Addiction treatment article

[Qwerk]

http://healthland.time.com/2012/06/...erica-not-based-on-science-not-truly-medical/

Not surprising if you've ever worked in or around (or within ten miles of) addiction treatment. Extremely non-standardized.

From the linked article:

Only six states require addiction counselors to have a minimum of a bachelor's degree; just one requires a master's degree, according to the CASA report. The main qualification for treating addiction in this country is having suffered from the disorder oneself — a standard of care that would be considered absurd if any other medical condition were involved.

I've always found it strange that addiction centers allow unlicensed, uncredentialed, untrained staff to provide counseling and treatment. These people might make great client advocates or peer advisors, but treatment providers?

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[wigflip]

I've always found it strange that addiction centers allow unlicensed, uncredentialed, untrained staff to provide counseling and treatment. These people might make great client advocates or peer advisors, but treatment providers?

I'm not trying to pick a fight here, but what do you see as the difference between allowing "unlicensed, uncredentialed, untrained staff to provide counseling and treatment" and allowing first year social work* students to begin practicums/internships where they are providing counseling and treatment** concurrent with beginning first year coursework? You're neither trained, nor licensed, nor credentialed after only a couple of weeks of classes.

*I mention social work and not MFT here because the MFT programs in my area appear to require some completed coursework prior to beginning internship, but that may not be the case everywhere.

** Yes, in theory first year social work students would receive training and supervision at the site, but a) some paraprofessional counselors also receive this and b) we both know that not all fieldwork sites provide quality training/supervision, regardless of what is required.

 

[Qwerk]

I actually agree with you this time, with the caveat that the work that first-year students do is not usually on par with the work that addiction counselors do. Lots of supervision, lots of training, much less clinical work. From what I've heard from my cohort -- and it's probably not the same at every school -- first-years typically do things like case management and/or group co-facilitation to get experience in individual and group work without being overwhelmed, with the clinical experience coming in the second-year practicum. What individual counseling I did in my first year was more in the line of "What college should I go to?" or "How can I get supplemental food?" than anything particularly clinical.

I do agree, though, that throwing inexperienced students (some of whom don't come from social work/psych backgrounds) into clinical work without training or adequate supervision is potentially harmful. Alas, there's nothing about this in the CSWE educational standards.

 

[wigflip]

I actually agree with you this time,

Boy Qwerk, this is getting scary!

 

[Qwerk]

Boy Qwerk, this is getting scary!

I hear the Twilight Zone music in the background...

Now to get to that process recording...grumble grumble 1200 hours of unpaid servitude grumble...

 

[Pragma]

The main qualification for treating addiction in this country is having suffered from the disorder oneself — a standard of care that would be considered absurd if any other medical condition were involved.

You don't have to be in recovery yourself to be an addictions counselor. But I'd wager that the majority of addictions counselors are. The nature of the problem certainly contributes to this pattern. People generally get better support from similar others (a la 12-step programs) and a counselor is also likely to have more credibility with their clients if they have their own personal recovery story.

But there are counselors that aren't in recovery. It is one of those individual/treatment fit variables, IMO. In particular, treatments that aren't based on 12-step or other abstinence-only orientations may be a common setting.

The overall point fo the article is frustrating though. I thought most states would require some form of licensure (which is the way it is where I live).

 

[Qwerk]

You don't have to be in recovery yourself to be an addictions counselor. But I'd wager that the majority of addictions counselors are. The nature of the problem certainly contributes to this pattern. People generally get better support from similar others (a la 12-step programs) and a counselor is also likely to have more credibility with their clients if they have their own personal recovery story.

The main thing that concerns me is that addiction centers seem to have made the leap from "people who have been in recovery should be involved in addiction treatment" to "people in recovery should be the primary clinicians involved in the treatment process, regardless of whether they have graduate-level training."

A friend of mine used to run an alcohol and drug treatment center with her husband. Not only did she have little training (not even a B.A.), I never, ever saw her without smelling alcohol. This is an extreme case, but the lack of regulation in addiction treatment in general is startling.

 

[Tarasaurusrex]

Just a thought, but perhaps former addicts get a "high" from being around addicts? For example they get a placebo effect from witnessing others' symptoms, or even they just become reminded why they don't use. I think there is a drive for an addict to be surrounded by addicts, because they are no longer part of that exclusive group of current users, but also don't exactly fit in with those who've never used.

Why they are allowed to treat, I am unsure, but I would hazard a guess that addicts feel more comfortable confiding in a former addict, than a trained professional that has only theoretical experience.

 

[BlackSkirtTetra]

Do you think that a small part of the reason so many addiction counselors are in recovery is because addiction is so widespread?

I'd wager than a large percentage of nail technicians, bakers, and auto shop employees are also in recovery. Not as high as those who go into addiction counseling, of course, but it's not negligible, either.

In regards to allowing first-year MSW or MFT students to provide counseling, I see this as an unfortunate-but-institutionally-necessary way to get free labor, and nothing more.

 

[Lil Mick]

I agree that all health professionals should have education before practicing. However, medical assistants, as well as other medical technicians, don't typically have a bachelor's degree, either. Perhaps those with less education in this field could serve in that sort of a role, rather than as a primary caregiver. (Some VA programs have peer counselors doing that sort of work.)

That being said, my personal experiences with treatment were that I felt a lot more comfortable and trusting with others in recovery than the doctors or PhDs who hadn't been able to fix me in previous types of drug treatment.