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Challenges abound in the substance use disorder workforce

September 16, 2014
by Rebecca Flood
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There are many workforce issues that we experience as treatment professionals working in the substance use disorder field. When we analyze these issues, I think it is important for us to understand the history of our profession. If we look back 50 years into this profession, the behavioral health field was nonexistent. During that time, we had mental health, alcoholism, and drug addiction. These were three separate distinct professions and never the twain did they meet. In the mental health arena we had psychiatrists, psychologists, and licensed social workers. All were providing care to those that suffered from chronic and persistent mental illness. In the “alcoholism” category we had recovering alcoholics, a 12 Step movement, and the beginning of what we now call treatment. Through this, the Minnesota Model emerged. In 1958, the Synanon organization was birthed by Charles Dietrich and used by recovering addicts. Fifty years ago we saw alcoholism and drug addiction as two separate and distinct problems, not one in the same. Thirty-five years ago, in the 1970s, the alcoholism and drug addiction professions began to see the need for certifications.

Each state was a little bit different during this time. There were minimal standards for people working with those that suffered from chemical dependency. The profession eventually created what is known as the “12 Core Functions.” Our workforce began internationally acknowledging a system that recognized licensed chemical dependency counselors.

In years gone by, there were many people in recovery who were compassionately and lovingly helping others suffering from alcoholism. Yet little education was needed. In order to have a license today, the educational level has been increased from those who barely finished high school or who were holding GEDs. In both professions we have come full circle to a place where we are now using peer support.

The way that we reference addiction and alcoholism has changed in our profession. Within the last 15 years we have begun to identify what is now seen as the “behavioral health field.” Our profession went from “alcoholism and drug addiction” to “chemical dependency,” from “chemical dependency” to “substance abuse” and from “substance abuse” to “substance use disorders.” Currently we are looking at both “substance use disorders” and “persistent mental illness” under an umbrella called behavioral health. We are seeing a melting pot of professional credentials: from LPCs to MFTs to CIPs to CADCs and LCDCs to psychologists, psychiatrists and physicians, all of whom have all types of certifications in addiction medicine. They are studying different topics, and they come together in what we nicely like to call multidisciplinary teams. From one provider to the next, these teams vary dramatically and there is a lack of consistency. There is no Yale, Harvard, or Stanford to educate those that consider themselves substance use disorder professionals.

I believe providing information about the history of this workforce helps in understanding why individuals enter this profession. Here are some reasons why individuals choose to work in the substance use disorder field. According to a previous study:

  • 95% of people indicated that they were drawn to this field because of the challenging and interesting work

  • 91% have a desire to work in a helping profession

  • 78% were motivated by the substance use disorder problems that they saw in their community




I have been trying to determine the recovery rates for substance abuse users since the field has required higher levels of education for substance abuse professionals and dual diagnosis treatment.

I can't find any statistics that show if the recovery stats are still; 40% achieve and maintain recovery w/the first treatment, 20% achieve and maintain recovery after two or more treatments and 40% relapse until they die.

I have tried NIH, NIDA and NIMH as well as general search engines.

Do you have a suggestion for where to find the stats? I am especially curious as a doctorate level neurological researcher has made the claim that 99% of all substance abuse users relapse.


Mz. Phoenix

Thank you both for your comments--this is a very interesting conversation. As Dr. Jeffrey mentioned, SUD treatment and corresponding education levels of SUD professionals are not uniform across the U.S.
Licensing and certifications vary from state to state, and from licensing body to licensing body. The number of employees within a licensed program who must hold certifications can also vary. Some require 90%, some as low as 10%. This also doesn’t take into account that credentials for those providing private practice care can vary drastically from state to state.

I don’t know at this point that a study has been done which shows the impact that the level of education has on the outcome of the consumer. With all of these variables, your question does indeed become a complex one, and it is complicated further by the fact that we don’t necessarily have a uniform definition for “recovery,” either. Some see relapse as part of a recovery continuum, along with whether or not an individual engages quickly in treatment afterward. Even within our field we have difficulty coming up with a uniform, consistent definition. With that said, I thank you both for your input on this topic. More conversations like this need to be held, and it can help determine where further research needs to happen. We need to continue to engage each other with these difficult questions!

Your question is interesting because you are looking for an outcome based on receiving treatment with consideration to the staff education and whether or not there is a another diagnosis interfering with the primary mental illness.

It seems to me that you are asking too many questions with the assumption that all states treat SUDs the same and that the workforce is similar in all states.

It seems that you mention a rule of thumb relapse rate, 99%. Well, with an outcome of 1% the entire industry is in question. You did not define relapse, one beer or a 3 day binge, or years of over-indulgence? and which dual characteristics are we talking about? depression, anxiety, chronic pain, etc. There are many variables in this mix. Perhaps you are discussion why there is a negative stigma against SUD counselors, licensed or certified by state law.

You may have more success looking for SUD & Depression stats state by state. Maybe not.

I think that one problem that I have witnessed over my last 15 years as a counselor is that it has devolved into more case management than counseling, at least at the inpatient level. I think this is due to regulations and the fact that instead of companies creating jobs to take care of some of these things they just have the counselors do them. This takes away from time spent with clients both in person and on treatment planning.

It has become more educational than treatment oriented.


Rebecca Flood

President and CEO of Ashley Addiction Treatment

Rebecca Flood is president and CEO of Ashley Addiction Treatment. She previously served as CEO...

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