Sunday, July 19, 2009

The Changing Face of Addiction Counseling

Most addiction workers are no longer addicts themselves.

For years, addiction therapists and counselors tended to be people who had been addicts themselves. These days, not so much. Drug and alcohol counselors who have experienced addiction firsthand represent a dwindling slice of the addiction therapy community.

But does it matter? A recent study by William L. White for the Great Lakes Addiction Technology Transfer Center and the Philadelphia Department of Behavioral Health and Mental Retardation Services suggests strongly that it does not. The study, “Peer-based Addiction Recovery Support” (PDF), concluded that “Studies of addiction counselors in the United States have not found that addiction counselors in recovery are more or less effective than addiction counselors who are not in recovery....”

This is a good thing, if true, since the report also documents that the percentage of counselors in personal recovery within the “addiction workforce” has fallen from a high of almost 70 % in the early 1970s to about 30% as of 2008. It is unclear what is behind this trend, given that “studies of the personalities of recovering men and women working as addiction counselors reveal few differences from counselors without addiction recovery backgrounds.” White suggests that as the “educational levels of people in recovery have increased,” the perceived differences between counselors in recovery and those not in recovery “diminish or disappear completely.”

The bottom line for counselors: “The key determinants of effectiveness do not include recovery status.”

Nonetheless, White argues, attitudes toward workers in addiction treatment continued to be “plagued by misconceptions and stereotypes that are contradicted by most scientific studies. The prevailing view is that the majority of addiction counselors are in recovery; that most recovering counselors do not have college or advanced degrees; and that recovering counselors differ in their attitudes beliefs, knowledge, skills, and effectiveness” from counselors who have never experienced addiction.

Nowadays, as it turns out, none of these views is correct.

White’s paper also reiterated the sad fact that recovering addicts who work in addiction treatment “are paid less than people not in recovery for comparable work, even when their educational credentials are equal.”

Photo Credit: US No Drugs


Anonymous said...

I am a recovered codependent and alcoholic of 17 years as well as a former certified addictions counselor. Several years ago, addiction treatment moved from being an entity of it's own, to falling under the mental health umbrella. At that time, the majority of addictions counselors were in recovery themselves. When addiction treatment was moved to the mental health field, it was determined by the "powers that be" that addiction counselors would now have to obtain a bachelors degree as opposed to state certification and graduation from an accredited program, as I did.
What happened was that as counselors who were in recovery themselves left the field, they were replaced by people who had bachelors degrees, most of whom were not in recovery.
If I learn to speak Spanish, but have no familiarity with the Hispanic culture, I can speak the language, but may totally miss the point because I have no frame of reference. Just as a woman who has been pregnant can totally understand what another pregnant woman is going through, or as a soldier who has been in combat can understand another soldier who has just returned from the front lines, it is arrogant and ignorant for us to believe that people who have no personal experience with addiction can be as or more effective in working with this population. It is possible that someone who is not in recovery may be able to reach some addicts. Possible, not probable. The desperation, helplessness, shame, and guilt that accompanies addiction, let alone the overwhelming power the addiction has over most addicts is extremely difficult for most "normal" people to try to understand. I think it is shameful that addiction has become just another money-maker in the machinations of our American medical system.
I offer this observation in closing: if people who are not in recovery are so effective at helping addicts recover - why are programs that are primarily made up of people in recovery still working worldwide? Common sense folks. Common sense!

Dirk Hanson said...

You make a number of excellent points. I agree with all three comments above--I too was surprised that the study suggests that it doesn't effect outcomes. Like you say, common sense would seem to argue otherwise.

One way of looking at it would be to say that overall outcomes a year down the road are uniformly crummy, regardless of the quality of counseling.

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John said...

The addiction treatment system has many problems that go beyond issues of counselors' recovery status. I continue to believe we have very good people working in our treatment system, regardless of their recovery status, but they often struggle in systems they did not create. These systems have resulted in: 1) excessive paperwork, 2) turnover higher than in fast food industry, 3) low pay for very hard work and big case loads, and 4) focus on evidence-based interventions over treatment as an art. I have wrote about this more on my blog at:

Anonymous said...

It was heartening to read this article,however, as a degree qualified addictions counselor but NOT in recovery I have found it extremely difficult to find a counselor post. It seems that those who employ and are in recovery themselves are unwilling to employ a non-recovery person. I have experienced open discrimination as employers seem to have the attitude that one can't be a good addictions counselor without having experienced the full affects of addiction personally. Perhaps they should remember the saying that 'in order to be a good brain surgeon one is not required to have experienced the affects of a brain tumour!' Additionally I have witnessed employed counselors who are in recovery relapsing and thereby placing those in their care at risk - a situation that is unlikely to occur with a counsellor who is not in recovery.

Dirk Hanson said...

It would be nice to think that addiction treatment centers would wish to higher the most qualified candidates, regardless of addictive status.

It's a problem--if you preferentially hire ex-addicts, they know their own experience but it isn't always applicable to everyone. And they can slip, as you say. And if you preferentially hire non-addicts, than you miss out on the opportunity to have some people on staff with whom patients can directly identify.

Seems to me the best deal would be to have both kinds of counselors involved. I can think of several traits--empathy, communication skills, patience, experience--that seem more opportunity than addictive status.

Discriminating against qualified candidates because they are not addicts seems a bit short-sighted at this stage.

Anonymous said...

