regulations only require that 30% of counseling staff be licensed or certified under the California Department of Health Care Services. All other counseling staff can be registered pursuant to Section 13015. In order to receive registrations it takes only a standing letter that says the individual is working in the substance use disorder field. After this registration, a person has two years in which they are supposed to get licensed or certified. It is within this time frame that people may or may not stay in the field, which causes attrition within work environments.

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Improvement in training in the substance abuse field in necessary to satisfy the demands of today's challenges such as co-ocurrent disorders in the substance abuse field.

Thank you for your article. Although I agree with most of your comments and suggestions, especially what I know about how many shortcuts are taken in this area, please realize that unless you have experienced yourself what addiction feels like, which yes, maybe in the beginning it seems like you just want to get high and have fun with your friends or are trying to mask the pain of past or any other tragedies you've encountered in your life. Whether you are 9 or 70 years old, you cannot begin to imagine the suffering an addict goes through. It all ends in pain.....it no longer provides a good time. It trails into a dark tunnel where you feel like you will never see the light at the end. This is just during the time the user is active in his or her addiction. It is no longer serving you, or working to mask that pain or a way of getting "high" and having a good time. It ends in finding a way all the time to get what you need just to feel what "normies" (a word I don't really like to use or agree with, feel normal or well. It's called "dopesick". I am sure as a professional you have heard this many many times, but, unless you experience that and the sickness of withdrawels from any substance and the isolation and hopelessness that takes you over....i don't think that any amount of education can properly prepare anyone to treat an addict. There is nothing I've experienced worse than the feeling of withdrawel and the fear that you can't get through it and life will never begin again (for some just to begin period). There are points where you just feel trapped in your own body and you know you'll never get out.....ready or not. I'm a 52 year old female who has been to the best, most expensive treatment and detox centers to the worst. I've used since the age of 10 and have had what some would call time clean" but somehow it creeps up behind you and grabs you by the throat and it literally wants to kill you. I was a dedicated A and NA member and have sponsored girls, i have given it several tries. Once Again Here I Am detoxing AGAIN and I honestly have given so many heartfelt tries to follow all the direction I have been given but due to a serious injury became readdicted to pain medicine. I've done the suboxene taper, I've done the hospitalization detox and as I said the best in and outpatient treatment I could get. I'm well connected with a great support system but it's friends, not "the program" or family (who all in fact have their own addiction issues but that's for another time. I cut all ties to my toxic family and users/dealers, changed phone numbers and moved but it seems to follow me around. I don't even want to bring up the subject of the massive amounts of money I've spent for all of the above. I don't want to get into my history which in all instances lead me down this path, that's for some other time. I take full responsibility for my affliction, however it's something that just takes over my body mind and soul and I can't take the pain, emotional and physical of this withdrawel this time and I'm scared. As most addicts like to be the biggest and the baddest and share war stories, I don't go down that path. I didn't ask for this and I don't want it nor am I proud to swap those stories when you see that gleam in their eyes romantisizing it. Surely I'll share my "experience, strength and what's left of my hope on this subject but most of these treatment centers and a great deal of their staff, even recovered addicts, really have no idea what this feels like? That being said what qualifies the non-addict REALLY know what a recovering addict is going through. Not to mention the staff at these facilities that do have first hand experience of what we go through but I think the hypocrisy behind that is not only ignorant but dangerous. I'm trying not to downgrade all forms of treatment and I'm not trying to be negative or give other addicts a free pass but it takes work......a lot of work to get and stay sober and one way to do that is have compassionate staffing that don't make you feel like a criminal or a difficult patient because every body is different, every experience is different and every person is different. There is no "textbook" cure or treatment. People have different levels of discomfort, experience, and tolerance levels. The medical industry needs to "WAKE UP" The politicians need to quit lining their pockets, and addicts need proper treatment. If I had the answer naturally I would divulge that information but here I go again. I have dreams and desires to wave a magic wand and take this all away from all of you sick, suffering, confused and hopeless people, but I dont. I also don't want you to think I have become bitter or jaded or, have completely lost hope because I havent. I hope this time it works and it sticks. Nobody should have to go through this kind of hell when really our intentions all along have been to escape from hell just to end up in a different sort of hell, just hell in our minds and bodies. Anyways, enough of my ramblings this is just the words and feelings of a sick and tired withdrawing drug addict.......i hope the answer is really out there. Thank you.....

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Rebecca Flood

Executive Director/CEO of New Directions for Women

Rebecca Flood

@NDFW

http://www.newdirectionsforwomen.org/

In more than 3 decades of experience in the health care industry, Becky Flood has demonstrated...