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October 22, 2013
by Joan E. Standora, PhD, LADC, CADC, CASAC
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The field should unite behind licensure of specialty counselors

The field of chemical dependency treatment and prevention is poised for major changes in workforce development this year. It is not easy to parse how these changes will affect our clients and our future work. Several influences have converged to create possibilities for change in how the addiction workforce is configured: first, the pressures for a response to what governments increasingly recognize as a public health crisis; second, the federal government’s focus on healthcare reform and the implications of that for behavioral health; and third, the dearth of credentialed substance abuse counselors in the face of overwhelming need.

The interrelationships among these factors are fairly clear: The need to address a major public health crisis can be fulfilled by providing high-quality, measurable care as delivered by accredited healthcare professionals. There are some positive signals that the Affordable Care Act (ACA), which is scheduled to be fully implemented in 2014, will force us to take action on the issue of the credentialing of addiction professionals across the nation.

Unfortunately, the possibility that the U.S. Supreme Court could reverse a key mechanism of the ACA this spring might result in the continuation of conflicting theoretical, non-evidence based approaches in addiction treatment and training, or even the total absorption of the addiction field into the generalist behavioral healthcare profession without acknowledgment of the need for special training.

According to the Bureau of Labor Statistics in 2008, employment of substance abuse and behavioral disorder counselors was predicted to grow by 21 percent, a rate much faster than the average growth for all occupations. The key problem at this critical juncture for the substance abuse field is that a “disconnect” exists. Despite our earnest efforts to address critical health issues, there is an ongoing gap between the professional standing of the broader behavioral health community and the tendency for many to see the addiction field’s frontline workforce as a paraprofessional class.

The underlying issue that will drive changes in the treatment of addiction is the federal rules for reimbursement under the ACA, should it be implemented as planned in 2014. For treatment programs and related agencies, will the reimbursement for individual and group services depend on the credentials of the provider employing counselors with generalist skills? Will there be requirements for practitioners to demonstrate that their licenses include competency in treating substance abuse?

Issues of reimbursability usually proceed apace with the process of professionalization of any health-related field. Side by side with this issue is the continuing debate about the knowledge base and the formal training that should be required for professional service in the prevention and treatment of addiction.

What will be recognized?

Too often, throughout the history of the addiction treatment field, practitioners with credentials from other behavioral health areas—social work, mental health, vocational rehabilitation—have engaged and treated chemically dependent clients without the requisite education or experience (i.e., a knowledge base in addiction and formal training in the diagnosis and treatment of addictive disease). Meanwhile, many of our current workers, with a variety of state certifications and either no, some, or many degrees, continue to help clients without any recognition of their very real expertise in treating substance use disorders.

So, practitioners in our field are an incredibly diverse group, and unless our current workforce of individuals is acknowledged as professionals through some sort of licensing process (perhaps involving a grandparenting mechanism), many of our counselors are going to be squeezed out of the workforce.

Joining the national conversation about the important initiatives in the addiction workforce, supported by the Office of National Drug Control Policy (ONDCP), the Department of Health and Human Services (HHS), the Department of Education and the Department of Labor, a number of national professional organizations are advocating a change in the way we recruit, educate and train our addiction professionals. To ensure that a professional, national “standard of care” exists for our clients, just as it does for individuals treated in mental health centers, medical settings and other healthcare environments, these groups support the idea of national core competencies for counselors that can serve as a foundation for the addiction education required of all practitioners who treat addicted clients.

Only half of the states mandate a specific substance abuse counseling “credential,” whereas more than 85% of states require a master’s degree for the mental health practitioner licensee. It is estimated that there are currently 86,100 individuals working in counseling positions in the labor force; a number of these counselors are not in the substance abuse treatment field per se, but many treat clients with substance use disorders.

It is time to take a hard line on advocating the licensing of addiction counseling to reflect a special area of expertise not shared by the generalist counselor. Certainly, with 2.5 million patients requiring some kind of care and approximately 25 million individuals at risk for substance abuse-related problems, there is a strong case for these addiction specialists to become a nationally recognized profession.

As parity in health insurance for mental health and addictive disease becomes a reality, Smith and colleagues note, “An expanded workforce of addiction professionals must be trained and positioned in a variety of treatment models to deal with the increased demand for treatment that parity will make possible.”1