California Licensure Requirements - Substance Abuse

[abovewaterlevel]

Hi All,

I'm new to the forum. I found out last week that I'll be relocating to California from the midwest! I'm very excited about the move, but it looks like I'll need to take a dedicated substance abuse course in order to get licensed as a psychologist in CA.

Does anyone have any recommendations for inexpensive ways to take the course and get credit for licensure?

Thanks!

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[Therapist4Chnge]

I believe it is offered online by at least a few different places. While I am completely against online training....this is purely a way to squeeze a few more $'s from applicants, so go with whomever is cheapest.

 

[Pragma]

I believe it is offered online by at least a few different places. While I am completely against online training....this is purely a way to squeeze a few more $'s from applicants, so go with whomever is cheapest.

I don't think many psychologists get adequate training in the area of substance abuse. One dedicated course as a requirement does not seem like milking $s, in fact it seems like an extremely lax requirement. Just sayin'

 

[abovewaterlevel]

The substance abuse requirement is much less lax than some of the other classes they require (I've bought four online for $400 total). As for substance abuse, I'm not coming up with anything that cheap. It looks like Argosy has something offered online, but it's a few thousand bucks.

 

[Therapist4Chnge]

I don't think many psychologists get adequate training in the area of substance abuse. One dedicated course as a requirement does not seem like milking $s, in fact it seems like an extremely lax requirement. Just sayin'

They are the only (or one of a few?) states in the country that requires it for licensure. I'd hope students were trained to address substance abuse during their training.

 

[Pragma]

They are the only (or one of a few?) states in the country that requires it for licensure. I'd hope students were trained to address substance abuse during their training.

I suppose it is just a general commentary on training in the area. Outside of psychologists that specialize in addictions, I haven't been impressed with the knowledge about substance use disorders among psychologists I have met. Sometimes the worst stigma I've seen comes from folks in the field. But I suppose you could argue our training might not be adequate in any area without specialization.

 

[wigflip]

I suppose it is just a general commentary on training in the area. Outside of psychologists that specialize in addictions, I haven't been impressed with the knowledge about substance use disorders among psychologists I have met. Sometimes the worst stigma I've seen comes from folks in the field. But I suppose you could argue our training might not be adequate in any area without specialization.

I realize I should tread lightly here since I'm not (currently) in a clinical field but rather in a research-only doc program, but the above bolded statement makes me really uneasy. It actually reflects my experience in my former masters program--people who didn't specialize in my areas disseminated some really problematic ideas about them (including "let's do couples counseling for domestic violence!"). At the time I thought it was a pitfall of masters-level training. Now I'm less sure.

 

[Psychadelic2012]

Oh, it definitely happens in doctoral-level training! APA-accredited training is, by design, generalist. It can certainly be a mish-mosh of people who have different specialities and who are also acculturated to be well-spoken about every issue.

 

[thewesternsky]

I realize I should tread lightly here since I'm not (currently) in a clinical field but rather in a research-only doc program, but the above bolded statement makes me really uneasy. It actually reflects my experience in my former masters program--people who didn't specialize in my areas disseminated some really problematic ideas about them (including "let's do couples counseling for domestic violence!"). At the time I thought it was a pitfall of masters-level training. Now I'm less sure.

Actually, this question is still being debated in the literature, and there's some evidence that conjoint therapy for mild to moderate domestic violence (especially if the violence is bidirectional, which is quite common) is appropriate and beneficial with appropriate safeguards. That said, I'm not sure your colleagues were familiar with that literature.

 

[Pragma]

I realize I should tread lightly here since I'm not (currently) in a clinical field but rather in a research-only doc program, but the above bolded statement makes me really uneasy. It actually reflects my experience in my former masters program--people who didn't specialize in my areas disseminated some really problematic ideas about them (including "let's do couples counseling for domestic violence!"). At the time I thought it was a pitfall of masters-level training. Now I'm less sure.

Well I doubt any training program is perfect, but hopefully folks have a strong enough understanding of where their competence is limited. I would never try to do couples therapy or work with a child with autism, for example, because I am not competent in those areas.

With addiction in particular though, I think there is a systemic training problem. Most people with substance abuse issues have some other type of mental health problem, yet I hear psychologists make statements that don't even reflect the current evidence about etiology and personal responsibility. There is also a very poor lack of understanding about what approaches to treatment are available and various social support groups (news flash: AA isn't the only thing out there - there are groups considered to be more appropriate for women or people who have experienced trauma).

