The field of addiction counseling currently is without a nationally standardized curriculum. While a good number of certificate and degree programs in addiction exist at the community or junior college level, they vary with regard to hours and content—even within the same state. Very few degree programs or courses exist at the bachelor's or master's degree level. If this remains the case, the profession of addiction counseling will languish. Other helping professions, including social work, marriage and family therapy, and mental health, understand the need to establish national standards in higher education, and they have done so through approved, certified, or accredited degree programs.
Throughout most of the addiction profession's history, the work of counseling has been provided by lay individuals who themselves have battled an addiction.1 Many individuals in recovery relied upon “what worked for them” in helping others. The presence of counseling skills and the understanding of addictions was rare to nonexistent; the main goal was to keep an individual alive. Today, a number of forces have changed this approach. This article will review where addiction studies have come from and where they are going.
Research over the years has indicated that there indeed remains much room for progress. Several studies of clinical training programs approved by the American Psychological Association (APA) found “a low level of training in the evaluation, treatment and prevention of substance abuse.”2 A follow-up study five years later “found few changes in the quantity or nature of university training in substance abuse.”3 Lawson and Lawson concluded in a review that there was consensus toward a need for minimum training standards for human service professionals, yet they found little agreement on prerequisites, curriculum, or instructor qualifications.4
The profession of addiction counseling began to solidify in the early 1970s when Congress passed the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. Adoption of this legislation provided substantial funding in the form of block grants to the states, both for treatment of patients with alcohol use problems and for training of individuals to work with this population.
During the same period, Congress established the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Banken and McGovern report that NIDA and NIAAA were the first organizations to establish specialized training focusing on counseling skills to meet the needs of addicted persons.5
States began to establish private substance abuse counselor certification boards at the time of the birth of two national organizations: the National Association of Alcoholism and Drug Abuse Counselors (now known as NAADAC, The Association for Addiction Professionals) and the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse (ICandRC). Also during this time, the Association for Counselor Education and Supervision (ACES) developed academic minimum standards at the graduate level for professional counseling.
Following this effort was the formation of the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the National Board for Certified Counselors (NBCC), both in the early 1980s. These organizations began to include within their mission standards for the certification of professional counseling. They eventually would play a role in the establishment of standards in addiction counseling as well.
Unfortunately during this time, states were given “the authority to determine acceptable professional credentials for individuals performing non-medical treatment services.”5 Horvatich and Wergin found in the field of addictions counseling that non-degreed individuals, or at the least high school graduates who were recovering addicts and alcoholics, were being recognized as qualified professionals to engage in counseling.6 Some states required counselors to have a certain number of years in the field before they could become state-certified. Only recently have some states required a bachelor's degree, yet others do not require certification if a counselor works in a state-certified facility. Any education that these individuals received was training provided by the state, state-certified institutions, and workshops and conferences, rather than academic institutions. Standards varied from state to state, with no established basis.