It is very short-sighted that agencies pass over qualified counselors for those in recovery. I am not saying that counselors who are not in recovery can't reach the addicts. I just believe it is not only easier for those in recovery, but that there seemed to be, in my experience, more clients that connected with those in recovery.
I have seen counselors who were not in recovery who seemed very passionate about their work and some in recovery who were less so. Seems to me that passion should carry for something.
Where I have seen counselors who are not in recovery shine, and where I believe there is an unbelievably enormous need, is in helping the codependent. This is a virtually untapped field who's issues, in my opinion, are at the very core of every addict I have worked with. We all share an affinity with these issues. On a personal level, this is my passion.

There are, unfortunately, plenty of addicts to go around. There is a place for you, Anonymous.
In this economy, as most of us know, the field of human services; addiction treatment specifically, usually suffers as funding is cut and facilities close. Just remember, "When the student is ready, the teacher will appear."

Anonymous said...

BTW John: I couldn't agree with you more about the many problems with the "system". You named them appropriately and I have personally experienced these so I am behind you one hundred percent!

Dirk Hanson said...

"In this economy, as most of us know, the field of human services; addiction treatment specifically, usually suffers as funding is cut and facilities close"

Too true. And it seems to me the current health care debate would be a perfect time to remind people how costly addiction can be, and how it is smart and humane, not to mention cheaper in the long run, to offer addiction treatment under a new health plan, if one comes to pass.

Anonymous said...

What is your idea, Dirk?

Dirk Hanson said...

I don't have any specific policy proposals, as public health is not my arena. But I was trying to think of specifics after reading a paper called "Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs," from the Open Society Institute:

Unforeseen Benefits.

Anonymous said...

I would like to see treatment become it's own entity again. But I doubt that will happen - at least not in the very near future.

Anonymous said...

I am an opiate addict who has attended several addiction treatment centers & programs. In California, I was given the option of treatment instead of jail/prison, under a law known as Prop 36. However, to be honest I am not really interested in living a 'spiritual" type lifestyle as promoted by the counselors, nor am I interested in attending 12 step meetings for the rest of my life. In my opinion, most of the other clients felt the same way as I, even though some had problems recognizing this truth or of being fully honest with themselves. I believe that this issue, more than any other, has to do with the abysmal success rates of these various programs. Though I loathe these types of programs & "faking it", I would even now still choose a program over jail/prison time if given the choice. I suspect most of the other "fakers" in these various programs would do the same. It is a shame that our society forces such choices on us, & that it criminalizes substance use. I personally look forward to the day when I can have the freedom to use the substance of my choice, to live in peace without fear of arrest or of having to spend months/years wasting time & money in programs that preach a lifestyle contrary to my values. It has been shown that "treating" drug offenders is cheaper than incarcerating them, but it is still expensive, especially when considering their low success rates. I do recognize that prop 36 type programs will probably be around for a while to come though, mainly because they are cheaper than incarceration. It is my guess that success rates for addiction "treatment" will remain low until such time as people are no longer "forced" or pressured into attending these programs without having a strong desire to quit using.

Anonymous said...

Dear Anonymous,
I truly appreciate your honesty. As a former addictions counselor, how refreshing it is to hear someone speak the truth - that you don't want to live a spiritual life and that you want to continue to use. I believe that punishment is the wrong approach. Unfortunately, our society offers only two choices, punishment or treatment.
I am aware of some alternative therapies that some people have reported success with in ending their addictions, but that doesn't sound like what you are looking for.
I would like to encourage you, however, to recognize your power in that, while you certainly don't like the two choices you are presented with, meaning punishment or treatment, that does not negate them as choices. It will empower you far more if you can consciously choose and then perhaps, spend some of your energy promoting a different choice. I don't know exactly what that might be, but the point I am trying to make is, don't make yourself a victim. If you don't like the choices and they are the only ones presented, choose consciously, and then move to promote a choice that you can get behind.
I wish you health, happiness, and success.

Dirk Hanson said...

I share some of your concerns about mandatory treatment. It can lead to an understandable tendency for some to fake their way through therapy programs of questionable value.

Anonymous said...

In my experience whether it be in my neighborhood, incarceration, or detox facilities, it matters a great deal to most "clients" whether the counselor was a recovering addict or not. In the addicts mind they feel the counselor who is in recovery "understands" what they have been through from this disease more than a counselor who hasn't. The client relates better and the counselor has more credibility. The example I see of "a brain surgeon doesn't need a tumor to work on someone's brain" philosophy is ridiculous at best. It is like a non gang member trying to convince a current gang member to leave the gang they're in because they read about the gangs history in a book. There is a reason why former gang members work with current gang members to get them help. I'm not saying a counselor that's not in recovery cant be effective but to say that it doesn't matter is wishful thinking. Only a soldier that has been in battle can fully relate to another soldier that was in a war/battle. I am all for disclosing to a client your recovery status if you feel it will help them make a connection or positively inspire them. Furthermore the at risk youth in my neighborhood that haven't responded to the upper middle class people the school provided to interviene have told me specifically that "them muthaf$$#!@ don't know sh?* about what we live in" because I asked them. I know for a fact that if the school brought in a successful person from the neighborhood who overcame the odds and made something of his life doing something legal they would listen. I know because again I asked. I am also 6 years sober and it made a difference to me knowing my counselor went through the Hell of addiction and could understand what being dopesick or "geeking" from crack was....thanks for the post and God bless.

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