It's just sad - it is like unless you actually have worked with this population, or at least visited a treatment center or attended 12-step meetings on your own, your only real understanding of what the culture is like will be from a) what you got in your psychopathology course and/or b) from your own personal experience.

Actually, this question is still being debated in the literature, and there's some evidence that conjoint therapy for mild to moderate domestic violence (especially if the violence is bidirectional, which is quite common) is appropriate and beneficial with appropriate safeguards. That said, I'm not sure your colleagues were familiar with that literature.

Yeah, I recall reading a paper about BCT indicating that it was a helpful intervention for reducing both drinking and domestic violence. But if i remember right, there couldn't have been any severe episodes of violence in the recent past in order for a couple to begin.

Aside from maybe an intervention with some evidence for efficacy, I'm right there with wigflip in saying that it is a ridiculous notion. I do fault training programs to some extent, because there should be more of an emphasis on potential iatrogenic effects and evidence when it comes to intervention selection. Not saying that all psychologists don't do this - but i am sure we all know some people who just seem to pick an intervention without putting much thought or research behind it.

 

[Therapist4Chnge]

With addiction in particular though, I think there is a systemic training problem. Most people with substance abuse issues have some other type of mental health problem, yet I hear psychologists make statements that don't even reflect the current evidence about etiology and personal responsibility. There is also a very poor lack of understanding about what approaches to treatment are available and various social support groups (news flash: AA isn't the only thing out there - there are groups considered to be more appropriate for women or people who have experienced trauma).

Comorbidity is definitely an elephant in the room, though there is a more dangerous animal in the room...the Competency Crocodile ( ). There are SO MANY different providers out there who don't know what they don't know about the actual literature and real outcomes of various treatments. There are also many alternative programs out there (Rational Recovery, SMART Recovery, Harm Reduction, etc), though they often aren't seen as a first-line response.

 

[Pragma]

Comorbidity is definitely an elephant in the room, though there is a more dangerous animal in the room...the Competency Crocodile ( ). There are SO MANY different providers out there who don't know what they don't know about the actual literature and real outcomes of various treatments. There are also many alternative programs out there (Rational Recovery, SMART Recovery, Harm Reduction, etc), though they often aren't seen as a first-line response.

Yeah, IMO a psychologist should be familiar with all of the alternatives and try to match the patient with something they are comfortable with. Even if they work at a place with a particular orientation, they ought to be able to refer elsewhere if they think it is a poor match. I doubt a lot of psychologists even know what some of these alternatives are though - or on the other end of the spectrum, they are so committed to harm reduction that they aren't able to adequately advise regarding abstinence-only approaches.

The historical division of MH and SU providers doesn't help matters, but I think if psychologists don't beef up the emphasis here, it will be MA level addictions counselors doing most of this work in the long term.

 

[cara susanna]

In our training, we're pretty much given the understanding that we're not competent at treating addictions and we should refer a client who needed addictions counseling.

 

[JeyRo]

https://www.psychceu.com

BTW, I've used these guys before. They're relatively cheap and they offer a substance abuse class that appears to satisfy prelicensure requirements (might want to double check). Way back when, I did my prelicensure class face to face at a local bay area university.

 

[Pragma]

In our training, we're pretty much given the understanding that we're not competent at treating addictions and we should refer a client who needed addictions counseling.

Well, that's one way to handle it! I actually have heard of that happening a bit, but I don't think most programs treat it that way.

 

[wigflip]

Yeah, I recall reading a paper about BCT indicating that it was a helpful intervention for reducing both drinking and domestic violence. But if i remember right, there couldn't have been any severe episodes of violence in the recent past in order for a couple to begin.

Aside from maybe an intervention with some evidence for efficacy, I'm right there with wigflip in saying that it is a ridiculous notion. I do fault training programs to some extent, because there should be more of an emphasis on potential iatrogenic effects and evidence when it comes to intervention selection. Not saying that all psychologists don't do this - but i am sure we all know some people who just seem to pick an intervention without putting much thought or research behind it.

Look at us, Pragma, agreeing all over the place!

