Addiction counseling as a discipline arose from a grassroots movement designed to meet a need that was not being met by counselors from the traditional mental health professions. Coordination between 12-Step programs and the preparation of counselors was a logical link, given that most persons who wanted to work in this field were recovering addicts. In the past 25 years, the counseling profession has evolved to include more persons who in addition to the recovery experience have studied the underlying causes of addiction and have pursued research related to successful treatment and recovery. The experience of the college at which I work is cited here as an example of the way addiction education programs have developed over time.
The addiction studies program at Metropolitan State College of Denver began in the early 1970s, with grants from the National Institute of Mental Health (NIMH) allowing for the training of 20 addiction counseling students per year. John Donohue, the first program director, hired for the program individuals who had experience working with street addicts; they began teaching addiction courses at the college as well as teaching Native American groups on nearby reservations.
Entering students were required to have five years of sobriety—many of these students brought with them a lot of street experience. In addition, some professionals such as physicians, nurses, and business administrators in recovery enrolled in the courses. A significant portion of the course content was based on the 12 Steps. The instructors of these classes faced numerous challenges, as students struggled to learn required information for state certification that did not always agree with their own experience of drug and alcohol use.
Learning with a purpose
Still today, there are several manifestations of an historical lack of coordination between educational experiences and professional standards for addiction counseling. There is no systematic national plan that shapes how workers enter and progress through the field, with no clear pathways of preparation for entry and advancement. Each state essentially has its own set of standards, and reciprocity between states is limited. People often have been hired as addiction counselors with the expectation that they will acquire knowledge and skills through the process of working in the field, rather than having an in-depth understanding of the issues clients face.
More than a decade ago, William White proposed the need to work from a higher standard of knowledge and skills required for service entry, and for a more rigorous system of supervision.1 This process should be embedded within education, certification, and licensing procedures, as well as within program accreditation, he stated. In addition, attention is needed to meet the ethical obligation of protecting clients from harm resulting from the actions of untrained and/or undersupervised workers.
At the time White was publishing his suggestions, coursework at Metro State was being altered to focus more on research related to the causes of addiction. A course in pharmacology was moved from an entry-level course to a junior-level course requiring a more in-depth understanding of substances' effects on the body. Courses in theory and practice began to address mental health and addiction issues presented by clients.
In addition, changes to state regulations for certified addiction counselors resulted in an increase in the required number of experiential hours working in addiction treatment, and standards for student performance in classes as well as in field placements were raised as well. For many years, Colorado had required that persons applying for state certification as addiction counselors complete 1,000 clock hours of experience in addiction treatment. Ten years ago, the experiential hour requirement changed to 1,000 hours for the CAC I certification, another 2,000 hours for CAC II, and another 2,000 hours for CAC III.
Metro State now takes care to meet the needs of working persons by scheduling required courses on weekends and evenings. Courses also are scheduled so that students can meet once or twice a week instead of three days a week. As a result of this scheduling policy, and also because accommodations for persons with disabilities are available, more students seeking addiction counseling certification are attracted to the program. In 2006, White wrote that at the beginning of the 21st century addiction counselors represented the most diverse workforce in the discipline's history.2
Those of us in higher education who also have clinical experience think there is an advantage to the academic preparation of the recovering person to become a professional who happens to be in recovery, as opposed to a recovering person who knows how to counsel. In addition, we have found that training of a credentialed clinical professional who is not in recovery and has little experience with family substance use can prepare that person to work successfully with clients.