Moving to licensure

Few issues, if any, have elicited greater controversy and dissension within the addiction counseling profession than the licensing of addiction counselors. Few issues have so challenged our resolve to honor the Twelfth Tradition of Alcoholics Anonymous to “… place principles above personalities.”

Efforts to license addiction counselors in Indiana proved to be no exception. If the wisdom from the Book of Proverbs that “… iron sharpeneth iron” is true, Indiana addiction counselors are better as a consequence. Overcoming many challenges, the Indiana Addiction Counselor Licensure bill was signed into law by Gov. Mitch Daniels in 2009. The Indiana model, which could serve as a template for other states considering licensure, will be highlighted in this article.

Clearing the hurdles

The necessity of licensing addiction counselors is often questioned by other counseling disciplines (e.g., marriage and family therapists, social workers, mental health counselors and psychologists). This is attributable in part to their view of addiction counseling as a specialty. Addiction professionals disagree with this assertion, while differences among certifying bodies prevail.

Prior to licensure, consumers were required to differentiate among a variety of certifications, including the following series of titles: ICAC I, ICAC II, NCAC I, NCAC II, MAC, CADAC I, CADAC II, CADAC III, CADAC IV, IMAC. Other licensed clinicians, regardless of their level of addictions specific training (e.g., LMFTs, LCSWs, LMHCs, etc.), were part of the available options to consumers as well.

The Indiana model for licensure was initiated as a consumer bill, specifically to minimize consumer confusion surrounding the various certifications and, more importantly, to clarify the scope of practice of an addiction counselor. Benefits for the profession include practice and title protection, which affirms academic standards within a clearly delineated ethical framework.

Historical legislative efforts to secure licensure were successfully challenged by the aforementioned disciplines, namely because of repeat attempts to license non-degreed or non-master's degree counselors at the master's level. Key legislators questioned the licensure of addiction counselors in the absence of a corresponding academic career ladder within our colleges and universities (from associate through doctorate levels). Values differences among certifying bodies, namely regarding the “grandparenting” level of existing non-degreed counselors, impeded passage of any meaningful legislation as well.

Fortunately, the licensure of addiction counselors in Indiana occurred for several reasons. First, a mediator with a legal and legislative background agreed to assist in the effort. Orchestration of meetings involved representatives from the two certifying bodies along with, as appropriate, representatives from other behavioral health groups such as the Indiana division of the American Association for Marriage and Family Therapy and the Indiana affiliate of the National Association of Social Workers. Since professional trust was essential, the content of the evolving bill remained available to all vested groups for consideration.

Other key factors that contributed to passage included the presence of a corresponding academic career ladder within Indiana's university system, coupled with bipartisan support for the bill. Efforts to establish an academic career ladder were initiated in the community college system and thereafter with a private university that was persuaded to respond to a national shortage of addiction counselors. Both sought and received an endorsement of their degree programs from NAADAC, The Association for Addiction Professionals.
A NAADAC-endorsed graduate program exists in Indiana as well, thus completing the addiction counselor career ladder. Funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) was instrumental in the development of a pilot, graduate-level addiction counseling program.

Licensed Addiction Counselor (LAC) and Licensed Clinical Addiction Counselor (LCAC) requirements

LAC Grandfathering Requirements

OPTION 1

• Level II or higher certification; or

• Certification as an addiction counselor or therapist approved by the Board.

• 10 years of addiction counseling experience

• Submit an application prior to July 1, 2011

OPTION 2

• Three years of addiction counseling experience

• Hold a valid Indiana license as a LSW, LCSW, LMFT, LMHC or psychologist

• Submit an application prior to July 1, 2011

LAC Requirements After Grandfathering

• Bachelor's degree in addiction counseling or related area (transcripts to be submitted directly from the university)

• Pass licensure examination

• Two years of supervised addiction counseling experience (150 hours of supervision, 100 hours of which must be individual and 50 hours of which must be group)

• 40 semester hours or 60 quarter hours; coursework requirements are:

  • - Addictions theory

  • - Psychoactive drugs

  • - Addictions counseling skills

  • - Theories of personality

  • - Developmental psychology

  • - Abnormal psychology

  • - Treatment planning

  • - Cultural competency

  • - Ethics and professional development

  • - 350-hour supervised practicum, internship, or field experience

LCAC Grandfathering Requirements

OPTION 1

• Master's or Doctorate degree before July 1, 2011 (transcripts to be submitted directly from the university)

• Level II or higher certification; or

• Certification as an addiction counselor or therapist approved by the Board.