My understanding is that the studies showing "bi-directionality" in DV are using measures like the Conflict Tactics Scale, which, if you'll pardon the pun, divorce any episodes of violence from the context in which they occur, or the consequences of any violence. So self-defense appears as violent reciprocity. So if you break my jaw, and in response I pound my little fists on your chest, hurting you not at all--guess what? Bidirectional violence. Feminists say: boo.

 

[wigflip]

In our training, we're pretty much given the understanding that we're not competent at treating addictions and we should refer a client who needed addictions counseling.

I'm not saying this is inappropriate (or that there's anything wrong with your program in particular, cara)--if you're not trained in X you should refer to someone who is--but I'm mystified that uni-based doc programs aren't providing adequate training such that any psychologist can effectively treat something with the prevalence rate of addictions.

 

[cara susanna]

Yeah, one of my professors hated that view and gave us information (manuals and articles) on a few interventions for substance abuse. Haha.

On the subject of DV and couples' counseling, even if research indicates that it might be helpful if the DV is "mild" (whatever that even means), I personally would not feel comfortable providing it in that particular context.

 

[wigflip]

On the subject of DV and couples' counseling, even if research indicates that it might be helpful if the DV is "mild" (whatever that even means), I personally would not feel comfortable providing it in that particular context.

 

[Ollie123]

On the original topic, I find requiring "coursework" at that level of specificity to be a bit ridiculous. I haven't taken a course in substance use and would strongly object to being required to take one for licensure given its my specialty area and I'm probably qualified to teach one at this point. I'd hope competency can be proven in other ways besides coursework - one of the big reasons I favor the direction PCSAS is going over APA for accreditation is their focus on outcomes rather than input.

I'd heard that many many years ago, Alan Marlatt was required to take a course in substance use to get his licensure and/or some certification. The course used his textbook. I'd hope that encouraged some policy reform.

 

[cara susanna]

That is absolutely hilarious, Ollie.

 

[Psychadelic2012]

On the original topic, I find requiring "coursework" at that level of specificity to be a bit ridiculous. I haven't taken a course in substance use and would strongly object to being required to take one for licensure given its my specialty area and I'm probably qualified to teach one at this point. I'd hope competency can be proven in other ways besides coursework - one of the big reasons I favor the direction PCSAS is going over APA for accreditation is their focus on outcomes rather than input.

I was just thinking to myself, what good is coursework anyway? Our program has one course in chemical dependence--that's it So, even if you add another class or some manuals, I still think it's not good enough. As someone with specialized addictions training AND experience (sub-doctoral level, of course), I think every psychologist needs to have a practical experience with that population. You can't learn that stuff in a course or a book--the lies, the manipulation, the lifestyle. You really only get it when you see it day in and day out. Then there's also the specialized paperwork and classifications. It really rattles my bones to see inexperienced or unexposed clinicians discussing substance abusing clients, because they seem so naive. You really don't know what you don't know, and when you do know, the idea of it all scares the s*** out of you!!

 

[Pragma]

I was just thinking to myself, what good is coursework anyway? Our program has one course in chemical dependence--that's it So, even if you add another class or some manuals, I still think it's not good enough. As someone with specialized addictions training AND experience (sub-doctoral level, of course), I think every psychologist needs to have a practical experience with that population. You can't learn that stuff in a course or a book--the lies, the manipulation, the lifestyle. You really only get it when you see it day in and day out. Then there's also the specialized paperwork and classifications. It really rattles my bones to see inexperienced or unexposed clinicians discussing substance abusing clients, because they seem so naive. You really don't know what you don't know, and when you do know, the idea of it all scares the s*** out of you!!

I don't think that one course solves the problem, but I do think that some kind of a training standard would be helpful. I also consider myself a specialist in addictions, and most of my training came from running research subjects and my own curiosity/advocacy efforts in the community. But had I been in a different lab or not done a lot of extra work to understand the complex landscape of what's out there, I would not consider myself competent based on training alone. We come across it in subspecialties like neuropsych or rehab a lot, but usually it is one of multiple issues (e.g., organ transplant, dementia, etc).

But, one class is at least a start. But I'd agree (as someone who has taught those classes), it isn't enough.

I think addiction is a widespread enough issue to warrant more attention in our training programs. Otherwise, we ought to just leave it to other people who specialize. What scares me is new practioners with little exposure providing subpar or even harmful care. In many employment situations for new psychologists, the financial motivation to refer elsewhere is zero. That's not good.

