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Commentary: State-Level Standards: The Substance Abuse Workforce After Healthcare Reform


As implementation of the Affordable Care Act (ACA) moves forward, states must ensure that people being treated for substance abuse are cared for by credentialed professionals.

All of us in the substance abuse treatment and prevention community have tracked the conception, birth and growth of the Affordable Care Act. Those who work with and as treatment and prevention professionals are no exception. Now, as treatment for addiction and abuse will be more accessible, the professionals who provide it must find a way to fit into the new world order.

Treatment for substance abuse is now mandated by the ACA, but to what degree remains to be determined. In addition, there is no simple answer for who will—or can—provide it. Policymakers who are “in the know” about substance abuse treatment, as well as substance abuse counselors, are a truly rare breed. It is also rather hard to find insurance executives with this knowledge. Add into the mix the recent curveball thrown by the Department of Health and Human Services, which will allow states to design their own essential health benefit package (rather than establishing a federal standard), combined with each state’s Medicaid system already wielding vast power under the law in terms of coverage and reimbursement, and the reimbursement waters cloud still further.

Many bodies responsible for reimbursement of health professionals look to whether a professional is licensed. In most health professions, and in most states, a license is contingent upon education in a specific pursuit. For instance, a doctor must attend an accredited medical school. Physicians, nurses, social workers, mental health counselors and many other health professionals are licensed by their respective states, or at least by bodies recognized by the state. Not every state offers licensing for substance abuse counseling, and many that do offer a license that can be obtained by virtue of a degree. Even in those states that do license substance abuse counselors, the education requirement is more often than not a degree in social work, psychology or other pursuit, with no guarantee that the licensed individual has been educated specifically in substance abuse counseling.

When setting standards for who can provide treatment, states need to look to a professional’s expertise. In the substance abuse treatment field, that is best judged by whether they are credentialed. Just as a doctor or nurse can be board certified in a specialty, a counselor can also be (and often is) certified. Not only are substance abuse counselors certified, but depending on the state, they can be certified in different specialties (for example, criminal justice, co-occurring disorders, prevention specialist) and at different levels (clinical supervisor, masters level, etc.). A very large majority of substance abuse counselors are certified by a state certification board that provides testing and standards of practice guidelines. As in any other medical specialty, a patient being treated for substance abuse or addiction may encounter different professionals with different degrees and different areas of expertise, no different than a cancer patient or HIV patient.

Those who have a stake in the treatment of substance abuse need to engage in advocacy at the state level to assure that consumers are treated by competent, educated professionals who have been trained in evidence-based practices. The days of policymakers who work off the assumption that a psychologist, social worker or even physician is competent to treat addiction by virtue of their degree must end.

As we move forward, we must illustrate that those in need of substance abuse treatment must be cared for by those trained in that pursuit, and these professionals must be compensated at a level worthy of their expertise. If Americans are to receive more competent, cost-efficient care, which is the whole point of the ACA, states would be wise to learn more about the highly trained, highly skilled workforce that provides substance abuse treatment to its citizens.

Andrew D. Kessler is IC&RC’s Federal Policy Liaison and Founder of Slingshot Solutions, LLC.

6 Responses to this article

  1. Avatar of Cretia
    Cretia / March 15, 2012 at 9:06 am

    As a Licensed Independent Chemical Dependency Counselor (LICDC) with 24 years experience, I have had harrowing experiences working along with untrained degreed professionals. On the other spectrum, being in recovery from addictions does not qualify as expertise in addictions counseling either. I have seen the worst of both. Unfortunately, and ultimately, it is our clients that suffer the consequences.

  2. Avatar of John French
    John French / March 5, 2012 at 3:32 pm

    As someone who has multiple college degrees, State and Nationally certified as an alcohol and drug counselor, interventionist and in recovery for 13 years I obviously believe in certification. I have worked with many counselors with Master’s degrees that just did not understand this disease as evidenced by comments such as referring to people with addiction as “those people”, but if we are counting on the ACA as being the savior, I think we are in deep trouble.

  3. Avatar of William Savard
    William Savard / March 4, 2012 at 4:18 am

    I am researching a retreat to help people with addiction problems, non 12 step. I would like to know what I can do to help.
    William A Savard Sr.
    Savard Companies
    1976 Wooddale Blvd
    Baton Rouge, La., 70806
    Main Office (225) 930 0685
    Private phone & FAX (225) 216 7222

  4. Jeff Kushner / March 2, 2012 at 4:19 pm

    As usual, no mention of the passion necessary and recognition of those people who have been there. Qualifications are necessary but lets find a way to recognize the passion, knowledge, and experience that recovering people possess rather than simply the book knowledge which doesn’t connect with most trying to find someone who can empathize with them and really help them get well.

  5. Luis / March 2, 2012 at 2:53 pm

    Still no proof the credentialed or licensed professionals achieve better results and outcomes when it comes to treating alcoholism and drug addiction. The only thing this will do is make treatment costly and unattainable by the vast majority of people who need treatment and recovery.

  6. Dave / March 2, 2012 at 2:41 pm

    As a state licensed clinical counselor and a state licensed alcohol and drug counselor, I appreciate the need for standards. But i don’t want to see treatment further fragmented by endless demands for specific certifications. For example, in my state they are now certifying people specifically for treating tobacco dependence and gambling problems. In my opinion, the better way to go is to require all professionals to get at least minimal education in the full range of human problems as well as having ethical standards that require specialist referral when the professional thinks the presenting problem is beyond their competence. For example, the American Society of Addiction Medicine is suggesting that all physicians receive training in treating addiction problems so that they can better prescribe the potentially addictive medications that are so often required. At the same time, there is an ethical requirement that most physicians respect to refer to an addiction specialist when these problems are so prominent that they are beyond the physician’s capability. But if the physician couldn’t be paid in the 1st place for treating substance dependence, much of the flexibility in making informed and ethical treatment decisions would be lost. Lets increase the depth of our professionalism rather than over-regulating the field in a way that fragments treament.

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