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A profession in peril

July 1, 2007
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The realities of the job make it difficult to attract new addiction counselors

“Help wanted: Addiction counselor to provide counseling for the city's homeless; hours vary. Good writing skills and solid work ethic. Must be state-certified. $16 per hour.”

I recently answered this ad, introducing myself as a private, for-profit treatment provider with a state-certified program next door to the city's homeless shelter. I welcomed the program's HR director to our addiction treatment community and wished him the best of luck in staffing his start-up program.

He'll need more than luck. This HR director will likely find himself empty-handed after spending many days and dollars trying to recruit staff. Many résumés he'll read will be from people who have years of successful, personal recovery experience and “just want to help people.” Twenty years ago, he could have hired these untrained, noncredentialed candidates and steered them toward the local community college for classes to become certified. The rank and file of addiction counseling was built on this process.

But those days are long over. Most states now demand that applicants for certification have a bachelor's degree; these degrees are earned in human services majors lacking a standardized, uniform curriculum that prepares students for entry to addiction counseling. Even the HR director fortunate to be located near a university that graduates master's-level candidates fares no better: Most newly minted master's degrees in human services also fail to deliver training in addictions that matches states' credentialing requirements. And as long as addiction treatment is viewed as an elective within human services coursework, our system of credentialing addiction treatment professionals will continue to struggle.

Revolving door

Many students are admitted to academic programs to become social workers, psychologists, and mental health counselors, but few enter the addiction treatment profession, considered by many to be the lowest-paid, highest burnout human services job. At a March 9 training conference in Baltimore, Cynthia Moreno Tuohy, executive director of NAADAC, The Association for Addiction Professionals, cited a staggering 33% turnover rate, with 5,000 new counselors needed annually to replace those leaving the field.

“Recruitment, retention, and rewards—the three Rs of our workforce—mean that state planning with key stakeholders and valuable partnerships within the field need to be addressed now,” Tuohy stated.

I've had my own experience with this high turnover rate. Of the nine master's-level interns I have supervised in the past six years, only one remains in the addiction treatment field. Eight potential addiction counselors walked out of my private practice because they learned some unhappy truths about addiction treatment in Maryland. To their dismay, they discovered that even private programs must provide the state with confidential data for “outcomes research,” although the data are used to award grants only to state-funded programs. They have to spend hours documenting and duplicating efforts to satisfy more regulations. They also are saddened and frustrated at how little appreciation and progress their clients demonstrate. And when they start looking for salaried, full-time jobs with benefits, they find only contractual positions offering $16 per hour with little or no benefits.

Then they leave the field.

The one intern who stayed on is in recovery herself, like so many addiction counselors. Gerard J. Schmidt, chief operating officer for Valley HealthCare System in West Virginia and chairman of NAADAC's public policy committee, said that “after getting licensed, most people don't want to devote more time and money for more training they should have already received. And unless you're coming into this field from a personal recovery experience, frankly, the interest has been practically nil.”

Gerry schmidt, mac, naadac clinical issues consultant, and joseph deegan, msw, mac, chair of the naadac political action committee (pac), at the naadac workforce development summit, march 2006

Gerry Schmidt, MAC, NAADAC Clinical Issues Consultant, and Joseph Deegan, MSW, MAC, chair of the NAADAC Political Action Committee (PAC), at the NAADAC Workforce Development Summit, March 2006

I began my career in addiction treatment with a dream of hanging my own shingle so that I could help others to recover and live their dreams. Almost two decades later, I find myself quietly loathing what my interns also loathe—the loss of human connection in a field in which humans must connect, because that is how recovery happens. Now I have to forfeit the therapeutic hour to the state's data-mining machine.

The government is consuming what is left of our profession, turning it into “McTreatment,” grinding small practices and private providers to function as miniature health departments. Many small private, for-profit providers have told me that they would rather scour pawn shops, yard sales, and auctions for used equipment and furniture than push paper for grants to polish the façade of a system scrambling to justify hiring more public health officials but not frontline staff.

One provider told me, “I'll give it one more year—and then do what? My life savings is invested in this business. I can't imagine doing anything else.” Yet as we retire—or are forced to close our doors for lack of staff who want to do the “dirty work” of addiction treatment—public health programs' waiting lists will overflow with clients, waiting for intake appointments with staff that these agencies too cannot find.