 

[Therapist4Chnge]

The historical division of MH and SU providers doesn't help matters, but I think if psychologists don't beef up the emphasis here, it will be MA level addictions counselors doing most of this work in the long term.

Some of the best addiction clinicians I know have moved into administration positions (and/or research) bc most residential/in-pt places won't pay for them when there are much cheaper options. They develop the interventions, validate them, and then pass them on to others to do; at some level that doesn't make sense.

So if you break my jaw, and in response I pound my little fists on your chest, hurting you not at all--guess what? Bidirectional violence. Feminists say: boo.

I have treated some women who REALLY laid a hurtin' on their sig other (male & female), though I know that is in the vast minority (even after estimating for non-reported instances bc the men are embarrassed). All violence is not created equal.

 

[Ollie123]

I don't think that one course solves the problem, but I do think that some kind of a training standard would be helpful. I also consider myself a specialist in addictions, and most of my training came from running research subjects and my own curiosity/advocacy efforts in the community. But had I been in a different lab or not done a lot of extra work to understand the complex landscape of what's out there, I would not consider myself competent based on training alone. We come across it in subspecialties like neuropsych or rehab a lot, but usually it is one of multiple issues (e.g., organ transplant, dementia, etc).

But, one class is at least a start. But I'd agree (as someone who has taught those classes), it isn't enough.

I think addiction is a widespread enough issue to warrant more attention in our training programs. Otherwise, we ought to just leave it to other people who specialize. What scares me is new practioners with little exposure providing subpar or even harmful care. In many employment situations for new psychologists, the financial motivation to refer elsewhere is zero. That's not good.

Oh I would fully agree with this. Indeed its widespread enough I'd argue its one of those things every clinician needs to be at least somewhat familiar with. Obviously not everyone will encounter pts with high levels of dep. who need inpatient treatment just to survive withdrawal, but I worry a great deal if clinicians aren't prepared to address "problem use"/abuse since I think its a missed opportunity to address something that could well escalate. Treating the comorbid dx isn't always (or even most of the time) going to be sufficient.

I just disagree with courses being a useful way to determine competency. I think some of our grads have had some minor issues with licensure in NY, which I believe requires a cultural diversity course. Its fused into all of our core curriculum, the department does everything possible to make sure we see a diverse caseload through the dept clinic and various practicums, but not everyone takes the optional diversity seminar (I didn't). Yet I'd wager that were an outcome-based assessment used, our students would have no problems doing as well or better than the average student who had completed such a course. I also disagree with CEUs because evidence has shown the way the vast majority our run will have absolutely no beneficial effect on end outcomes (i.e. improved practice). The issue is that these things are clearly politically motivated - someone wanted to create the illusion of addressing the problem, without actually investing the time/money needed to address the problem. If we're gonna do it, let's at least find a way to do it well.

 

[DocRacz]

Abovewaterlevel, I am a California transplant out to the Midwest, looking to go back to California - any chance you could PM me about the classes you took to fulfill CA licensure requirements? I would appreciate it very much!

 

[paramour]

Oh I would fully agree with this. Indeed its widespread enough I'd argue its one of those things every clinician needs to be at least somewhat familiar with. Obviously not everyone will encounter pts with high levels of dep. who need inpatient treatment just to survive withdrawal, but I worry a great deal if clinicians aren't prepared to address "problem use"/abuse since I think its a missed opportunity to address something that could well escalate. Treating the comorbid dx isn't always (or even most of the time) going to be sufficient.

I just disagree with courses being a useful way to determine competency. I think some of our grads have had some minor issues with licensure in NY, which I believe requires a cultural diversity course. Its fused into all of our core curriculum, the department does everything possible to make sure we see a diverse caseload through the dept clinic and various practicums, but not everyone takes the optional diversity seminar (I didn't). Yet I'd wager that were an outcome-based assessment used, our students would have no problems doing as well or better than the average student who had completed such a course. I also disagree with CEUs because evidence has shown the way the vast majority our run will have absolutely no beneficial effect on end outcomes (i.e. improved practice). The issue is that these things are clearly politically motivated - someone wanted to create the illusion of addressing the problem, without actually investing the time/money needed to address the problem. If we're gonna do it, let's at least find a way to do it well.

I admit that I could be mistaken here, but does the APA not require a diversity course/seminar? Our dept requires everyone take one, and their rationale was that it's required to be accredited (or at least this is what I heard)... so I sort of thought everyone was doing the same.

