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CASA report decries quality of addiction treatment system

June 26, 2012
by Gary A. Enos, Editor
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Analysis says patients, counselors pay the price for a lack of standards
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 While few of its individual findings will come as much of a surprise to seasoned professionals in the addiction field, a newly issued report from the National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) packs a punch in its assault on current substance use treatment practice.

Perhaps the most stinging, if still not stunning, comment in the report is its statement that the medical profession is largely absent from addiction practice and that the counseling professionals who deliver most of the treatment services to patients are often subject to few or no qualification standards.

“There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards,” CASA Columbia vice president Susan Foster said in a news release issued this week.

CASA this week released a mammoth report of nearly 600 pages, entitled Addiction Medicine: Closing the Gap Between Science and Practice. The research team led by Foster relied on numerous data sources that included but was not limited to five national data sets, a survey of more than 1,100 members of addiction treatment organizations, and a survey of 360 individuals in recovery. Grants from several charitable foundations financed the five-year project.

Here are some of the findings CASA is highlighting from its report:

·        Only about 1 in 10 individuals who need treatment for addiction are receiving it, compared with 7 of 10 individuals with chronic illnesses such as diabetes and depression who are receiving treatment for those conditions.

·        A total of $28 billion was spent in the United States in 2010 to treat addiction, an illness that affects 40 million people. By comparison, $107 billion was spent that year to treat heart disease, which affects 27 million people.

·        Only 2 cents of every dollar spent on addiction-related costs pays for treatment and prevention efforts, as the vast majority of spending focuses on the health consequences of substance abuse.

·        Addiction treatment remains largely disconnected from mainstream medical practice. The report cites research data showing that only 29% of individuals who visited a general medical practitioner in the past year were ever asked about alcohol or other drug use.

·        The counselors who handle the majority of clinical care in addictions are subject to a hodgepodge of educational and credentialing requirements from state to state, with nearly one-third of states requiring no certification or licensure to practice and only half a dozen states requiring that counselors hold a bachelor’s degree or higher.

The report characterizes the gap between research and practice as “unfair to the thousands of addiction counselors who struggle, in the face of extreme resource limitations and no medical training, to provide help to patients with the disease of addiction and numerous co-occurring medical conditions.”

The report issued numerous recommendations to improve addiction treatment practice and policy, including:

·        Developing core clinical competencies for addiction treatment and prevention and requiring that they be taught in all relevant education and training programs.

·        Standardizing the language that is used to describe the full range of severity of substance use problems in the population.

·        Requiring routine screening and brief intervention for individuals in all government service systems, from corrections to housing to child welfare.

·        Requiring that all addiction treatment facilities be licensed under the same provisions and standards as other healthcare facilities.

·        Implementing a national public health campaign coordinated by federal government agencies to educate citizens about all forms of risky substance use.




Addiction counseling is a profession. Addictions counselors are trained in all aspects of drug and alcohol misuse, and there are established core competencies that are promulgated by SAMHSA, the TAP 21 Addiction counselor competency document endorsed by all addictions constituencies. By contrast, most MDs have little if any exposure to alcohol and drug misuse information, skills, etc. I wonder what the agenda is in this report.

Peter L. Myers, Ph.D.

New accreditation standards are evolving for various aspects of the addiction profession. There is a new National Addiction Studies Accreditation Commission that was founded with the support of SAMHSA and has a broad advisory group. There are new standards for recovery houses, treatment alumni, etc. MA level licensure is in about 1/2 of states, and there is an organizing committee to form a federation of licensure boards, which I guess will put the ICRC/AODA and NAADAC systems somewhat in the shadows. If you are on a licensure board you can contact Dr. Ed Reading The addiction studies website is down for upgrades, but should be back up soon, I believe it is and if you teach in the field you can join the faculty network

I have been in the field of addictions for at least 35 years and I find it very curious that suddenly there is a report that the medical profession is largely absent from addiction practice. Why is this so important now? My opinion is that if someone with addiction problems were to receive medical treatment without clinical intervention the patient would suffer. What is this really about? Treating addictions requires clinical training and licensure and suddenly the medical profession wants to be able to treat addicted patients with their own credentials and not with the experience and credentials that everyone in the addiction field feel are necessary, as has been pointed out in study after study over the past 30 years. I don't know what state you are referring to but in my experience all of the states require licensure and the necessary education and experience to obtain licensure. In my experience nurses want to be able to offer counseling to addicted people. They neither have the education, training, or experience necessary to provide clinical interventions.

I would like to read the supporting data regarding the reference to hodgepodge education and credentials of current treatment professionals. I suspect it is old data, and it is wrong. Both NIDA and SAMHSA have published workforce documents in the last 5 years that state that over 50% of staff have MA degrees in counseling, and the vast majority of counselors have a minimum of BA degrees and certification. Yes, there was an era when paraprofessionals in licensed treatment programs were the norm but from what I have read, the tides have turned. Programs are now hiring licensed counselors, just check the classified ads. One does not get a license without formal education. Perhaps the author was referring to the new field of Recovery coaches?

As a Mastered degree counselor, certified and well trained, I stand up for my colleagues and know the lengths we are all going to so we can stay relevant and helpful. I do agree wholeheartedly with the need for better collaboration with medical field, and sadly, I have worked in many programs who had a Physician on the payroll, but that person kept the charts sober, they didn't help clients.
Here's to better days ahead for all of us.

The CASA report points out exactly what your letter inadvertently states. Yes, there are masters degrees and certifications for counselors. None of these degrees or certifications allow the application of the disease model of addiction to be fully applied to the treatment of the patient. Yes they are "patients" with a medical disease.
The CASA findings are an indictment of the medical community, not certified counsellors. What if those that presented with an acute asthma attack or diabetic crisis were treated at facilities with masters level educators, not physicians? What if a patient presented with an acute schizophrenic psychosis was treated at a place where a physician stabilized them for 4-5 days, then they received counseling and group therapy for several more days, then they were discharged with instructions to continue group therapy. It would fail miserably.
There is a gigantic disconnect between the medical community and the treatment of the DISEASE of addiction. This fact in no way discounts the value of certified counsellors.

The reality is that addiction is a disease of the mind, will, emotions and body- in short, the self. Medicine only treats one of these components and even the mind part has diagnoses that are described behaviorally, but then treated chemically. It really makes no sense to ignore the real spiritual causes and effects of addiction in which even many counselors have little or no training in - the field of trauma remediation.

Trauma(mostly childhood abuse) is the primary etiology of addiction in 80% of the cases out there and it is mostly ignored or treated as something to be coped with instead of healed. My mother was in inpatient treatment for depression on and off for 30 years and her past (alcoholism in her family) was rarely addressed. Psychotropic drugging is is a waste of time except in acute care interventions.

Addicts do not get better unless their trauma is addressed. A must read is Chris Prentiss' "The Alcoholism and Addiction Cure"

When people aren't getting enough care when its comes to their health. There is no excuse for such behavior.

"Many people do not understand why or how other people become addicted to drugs. It is often mistakenly assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior." ."The damage addiction does to your relationships and self-esteem is far deeper and takes longer to repair. You've hurt friends and family. "I just read this in one of articles I stumbled on regarding to drug addiction. It clearly states their the cause and effect of drug addiction. That's explains it.