Making counselor education relevant

Addiction counseling as a discipline arose from a grassroots movement designed to meet a need that was not being met by counselors from the traditional mental health professions. Coordination between 12-Step programs and the preparation of counselors was a logical link, given that most persons who wanted to work in this field were recovering addicts. In the past 25 years, the counseling profession has evolved to include more persons who in addition to the recovery experience have studied the underlying causes of addiction and have pursued research related to successful treatment and recovery. The experience of the college at which I work is cited here as an example of the way addiction education programs have developed over time.

The addiction studies program at Metropolitan State College of Denver began in the early 1970s, with grants from the National Institute of Mental Health (NIMH) allowing for the training of 20 addiction counseling students per year. John Donohue, the first program director, hired for the program individuals who had experience working with street addicts; they began teaching addiction courses at the college as well as teaching Native American groups on nearby reservations.

Entering students were required to have five years of sobriety—many of these students brought with them a lot of street experience. In addition, some professionals such as physicians, nurses, and business administrators in recovery enrolled in the courses. A significant portion of the course content was based on the 12 Steps. The instructors of these classes faced numerous challenges, as students struggled to learn required information for state certification that did not always agree with their own experience of drug and alcohol use.

Learning with a purpose

Still today, there are several manifestations of an historical lack of coordination between educational experiences and professional standards for addiction counseling. There is no systematic national plan that shapes how workers enter and progress through the field, with no clear pathways of preparation for entry and advancement. Each state essentially has its own set of standards, and reciprocity between states is limited. People often have been hired as addiction counselors with the expectation that they will acquire knowledge and skills through the process of working in the field, rather than having an in-depth understanding of the issues clients face.

More than a decade ago, William White proposed the need to work from a higher standard of knowledge and skills required for service entry, and for a more rigorous system of supervision.1 This process should be embedded within education, certification, and licensing procedures, as well as within program accreditation, he stated. In addition, attention is needed to meet the ethical obligation of protecting clients from harm resulting from the actions of untrained and/or undersupervised workers.

At the time White was publishing his suggestions, coursework at Metro State was being altered to focus more on research related to the causes of addiction. A course in pharmacology was moved from an entry-level course to a junior-level course requiring a more in-depth understanding of substances' effects on the body. Courses in theory and practice began to address mental health and addiction issues presented by clients.

In addition, changes to state regulations for certified addiction counselors resulted in an increase in the required number of experiential hours working in addiction treatment, and standards for student performance in classes as well as in field placements were raised as well. For many years, Colorado had required that persons applying for state certification as addiction counselors complete 1,000 clock hours of experience in addiction treatment. Ten years ago, the experiential hour requirement changed to 1,000 hours for the CAC I certification, another 2,000 hours for CAC II, and another 2,000 hours for CAC III.

Metro State now takes care to meet the needs of working persons by scheduling required courses on weekends and evenings. Courses also are scheduled so that students can meet once or twice a week instead of three days a week. As a result of this scheduling policy, and also because accommodations for persons with disabilities are available, more students seeking addiction counseling certification are attracted to the program. In 2006, White wrote that at the beginning of the 21^st century addiction counselors represented the most diverse workforce in the discipline's history.2

Those of us in higher education who also have clinical experience think there is an advantage to the academic preparation of the recovering person to become a professional who happens to be in recovery, as opposed to a recovering person who knows how to counsel. In addition, we have found that training of a credentialed clinical professional who is not in recovery and has little experience with family substance use can prepare that person to work successfully with clients.

In an academic program, there is an attempt to provide experiences and information that will break down the rigidity of thinking that there is only one answer. Exposing students to persons with different belief systems and to knowledge of the addiction process encourages them to move toward meeting the client at his/her level. In an academic program there is an opportunity beyond teaching knowledge—professional and personal development is taught and modeled through interaction of student peers and professors. Students have an opportunity to learn from professors who have worked in the discipline and who have knowledge essential to understanding addiction. Interaction with fellow students with widely varying experiences, and with mentors in field placements, provides the opportunity to explore diverse ways of approaching treatment.

The view from students

The comments below, provided by a student who has graduated from the Metro State program and a current junior in the bachelor's degree program, are presented to demonstrate the value of an academic addiction studies program.