 

[paramour]

In our training, we're pretty much given the understanding that we're not competent at treating addictions and we should refer a client who needed addictions counseling.

Well, that's one way to handle it! I actually have heard of that happening a bit, but I don't think most programs treat it that way.

Our program treats the same way. We receive absolute zilch in addictions training and automatically refer anyone beyond the occasional pot smoker out ASAP. There are some other presenting clinical issues that are referred out immediately as well.

I lucked out one semester because I managed to have a clinical supervisor who had some addictions experience. The clinic director opted to give the supervisor final say over whether or not I was allowed to keep a few clients outside of our usual acceptance policies. After that supervisor left, it was back to business as usual. Automatic referrals.

 

[Ollie123]

I admit that I could be mistaken here, but does the APA not require a diversity course/seminar? Our dept requires everyone take one, and their rationale was that it's required to be accredited (or at least this is what I heard)... so I sort of thought everyone was doing the same.

I also may be wrong, but I believe APA says something like "Coursework must include coverage of diversity issues" or something that is slightly more vague. We have a two-semester sequence that combines diversity, professional issues, and some other things together in addition to diversity issues being fused into some other courses (e.g. our psychopathology course).We were just re-accredited for the full time so apparently APA is okay with that approach too. The issue was more with NY or some other state that had weirdly specifically-worded licensure laws and the board needed prompting to do more than just look at the course titles.

 

[paramour]

I also may be wrong, but I believe APA says something like "Coursework must include coverage of diversity issues" or something that is slightly more vague. We have a two-semester sequence that combines diversity, professional issues, and some other things together in addition to diversity issues being fused into some other courses (e.g. our psychopathology course).We were just re-accredited for the full time so apparently APA is okay with that approach too. The issue was more with NY or some other state that had weirdly specifically-worded licensure laws and the board needed prompting to do more than just look at the course titles.

Ahhh, now I see. This makes sense. I *think* our dept tries to cover diversity issues in most courses, but they also have it dedicated to be covered more in-depth specifically within one course. So they combined "multiculturalism/diversity" in with another course for the semester. For a while, they were covering it with ethics (half semester ethics; half semester multiculturalism/diversity); now it's been changed into our semester course on professional issues in supervision, consultation, and multiculturalism/diversity. I'm oh, so lucky to have gotten in both as I was present for the change.

EDIT: Then we also have a "multiculturalism/diversity" experiential component that we must fulfill every semester until we successfully propose our dissertation.

 

[voyeurofthemind]

Comorbidity is definitely an elephant in the room, though there is a more dangerous animal in the room...the Competency Crocodile ( ). There are SO MANY different providers out there who don't know what they don't know about the actual literature and real outcomes of various treatments. There are also many alternative programs out there (Rational Recovery, SMART Recovery, Harm Reduction, etc), though they often aren't seen as a first-line response.

Thanks you! For giggles I was looking through the Psychology Today listings of therapists in the area and reviewing the areas that many clinicians claimed to treat - everything under the sun from child behavioral disorders to OCD to eating disorders. No way could one clinician really have competency in the 20+ areas I saw them claim. It irked me. My 0.02.

 

[AcronymAllergy]

I also may be wrong, but I believe APA says something like "Coursework must include coverage of diversity issues" or something that is slightly more vague. We have a two-semester sequence that combines diversity, professional issues, and some other things together in addition to diversity issues being fused into some other courses (e.g. our psychopathology course).We were just re-accredited for the full time so apparently APA is okay with that approach too. The issue was more with NY or some other state that had weirdly specifically-worded licensure laws and the board needed prompting to do more than just look at the course titles.

I'd thought APA was now actually requiring an explicit diversity course, but I could be wrong. Might be one of those situations where they require a separate course unless the program can provide support that the information is sufficiently covered in other courses.

We had one that began becoming required right about the time I started grad school (along with ethics as well), although that might've been due more to an attempt to universally meet licensing board requirements than to anything APA had said.

 

[cara susanna]

My program has a diversity course.

 

[Pragma]

Thought I would share this relevant article I came across addressing addiction training within APA accredited programs. Interesting stuff...less than one third of programs offered a course in this. Certainly is congruent with my observations of poor understanding of addiction issues among psychologists not engaged directly in this type of work.

http://informahealthcare.com/doi/abs/10.3109/16066359.2012.712731