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Is it any wonder then that many addiction or rehab programs still rely on an outdated model that’s directly dependent upon how long companies are typically reimbursed for treatment — 30 days?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.”
These eye-opening facts come from a report published last summer by the National Center on Addiction and Substance Abuse at Columbia University. The New York Times has the story, including noting that one of the most popular myths about effective addiction treatment is that you have to go to an addiction or rehab center in order to be treated:
“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.
Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”
Just over 43 percent of addiction treatment spending is spent at those specialty addiction treatment centers — the ones that inevitably discharge patients after 30 days, whether they’re successfully treated or not. That’s the biggest chunk of the addiction spending pie.
Successful addiction treatment is difficult — just 42 percent of those who seek out treatment for addiction complete it. That’s not surprising given the characteristics of addiction, and the fact that more often than not, an actual addictive substance is involved. But a system that focuses on evidence-based treatments could do a better job and substantially increase that number.
This profound gap between the science of addiction and current practice related to prevention and treatment is a result of decades of marginalizing addiction as a social problem rather than treating it as a medical condition. Much of what passes for “treatment” of addiction bears little resemblance to the treatment of other health conditions.
Much of what is offered in addiction “rehabilitation” programs has not been subject to rigorous scientific study and the existing body of evidence demonstrating principles of effective treatment has not been taken to scale or integrated effectively into many of the treatment programs operating nationwide.
Addiction treatment in the U.S. is yet another orphan system in the overall health care system — kind of like the mental health system’s little, sometimes neglected brother. One of the report’s recommendations is to bring the addiction treatment system into the larger mainstream health care system — mainstream it, if you will.
That’s a recommendation I can get on board with. Effective addiction treatment needs to be brought out into the spotlight in order to highlight what research shows actually works and is effective. We’ll highlight some of those findings in the coming months.
Read the full New York Times article: Effective Addiction Treatment
12 comments
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.
Yup! I agree with you guys that there is a problem with addiction treatment services due to those addicted people get suffered. There should be certified centers & well certified doctors, which have get their degree from well known university.
I agree with your information.I am fond of reading useful posts like yours.The treatment system needs to be changed.Medical meetings on addiction needs to be organized by professionals.Surveys should be conducted on time.The most important is to consult best professionals for treatment who can guide the best treatment therapies and strategies to overcome addiction.
You make some great points in your article. The primary modality used in addiction treatment, today, is the 12-step program, which is clearly a failed approach. Although, many of the methods used by licensed clinicians are not necessarily effective either. I would say that Multi-dimensional family therapy probably comes closet to hitting the mark. However, there are some holes in that approach as well. If we are to dramatically reduce addiction, we begin to address the root causes and issues.
While I don’t necessarily disagree that 12-step programs are a failed approach, 12-step Facilitation Therapy is considered an evidence-based practice according to SAMHSA’s National Registry of Evidence-based Programs and Practices. I’m just saying…. (NREPP)http://nrepp.samhsa.gov/AdvancedSearch.aspx
I think there is a lot of truth in this article but that recovery is not an exact science. Academic knowledge does not always make a great practitioner. Compassion and empathy are not someone you learn in school. I think the path to recovery is also highly individualized. I didn’t resonate with the 12 step model, although I appreciated the support community, the ability to share my story, and picked up tidbits of practical wisdom at every meeting. I personally didn’t need any help whatsoever to stop using. I was sober for 3 months before developing severe Post Acute Withdrawal Syndrome which led to depression and anxiety. I want to a residential program for 90 days to help me through that and it saved my life. I received excellent medical and psychological care from professionals, but the counselors and program director didn’t have more than basic certification, and just their compassion, personal experience, and support meant a world of difference. Furthermore, I had no insurance, and they created a way for me to get the help I needed at no cost, in exchange for service work after I recovered. The people at Bodhi Addiction and Wellness in Santa Cruz, CA (bodhiaddiction.com) got me placed in the program which saved my life. That was my experience. There were people there who absolutely could not get clean without inpatient treatment, and people there who couldn’t stay clean even with all the help in the world. I met people who sweared by 12 steps and those who thought it was bs. While the system as a whole might be fragmented and broken, there are still places in this world who truly put people first and money second, and can provide excellent, effective care regardless of academic training.
I am just a mother who went through addiction with my husband, and after separation raised my 2 children alone and broke. My son, who became an addict suffered several painful years, 3 rehabs, and finally put him on subs. over 2 years on subs. The treatment is way to expensive, not many have the money, he is stable, working, satisfied but I don’t ever see him getting off subs. His choice of drugs was heroin and pills. Its not only getting sober, its trying to find a life and a job after a drug record of 7 years, no one would hire him with a background check. I believe with the information here. I had to deal with it without insurance, although prayers were involved, all most moms say is “give it to God, or I’ll pray for you”. Sorry but that was never enough. His sub doctor never gives him psyshological treatment which I believe is so important. Its just the money he wants. Many have inner physological problems that need to be addresed. Again, no money to pay for it. Its like living a nightmare alone, people look down on him and me. No one has truly isolated a correct treatment to help them have a “future”. I could talk for days but will thank you for reaching out, new options are needed. I only watch it all, my son lives it. Alone, scared, addicted, he once said to me, “I may be an addict but I still have a heart that feels and breaks.” Will stop at that. Thanks.