Did you know that most addiction treatment specialists have little formal education or training in addiction? Fourteen states require only a high school diploma or a GED to become an addiction counselor; 10 require only an associate’s degree.
But it gets worse — fully 20 states in the U.S. don’t require any degree, or don’t even require addictions counselors to be certified or licensed in any way.
Is it any wonder then that many addiction or rehab programs still rely on an outdated model that’s directly dependent upon how long companies are typically reimbursed for treatment — 30 days? Or that many programs still use treatment methods largely unchanged from the 1950s — not research-backed, modern approaches to treatment?
A groundbreaking report published last year from Columbia University lays out the sad facts of addiction treatment in the U.S. As the report notes, “Some [treatment programs] promise “one time” fixes; others offer posh residential treatment at astronomical prices with little evidence justifying the cost. Even for those who do have insurance coverage or can pay out-of-pocket, there are no outcome data reflecting the quality of treatment providers so that patients can make informed decisions.”
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Thoughtful post. I read Brody’s piece in the NYT and had some of the same thoughts you did.
There are a number of addictionologists who blog here at PT, both Ph. D. level and Masters level people. I suspect they will join this discussion shortly.
There are a few problems with addiction treatment services beyond the training of clinicians in the field. The first is the specialty of addiction psychiatry has perverted the basic premise of what is true among the addiction population: it is still true that about 50% of addicts have real comorbid mental health diagnoses. But no, for the specialty to thrive and control the literature, it is imperative that people not only believe, but accept in care interventions that over 80% have this comorbidity. So, we see more people overdiagnosed and mistreated, and in my opinion, adding to the risks of relapse by the very psychiatric meds that should allegedly lower the risk.
Second, why is it the importance of NA and AA meetings, sponsors, and being in groups with fellow addicts is more minimized these days, and demanding that recovery first be involved in rehabs or intensive outpatient programs ALONE? Again, there is money to be made first, and oh, maybe sizeable care interventions to be made second?
Third and last, even with addiction itself, we are seeing more pushes for medication interventions as primary treatment causes. What does that sell, that addiction is solely a biochemical imbalance alone? Umm, what have we learned with that model in psychiatry already? Oh, and who are the ones most qualified to provide these meds? Those psychiatric specialists again.
Also, why is psychiatry the primary and only field to have to work with addiction? I don’t get this. I am not saying psychiatry has no place in addiction care, but, why is it fairly much dumped on us as the only discipline to intervene?
I mean, if it is a biochemical model of cause, then there are plenty of medical interventions that could involve lots of other health care specialties to effectively intervene and improve remission rates. But, it seems to involve spending time, money, and energy to provide this. Don’t see what composes most of medical care interested in spending MORE time with patient care these days.
Do you?
I find the lack of professional education hard to believe. I’m in the field with a master’s degree and certs. Most states have a lot of demands to work in the field and review records and employee training a lot. Community agencies have to comply with strict standards to get meager funds. I’d like to know which states are still giving professional level jobs to recovering people with GEDs. This doesn’t sound valid.
Here clients in treatment are made to submit to periodic UAs (urinalysis tests). What other kind of therapy would require such a thing? Why couldn’t they go to treatment and still smoke pot occasionally? The important thing is to get better and use or drink less. And to have rapport with the counselor? The treatment model relates more to criminal justice than to social work or other forms of client-based therapy.
co-author of Addiction Treatment: A Stengths Perspective
It is interesting that we keep requiring more and more education to be in this field. I have observed professionals in the field for 27 years. Those without masters degrees are applying the researched methods as consistently as those who do. The certified staff have training on a regular basis and implement best practice. This field requires a desire to work with people with additions. I have heard many Mental Health professional say, “I don’t want to work with those people. They are hard to work with”. A Masters degree does not equal care or professionalism.
The salary in this field is low. I would not want to have college debt and have to pay it off while working in the additions field.
I believe the field of additions could loose some professional, experienced, effective practioners with requirements for more and more degree requirerments.
Thank You, for adding to the sterotypes/myths about Chemical Dependence (not addiction) treatment in the US. It is true that some (not all states) do not require master degree’s for clinicians. However, that does not indicate that those folks are not required to have a certain amount of Alcohol/Drug Specific Education Hours, along with (in some cases) thousands of supervised hours prior to being allowed to practice as a Substance Abuse/Chemical Dependence Counselor. Oh and by the way I am in the process of completing my education (currently have 170 college credits), which has provided less AOD Specific Education as compared to the hundreds of hours of trainings/CEU credits I have recieved over the last 5 years as a Nationally Certified Alcohol and Drug Counselor and a NAADAC/NCAC Level I Certification.