On the whole, addiction treatment clinicians believe their organizations are doing a better job of addressing the self-care needs of staff members. A growing number of clinicians say they are fairly compensated for their work. But is it enough to keep them in the field? At a time when caseloads continue to grow and extra hours pile up, an increasing number of clinicians aren’t so sure.
Conducted in September, the third annual Addiction Professional Quality of Life Survey drew responses from more than 650 clinicians. The survey is open to all clinicians in the field, and therefore, the individuals who have participated have varied from year to year.
While more than half of the respondents said they plan to continue working in the field until they retire, the percentage of those who expect to do so dropped 9% from 2016 and 12% from the inaugural survey in 2015.
Responses in general painted a picture of clinicians making the most of their hours and understanding the importance of self-care, but with more possessing a willingness to consider other career options.
In it for the long haul?
A growing number of clinicians surveyed said they can see a future that doesn’t include working in addiction treatment. Two years ago, 71% said they planned to continue working in the addiction treatment field until they retired. Now, that figure has dropped to 59%, with 17% of respondents saying they would stay in the field for a while, but expect to eventually find a new career, up from 9.8% in 2015.
Jonathan Maxson, a treatment consultant who specializes in short- and long-term recovery coaching and sober companion work for Recovery Care Partner in Silver Spring, Md., says that although he personally expects to stay in addiction treatment until retirement, he’s not surprised that more clinicians are weighing whether to move on.
“Not at all,” he says. “For so many of the treatment centers I work with, the case managers are trying to manage 10, 15, 20, 30 people and their families. A lot of them are overworked. Even in some of the most premier treatment centers, the people are burned out.”
Handling heavy workloads
Notably, respondents to the survey once again said their caseloads have increased over the previous two years, but fewer said they are working more hours than they expect and the percentage of clinicians who said their caseload was too heavy was the lowest it has been in the three years of the survey.
Of those surveyed for 2017, 52% said their caseload has increased, continuing an upward trend from 47% in 2015 and 51.3% in 2016. Meanwhile, 19.5% of respondents said their caseload is too heavy, a decrease from the previous two years.
Shantelle Collins, MS, LCDC-I, is a project manager of substance use disorder outpatient programs at My Health My Resources, Tarrant County in Fort Worth, Texas. Collins, who has worked in the field since 2004 and in her current role since 2013, says the evolution of treatment best practices throughout her career has played a key role in changes to her workload.
“What we’re looking at now is dealing with the whole person as opposed to the services being provided,” Collins says. “Now we’re focusing more on the individual as they get better. "If substance abuse or mental health or primary care needs are an issue, we’re trying to integrate all of those into one so we can deal with that person.”
The amount of extra work time clinicians are putting in continues to be all over the board. The most common response regarding unexpected/unscheduled work time in a typical week was between one and three hours (40.4%).
Maria Landry, an outpatient counselor with OneEighty, which offers substance abuse prevention, intervention and treatment services in Wooster, Ohio, is one example of walking the tightrope of a heavy caseload while reining in hours. She works an even 40 hours per week—a practice that is encouraged by her employer—but says she sees clients for an average of 25 hours a week.
“They allow us to set our own schedules, and I’m one of those Type A personalities,” she says. “I, unfortunately, schedule myself too frequently without breaks in between. Usually, I know when I’m getting short-tempered with minor things, that I’ve had too many clients on my schedule. That’s when I have to take a five-minute break and go for a walk.”
The large majority of survey participants said self-care is addressed in their workplace, with 33.4% calling it a high priority and 41.2% saying it's an occasional topic of discussion.
For Landry, self-care options at OneEighty extend beyond the staff area where she takes walks to recalibrate. On the recommendation of a non-clinical staff member, OneEighty now offers its employees paid time off for a 15-minute chair massage on site. (While the time for the massage is covered by the employer, staff members pay for the massage itself.)
Self-care takes on various forms at different treatment organizations, as experienced by Keri Nider, a mental health and drug and alcohol counselor in Lincoln, Neb. Nider says self-care doesn’t come up often with her colleagues at Lincoln Behavioral Health Clinic, where she works with clients for 10 hours per week, but it’s an ongoing focus with her equine-assisted psychotherapy at Take Flight Farms in Omaha, Neb., as staff members will work with the horses on site to address their own needs.
Nider also serves as an adjunct instructor for the Counseling Program at Doane University in Crete, Neb., as well as the Human Services department at Southeast Community College in Lincoln, where she helps students gain a deeper understanding of self-care best practices that keep clinicians in a healthy frame of mind.
“A lot of times, we think self-care is taking a vacation, or getting a massage or pedicure. That’s not necessarily it,” Nider says. “It’s talking about things, doing things, getting other people in your life on board to say, ‘Have you experienced this?’ It’s normalizing some of the things we hear and see on a regular basis. We can’t talk about these things with our husbands or wives or friends who don’t work in this field. We have to have our colleagues. They are critical in our self-care process because of the things we do, see and hear.”
Additional survey insights
Participants in the Addiction Professional Quality of Life Survey weighed in on several other topics:
Compensation. Nearly 29% of respondents said they feel their annual salary adequately reflects their training, experience and demands of their job. That is a 4% increase from 2016, the first year the question of compensation was included in the survey.
Training and credentialing. While 46% percent of respondents are not pursuing any training right now, specialized training in a treatment approach (26%) was the most common form of education being pursued.
Clinical supervision. About half (49.9%) of respondents have favorable views on the quality of their clinical supervision (23.5% offering a rating of “very good,” and 26.4% “good”). These figures are in line with responses given in 2015 and 2016.
Philosophical differences. 34.9% said they have quit a job in the addiction field because they had disagreed with the treatment philosophy or quality of care at a facility, a 5% increase from 2016, but still below 2015 (38.2%).
Tom Valentino is Senior Editor of Addiction Professional.