Volume 1, Issue 3

Understanding Addiction Treatment Workforces: Capturing the Full Diversity is Crucial
By Dennis McCarty, Ph.D., and Tracie Reichmann, Ph.D.
Oregon Health and Science University
Tracie ReichmannDennis McCarty

The National Drug Abuse Treatment Clinical Trials Network (CTN) completed one of the more comprehensive organizational and workforce assessments, focusing on the membership of the CTN (Fitzgerald & McCarty, 2009; Fuller et al., 2007a; Fuller et al., 2007b; McCarty et al., 2008; McCarty et al., 2007). A summary of the results reveals a diverse workforce that varies by job title and across levels of care.

A three stage survey obtained responses from 106 of 112 organizations (95% response rate) describing the corporate structures and identifying 384 treatment units (residential, outpatient, detoxification and methadone). Next the 348 treatment units (91% response rate) provided data on their services, clients served and generated lists of employees by job category. Finally, 3,786 individuals (71% of the 5,334 eligible employees) completed a survey assessing education and training, opinions toward specific behavioral therapies and medications, and organizational readiness to change. Respondents to the workforce survey included 1,757 counselors, 908 support staff, 522 medical staff, and 511 managers or supervisors (88 were missing data on job category). Most workforce surveys collect data only from counselors. Thus the resulting descriptions of the addiction treatment workforce have been incomplete and fail to offer a comprehensive perspective on the complexity of the workforce and its needs.

Within treatment units participating in the CTN, support staff (e.g. counselor aides, receptionists, intake administrators) represented 24% of the workforce and reported more hours of direct patient contact than counselors. Their attitudes and beliefs about addiction treatment, therefore, may have substantial influence on shaping program cultures and normative expectations. Over half (58%) of the support staff completed their education with a high school diploma or less, 71% were women, and 46% were minorities (African American = 31%, Latino/Hispanic = 11%, multi-racial = 3%; other = 1%). As a group, support staff tended to be less supportive of pharmacotherapy and behavioral therapies. They were more supportive of discharging noncompliant clients and using confrontation with clients. Efforts to introduce evidence-based practices, therefore, may need to direct attention toward support staff as well as counseling staff.

Counselors (48%) and manager/supervisors (14%) accounted for more than 6 of 10 respondents to the workforce survey. Graduate degrees were relatively common (counselors = 42%, manager/supervisors = 58%). Counselors in outpatient settings were much more likely to have graduate degrees (53%) than those working in residential settings (30%). The most common masters degrees reported were in social work (29%), counseling (27%) and psychology (22%). In contrast with the findings among support staff, managers tended to have the most positive attitudes toward evidence-based pharmacological and behavioral therapies and were least supportive of using confrontation and discharging patients for noncompliance.

Nurses (64%; n = 251) dominated the the total number of licensed medical practitioners working in the participating programs (n = 392). A relatively large number of potential prescribers (physicians = 77; nurse practitioners and physician assistants = 8) completed the survey. Based on the 348 treatment units providing data for the workforce survey, there is, on average, about one prescriber per four treatment units (85/348 = 0.24). Medical staff had the most positive opinions about pharmacological treatments for addiction. Overall, support for the use of evidence-based pharmacological and behavioral therapies was variable but modest.

Finally, a more ambitious assessment would also include licensed practitioners in private practice and group practice settings. CSAT sponsored assessments of addiction treatment within practice research networks for psychiatrists (Svikis, Zarin, Tanielian, & Pincus, 2000), psychologists (Smith, 2001), and NAADAC (National Association of Alcohol and Drug Abuse Counselors) members (Kowalski, Harwood, & Ameen, 2001). Practitioners in private practice settings will have different workforce development needs than those employed in specialty addiction treatment centers.

The bottom line is that the addiction treatment workforce is actually many workforces across a range of treatment modalities and without a common educational core. Analyses of the workforce and assessments of their professional development needs, therefore, must examine levels of care and job categories in order to embrace the full diversity of women and men working in treatment centers that address alcohol and drug use disorders.

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