Lawrence K. Weckbaugh, MHS, CAC III, family program manager at CeDAR: A college-based educational program for chemical dependency treatment and counseling has benefited me in three ways: 1) A broad base of education covering a full spectrum of treatment issues from childhood development, sexual/physical abuse, DSM symptomatology and co-occurring disorders, socioeconomic background, diversity, physically and mentally challenged populations, domestic violence, etc.; 2) Assistance in locating employment candidates and vetting references; and 3) Personal and professional development through ongoing relationships with the Center for Addiction Studies as an alumnus.

There are many examples of how I put these benefits into practice. In the hiring of new employees, if I have two candidates with equal credentialing and all other things equal except educational background, with one from a college-based program and the other from a training facility, I will choose to hire the college-educated person. In my own professional development, staying involved with alumni activities at my alma mater assists me in giving back to the community personally and financially.

S.T., current student: Like many students who are attracted to the field of addiction studies, I am a recovering addict. My own struggles and successes sparked a desire in me to empower others through their own process of recovery, and I truly see it as an opportunity to give back for the gift I have been given.

I have a sponsor and have been a sponsor. I have learned a great deal from my sponsor and have experienced a great deal of growth as a result of her feedback and insight. But being a great sponsor does not automatically make one a great counselor, and I have seen and experienced the difference firsthand. Sponsorship in my experience is highly supportive and directive in the best of cases, but in the worst of cases many of these relationships could be labeled codependent.

Through my educational experience I have learned a great deal about how different these two avenues of helping really are. When I decided to pursue a career in counseling, it wasn't even a consideration for me to go through a training workshop—in fact, I thought I needed at least a bachelor's degree. It is a bit disheartening to find out that addiction counseling is not a very well-respected field in that it does not require a college education. I am of the strong opinion that it should. We are talking about people's lives here.

In addition, one of the key characteristics of an effective counselor is self-awareness. We need to know who we are and what we think, believe, and value. Particularly in the field of addiction counseling, it is imperative that we are in a process of resolving our own issues to reduce the possibility of countertransference with our future clients. The university experience provides an excellent platform for that journey of self-discovery. We are all seeking a degree, but education is just as much about our growth process as it is about the end result.

References

1. White WL, Joleaud B, Dudek FA, et al. The Training Life: Living and Learning in the Substance Abuse Field. Bloomington, Ill.:Lighthouse Institute; 1994.
2. White WL.Alcohol, tobacco and other drug use by addictions professionals: historical reflections and suggested guidelines. Great Lakes Addiction Technology Transfer Center Bulletin 2006 Sept;1-20.

Sidebar

More health professionals need addiction training

BY LARRY ASHLEY, EDS, LADC, CPGC

Colleges and universities that prepare students to become medical and behavioral health professionals have an ethical obligation to provide training on addictive disorders. While this seems like common sense, it is far from the case in practice. In many universities in the United States it is possible to obtain advanced degrees such as MD, PhD, and MSW without being required to have taken one course on addictive disorders. Few programs require training in co-occurring disorders.

Yet once individuals graduate with such degrees they qualify to be licensed to treat patients who have issues with addictions or mental illness. Because of the lack of education and clinical training provided by many universities, new professionals are not prepared to recognize addictions. As a result, many individuals with addictive disorders go undetected or, worse yet, are misdiagnosed.

In an effort to correct the absence of education in addictive disorders in graduate training programs, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) will require courses in addictions in all master's and doctoral degree programs, beginning with its 2009 standards. The council, the professional accreditation body for counselor education programs, also will list requirements for a master's degree in addiction counseling.

In addition to imparting a strong working knowledge relative to addictive disorders, it is imperative that university programs provide a foundation on the integrated model of treating co-occurring addictions and mental health issues. Because the signs and symptoms of addictions and mental illness are at times similar if not identical, addiction professionals must be competent mental health professionals.

The University of Nevada, Las Vegas Department of Counselor Education is at the forefront of providing comprehensive addiction education programs at the undergraduate and graduate levels. Because it is recognized that many graduate behavioral health training programs do not require coursework in addictive disorders, the department offers an Advanced Graduate Certificate in Addictive Disorders for individuals with master's or doctoral degrees or those in the process of obtaining these degrees who wish to have an addictions specialty. Also available are advanced graduate certificates in mental health counseling and rehabilitation counseling, as well as a master's degree in community mental health counseling. The department is also designing a PhD in counseling with an emphasis on addictions and mental health, which would prepare professionals in the treatment of co-occurring disorders.

Larry Ashley, EdS, LADC, CPGC, is Undergraduate Coordinator at the Department of Counselor Education and Director of the Problem Gambling Treatment Program at the University of Nevada, Las Vegas. His e-mail address is larry.ashley@unlv.edu.