Many were witness to history at the 2010 National Conference on Addiction Disorders (NCAD) in Washington, D.C. Attendees celebrated three years of work by the National Addiction Studies and Standards Collaborative Committee (NASSCC), culminating in establishing the National Addiction Studies Accreditation Commission (NASAC). NAADAC, The Association for Addiction Professionals and the International Coalition for Addiction Studies Education (INCASE) worked together to move the addiction counseling field toward a national standardized curriculum in higher education, with a connected scope of practice forming a career ladder.
NASAC's creation solidifies the addiction field as a profession and begins a new era in the practice of counseling.
At the 2011 NCAD conference, to be held Sept. 17-21 in San Diego (www.ncad11.com), two workshops related to these developments will be of importance. One will roll out the national standardized addictions curriculum with the new scope of practice. The second will be related to changes coming in the move from certification toward professional licensure in addiction. This article will place into a historical context the path that the field has taken, and then will present the template for a new era for the counseling profession.
Legislative lessons learned
In the early 1990s, Indiana began the process of adopting the state's first licensure bill in addiction counseling. The bill was based on a two-tier system connected to existing addictions certification competencies and foundational to a bachelor's and master's degree in behavioral or social science. Also included was a one-year grandfathering provision for those without a degree, or those in the allied professions who were already licensed and met certification requirements.
The licensure initiative was short-lived, however, as the chair of the presiding legislative committee (a licensed nurse) stated to me at the time, “Mr. Osborn, this bill cannot go forward. Addictions counseling without academic standards is not a profession but a subspecialty. Until there are academic addictions standards, there will be no bill.”
I found myself in reluctant but complete agreement. Besides, to debate the need for such a bill with a committee chair who was licensed in a profession with graduated levels of academic standards on which the licensure was based was ludicrous. The bill was dead, and a personal quest began.
A few years prior, Indiana legislators had passed a social work, mental health and marital and family therapy licensure bill. An invitation had been given to addiction counselors to join at that time, but the offer was declined, in part because of the belief that “only addiction counselors can do addiction counseling.” This would prove to be a naïve stance.
Passage of that bill without addiction counseling's inclusion set a “legislative precedent.” For addiction counselors to have a bill in the future, they had to emulate the previous bill as the new standard. For addiction counseling to assert itself as a profession, the development of an addictions curriculum in higher education was essential.
Other issues remained for resolution. Addiction counselors in Indiana had begun separating into camps. There were those who opposed the bill if it was going to include anything but current certification competencies. Concern was raised that the grandfathering piece was not going to be enough for those with certification, years of experience, and no degree.
The allied professions had developed their own national standardized curriculum on which licensure was based, and many in the addiction field struggled with the issue of those in the allied professions doing addiction counseling. The prominent thoughts were, “How can they be doing addiction counseling? They are not certified in addictions. They are not in recovery; how can they understand addictions from a book?”
Certification and licensure
For the previous questions, the answer is simple on two levels. Licensure supersedes certification. Certification is created by a field that incorporates the requisite knowledge and skills an individual needs to possess, verifying this through examination in order to practice. Licensure represents a higher standard for independent practice (without clinical supervision). In most professional licensures a set of academic standards for accredited institutions and programs is foundational, giving credence to the profession.
What some in addictions failed to understand is the allied professions had established a standardized national curriculum and scope of practice. In the curriculum, especially at the graduate level, a course in psychopathology is required. In this course, diagnosis and treatment protocols from the Diagnostic and Statistical Manual of Mental Disorders (DSM) are mastered. One of the diagnostic categories is the spectrum of substance-related disorders. Inclusion of such a course as part of licensure opens the allied profession to diagnose and treat substance abuse, even if an individual is not certified or licensed in addictions.
The charge of not being in recovery was not an issue, nor was it a “perceived requirement” for any other profession except in addiction. Logic countered that one did not need to have schizophrenia to be a mental health counselor, nor to be married or divorced to be a marriage and family therapist. Why, then, should addiction have such a perceived requirement?