The addiction treatment community increasingly acknowledges the many diverse paths to illness and recovery, but is the academic world keeping up in the way it educates and trains the clinicians of the future?
Some counselor education programs appear to be making a concerted effort to broaden their students' understanding of both the causes of addiction and the diverse avenues to a better life for their patients. At Adler University in Chicago, leaders recently reworked course syllabi to ensure that harm reduction approaches to addressing addiction are incorporated in some way into all courses.
Geoff Bathje, PhD, a member of the school's core faculty for the M.A. in Counseling Program, says individual instructors have leeway to determine how much harm reduction information is included in each course. But he believes that with an increasing emphasis on harm reduction approaches in research, clinicians should be armed with more information for their patients in this area.
“Even if a patient comes in wanting complete abstinence, regardless of what their goals are, there should be some harm reduction information available,” says Bathje, who teaches an Introduction to Addiction Counseling course to master's students who are preparing to become licensed behavioral health counselors.
Application of knowledge
In one particularly timely component of Bathje's instruction, he has invited into his classes individuals who conduct trainings in drug overdose prevention using the medication naloxone (Narcan). Students then have the opportunity to apply their knowledge about the medication in their work in the community.
“There have been five or six treatment sites where students in one of my classes have been able to convince leaders to train staff at a program where they have been working,” says Bathje.
He believes that at a minimum, students should have knowledge of the basic concepts of overdose prevention and needle exchange programs, for example. Yet he says harm reduction also applies to the overall therapeutic approach to working with the patient, and that has become more apparent as Motivational Interviewing (MI) strategies have received more attention in practice.
“The idea of harm reduction counseling as a model is still early in its development,” says Bathje. “It fits well with MI, which is about meeting clients where they're at.”
He adds, “The definition of harm reduction that I really like is 'any positive change.'” Therefore, if an individual who enters treatment with poly-substance issues is able to eliminate use of one substance at the outset, that is harm reduction, he says. Maintaining a positive therapeutic relationship in the face of challenges also constitutes harm reduction, he adds.
Bathje understands that the vast majority of treatment programs consider themselves abstinence-based and still would find at least some harm reduction approaches not to be a fit. “There's the reality,” he says. But with government officials starting to move away from the drug war references of the past and becoming more open to public health strategies such as overdose prevention, he believes students should be prepared for what might become a future need in treatment programs.
“There's still a lot of work to be done to refine what harm reduction counseling means,” says Bathje. “To some, all it means is the public health stuff. But there are broader goals that counselors can achieve with clients.”
Other trends that he sees as becoming more prominent include an incorporation of more non-Western healing techniques in healthcare generally, which inevitably will lead to more acceptance of alternative therapies as a potential component of substance use treatment.
Bathje writes on the school's website, “My overarching goals in teaching are to promote multicultural competence, awareness of contextual/environmental issues, critical thinking, and self-reflective thought in all areas of training and practice.”
Inclusivity in training
For the exclusively online-based counselor training programs at California Southern University, the addictions curriculum has expanded from a single-course approach to a track structure, says curriculum developer Robert Weathers, PhD. Even for clinicians-in-training who expect to practice in a mental health-focused setting, they will find that “one in two clients coming into therapy presents with a substance use disorder,” says Weathers, a former clinical director at Passages Malibu. “Having one course in addictions doesn't square with this.”
Weathers believes students need to be exposed to a broader range of topics relative to addictions. “There needs to be more inclusivity in training,” he says. “It is no longer enough to specialize in one domain of addiction.”
Many programs do a good job of training in therapeutic technique, he says, but don't focus enough on findings in neuroscience that are leading to a greater understanding of addiction, optimal treatment, and recovery.
“In teaching marriage and family therapy courses, I see that there is a naïvete in understanding the complexities of working with a couple in active addiction or recovery,” says Weathers. He adds, “We try to emphasize what goes on in the brain and the impact it has on the addict.”
Weathers also believes bridges need to be built between a 12-Step community that knows addiction and a treatment community that knows therapy. Many still see 12-Step approaches that are rooted in spiritual terminology as antithetical to the academic world, he says, and that is part of the reason why it often seems that there is little to no common ground between the 12-Step and therapy communities.