The substance use disorder profession suffers from what we call “The Graying Out of Leadership.” We currently have a great number of executive-level leaders who will be retired over the next five to ten years. Our profession has very few identified, effective leadership training programs that will take the workforce to the next level. Even though most recent studies show that there is an influx of young people coming through the clinical ranks, there is not enough capacity to compensate for those that are aging out of the profession.
So what are some of the critical issues and trends that impact the workforce? In large part, prevention and treatment services have been driven more by tradition than science over the last few decades. Most recently, this profession has talked more about evidence-based best practices. Oftentimes it can take more than a decade to get evidence-based best practices out into the general population. We found that it takes five years of a demonstration project to show what is qualified as a best practice, and it takes another five years to write it, document it, disseminate information, train people, and incorporate these practices into services. Because of this time frame, our field has begun to look at what are called “Promising Practices.” Here is how it works: While practices are being researched, clinicians have begun to implement the new models of care based on what we believe to be good results. These practices are not evidence-based but are in the process of being researched and documented. Why is this helpful? It allows for practices to be utilized in a more timely manner.
In part one of this blog, we explored how more people than ever are receiving higher degrees within the substance use disorder field. But what we haven’t answered yet is this: How many are still not required to have a degree? At present, the skill set needed to treat our populations is rapidly changing. People in need of care are experiencing more co-occurring disorders. Clinical staff in our profession are not trained well enough to deal with the severity of illness that the populations are presenting with. Let’s take, for example, the state of California. California’s facility licensing regulations only require that 30% of counseling staff be licensed or certified under the California Department of Health Care Services. All other counseling staff can be registered pursuant to Section 13015. In order to receive registrations it takes only a standing letter that says the individual is working in the substance use disorder field. After this registration, a person has two years in which they are supposed to get licensed or certified. It is within this time frame that people may or may not stay in the field, which causes attrition within work environments.