Training for Success: Empowering Our Staff
Anyone impacted by the negative effects of substance use will tell you, it takes a village. Treatment providers include physicians, physician assistants, nurses, psychologists, mental health counselors, therapists, social workers, acupuncturists and addiction counselors. However, the stark truth is that only a finite number of these professionals are actually practicing addiction medicine specialists and self-identified practicing addiction psychologists. In medical school, separate courses are rarely taught on addiction medicine, and they are often treated as a subtopic on board exams. Addiction counselors make up the vast number of treatment providers and sadly are not required to have any medical training.
The statistics are startling:
· Number of states that don’t require addiction counselors to be licensed or certified – 14
· Number of states with no minimum degree requirement for addiction counselors – 6
· Number of states requiring a minimum of a high school degree or GED – 14
· Number of states requiring a minimum of an associate degree – 10
· Number of states requiring a minimum of a bachelor’s degree – 6
· Number of states requiring a minimum of a master’s degree – 1
Because addiction care is so disconnected from mainstream medicine, patients are forced to turn to a broad range of practitioners who are largely exempt from medical standards. There are no national standards set for those who want to provide addiction treatment in the United States, which makes quality assurance almost impossible. There is no other disease where appropriate medical treatment is available is as neglected by the healthcare system.
New clinicians are often thrust into the workplace without adequate training to work with complicated patients. We have a responsibility to provide our workforce with innovative training to reflect our latest understanding of the chronic nature of addiction. Administrative staff need regular training to understand the symptoms of substance use and behavioral health disorders. These staff often interface with individuals far more than the trained addiction treatment professionals they work alongside. That said, there needs to be an approach balancing compassion and competence to better understand these behaviors and to deescalate situations that may be harmful to the individual in treatment. Are we ensuring the individuals we serve receive competent clinical care based on their specific and unique needs? Do we have clinicians trained in trauma work, anxiety/depression and DBT? It is our responsibility as a field to create strong structures of support, supervision and feedback for our clinicians and front-line staff members.
If we are going to change the way we help individuals suffering from substance use disorders, we need to reform health care practice. This requires the development of core competencies, standards and best practices that would become vital components of all medical school curricula, residency training programs, licensing exams, board certification exams and continuing medical education (CME) requirements. National accreditation standards for addiction treatment facilities and programs must be established to reflect evidence-based care.