• Submit an application prior to July 1, 2011

OPTION 2

• Master's degree (transcripts to be submitted directly from the university)

• 5 years of clinical addiction counseling experience

• Hold a valid Indiana license as a LSW, LCSW, LMFT, LMHC or psychologist

• Submit an application prior to July 1, 2011

OPTION 3

• Bachelor's degree earned prior to July 1, 2011 (transcripts to be submitted directly from the university)

• Hold a Level IV certification; or

• Certification at the Internationally Certified Advanced Alcohol and Other Drug Abuse Counselor level from the International Certification and Reciprocity Consortium

• 20 years of clinical addiction counseling experience

• Submit an application by July 1, 2011

***Cannot have a conviction of violence or be convicted of anything that has a direct bearing on your ability to practice competently in the previous two years

LCAC Requirements After Grandfathering

• Master's or Doctorate degree in addiction counseling/therapy or related area (transcripts to be submitted directly from the university)

• Pass licensure examination

• Two years of supervised addiction counseling experience

• 200 hours of supervision (100 of which must be individual, and 100 of which must be group)

• 27 semester hours or 41 quarter hours; coursework requirements are:

  • - Addictions counseling theories and techniques

  • - Clinical problems

  • - Psychopharmacology

  • - Psychopathology

  • - Clinical appraisal and assessment

  • - Theory and practice of group addiction counseling

  • - Multicultural counseling

  • - Research methods in addictions

  • - Legal, ethical and professional standards (two hours)

  • - Appraisal and assessment for individual or interpersonal disorder or dysfunction (two hours)

  • - 700-hour supervised practicum, internship, or field experience

  • - 280 face-to-face client contact hours by a LCAC with five years of experience

  • - 105 hours of supervision by a LCAC with five years of experience

Details of requirements

The eventual bill included a two-tiered approach for licensure featuring a bachelor's-level (Licensed Addictions Counselor) and master's-level (Licensed Clinical Addictions Counselor) designation, with each tier reflecting clearly delineated academic requirements and a definitive clinical scope of practice.

Grandparenting components of the bill provided a mechanism for allied clinicians and non-degreed counselors, with documentable addictions-specific training, to become licensed without additional examination. (See box for the detailed licensure requirements.)

Several states have enacted licensure laws for addiction counselors, while others are considering licensure as a means of gaining additional credibility with their colleagues from other counseling disciplines. Success seems correlated with a willingness to adhere to principles, collaboration, and commitment to a process.

National licensure may come sooner than expected for many. The creation of the National Addictions Studies Accreditation Commission (announced last September at the NCAD 2010 conference), with its nationally standardized curriculum for higher education, provides the educational components for national licensure. The commission will establish procedures for the first-ever accreditation of addiction studies programs at the undergraduate and graduate levels.

Additional details regarding the Indiana model are available at www.ipla.in.gov.

Stewart Turner-Ball, MAC, LCAC, is the Founding President of the Indiana Association for Addiction Professionals (IAAP). He became assistant director of the Addictions Counseling Program at Indiana Wesleyan University in 2009. His e-mail address is stewart.turner-ball@indwes.edu.
Brent Stachler, MAC, LCAC, became the Clinical Director for The Fort Wayne Rescue Mission Ministries in March 2011, and is immediate past-president of the Indiana Association for Addiction Professionals. Addiction Professional 2011 March-April;9(2):9-11