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New models in Minnesota

July 1, 2007
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The latest entrants to counseling bring new skills, hopes for a career track

David t. smith, phd, licsw

David T. Smith, PhD, LICSW

Progressive trends are providing glimpses into the future of addiction counseling and are continuing to reshape and augment the traditional 12-Step treatment model. The proliferation of theoretical models and clinical techniques such as cognitive-behavioral therapy, Motivational Interviewing, and harm reduction (highlighted by Carlton Erickson, PhD, in the January/February 2007 issue of this publication) illustrates the overall direction in the field of addiction treatment. These trends have generated a discussion of clear distinctions in experience, training, and ideology between those viewed as “traditionalist” counselors and our newest generation of addiction professionals, with the most important being perceived differences in professional competencies.

Recent statutory changes affecting clinical providers in Minnesota continue to transform the traditional “Minnesota Model” of 12-Step treatment into a hybrid behavioral health/medical model quite unlike its predecessor. Minnesota's traditional chemical dependency treatment model has been dramatically affected by two major changes: the state's implementation of American Society of Addiction Medicine (ASAM) dimensional criteria for treatment planning in state-licensed facilities, and operationalizing of the Board of Behavioral Health and Therapy, a state board governing licensure of alcohol and drug counselors, or LADCs.

In the case of the ASAM criteria, Minnesota responded to national trends. On Jan. 1, 2005, the state implemented “Rule 31,” the latest regulation governing the licensing of chemical dependency programs. ASAM's six identified “dimensions” of recovery were deliberately written directly into the rule as part of an overall aim to change significantly the nature of traditional addiction treatment services.

The second change, involving the efforts of the Board of Behavioral Health and Therapy, addressed a latent need to professionalize further the addiction counseling degree, training, and licensure processes. The old saw about how one becomes a counselor (“All you need is an AA Big Book and a coffee cup”) quaintly obscured solid economic and clinical reasons for raising professional standards. Counselors required more clinical experience prior to employment, improved ethics training, and more comprehensive skill sets.

The state's new licensure rules will require would-be addiction counselors in Minnesota to complete a four-year degree program including five months of clinical internship and 2,000 hours of post-degree clinical supervision. Today's requirements for success in the addiction counseling market cannot be explained away by mere differences in treatment philosophies or generational gaps. They represent a significant shift in actual needs.

The new-look counselor

Amid an enrollment surge in counseling programs in our state, changes in student characteristics appear to be an even more dramatic development. Newer students differ from traditional addiction counseling students in that many have little or no “recovery experience,” which until recently was considered a benchmark of employability in the chemical dependency field. Conversely, today's graduates are demonstrating considerable skills that many earlier graduates did not possess. Traditional counselors entered the field predominantly in response to a calling and had to meet only minimal requirements (in relation to other licensed professionals) to become work-ready. Today's students are viewing the LADC as an alternative career choice to social work or education—similar tracks leading to comparable salary scales. More students today are choosing addiction counseling because it technically offers licensure-related income potential.

2005 conference program for the naadac annual conference in corpus christi, texas
2005 Conference Program for the NAADAC Annual Conference in Corpus Christi, Texas

The model is changing from experience-based to competency-based, possibly crowding out some traditional students yet opening the door to a new generation. This dynamic is generating a vibrant dialogue at almost every level regarding a changed future for addiction counseling. Reviewing and understanding these skill sets required for success in an ASAM-based environment has helped our programs prepare for a period characterized by large-scale and lasting change:

Improved Organizational Skills. Current and future addiction counselors undoubtedly require strong organizational skills. Adaptation of the ASAM criteria has ushered in the development of an extraordinarily useful multidimensional, multidisciplinary addiction counseling model. For treatment program directors and counselors, the ASAM model's usefulness depends on organizing and tracking individual client, aggregate caseload, and milieu variables. Imagine even a simple scenario involving a counselor with a caseload of 15 clients presenting with “multiple complex problems.” Assessment and treatment planning over six dimensions for any length of time can generate literally hundreds of data pieces. This fact alone points out potential weaknesses of any ASAM-based model: information overload, increased paperwork, and decreased clinical time.