Journey to a profession: c ounselors already have taken important steps to position for the future.
NASAC's creation solidifies the addiction field as a profession and begins a new era in the practice of counseling.
At the 2011 NCAD conference, to be held Sept. 17-21 in San Diego (www.ncad11.com), two workshops related to these developments will be of importance. One will roll out the national standardized addictions curriculum with the new scope of practice. The second will be related to changes coming in the move from certification toward professional licensure in addiction. This article will place into a historical context the path that the field has taken, and then will present the template for a new era for the counseling profession.
Legislative lessons learned
In the early 1990s, Indiana began the process of adopting the state's first licensure bill in addiction counseling. The bill was based on a two-tier system connected to existing addictions certification competencies and foundational to a bachelor's and master's degree in behavioral or social science. Also included was a one-year grandfathering provision for those without a degree, or those in the allied professions who were already licensed and met certification requirements.
The licensure initiative was short-lived, however, as the chair of the presiding legislative committee (a licensed nurse) stated to me at the time, "Mr. Osborn, this bill cannot go forward. Addictions counseling without academic standards is not a profession but a subspecialty. Until there are academic addictions standards, there will be no bill."
I found myself in reluctant but complete agreement. Besides, to debate the need for such a bill with a committee chair who was licensed in a profession with graduated levels of academic standards on which the licensure was based was ludicrous. The bill was dead, and a personal quest began.
A few years prior, Indiana legislators had passed a social work, mental health and marital and family therapy licensure bill. An invitation had been given to addiction counselors to join at that time, but the offer was declined, in part because of the belief that "only addiction counselors can do addiction counseling." This would prove to be a na ve stance.
Passage of that bill without addiction counseling's inclusion set a "legislative precedent." For addiction counselors to have a bill in the future, they had to emulate the previous bill as the new standard. For addiction counseling to assert itself as a profession, the development of an addictions curriculum in higher education was essential.
Other issues remained for resolution. Addiction counselors in Indiana had begun separating into camps. There were those who opposed the bill if it was going to include anything but current certification competencies. Concern was raised that the grandfathering piece was not going to be enough for those with certification, years of experience, and no degree.
The allied professions had developed their own national standardized curriculum on which licensure was based, and many in the addiction field struggled with the issue of those in the allied professions doing addiction counseling. The prominent thoughts were, "How can they be doing addiction counseling? They are not certified in addictions. They are not in recovery; how can they understand addictions from a book?"
Certification and licensure
For the previous questions, the answer is simple on two levels. Licensure supersedes certification. Certification is created by a field that incorporates the requisite knowledge and skills an individual needs to possess, verifying this through examination in order to practice. Licensure represents a higher standard for independent practice (without clinical supervision). In most professional licensures a set of academic standards for accredited institutions and programs is foundational, giving credence to the profession.
What some in addictions failed to understand is the allied professions had established a standardized national curriculum and scope of practice. In the curriculum, especially at the graduate level, a course in psychopathology is required. In this course, diagnosis and treatment protocols from the Diagnostic and Statistical Manual of Mental Disorders (DSM) are mastered. One of the diagnostic categories is the spectrum of substance-related disorders. Inclusion of such a course as part of licensure opens the allied profession to diagnose and treat substance abuse, even if an individual is not certified or licensed in addictions.
The charge of not being in recovery was not an issue, nor was it a "perceived requirement" for any other profession except in addiction. Logic countered that one did not need to have schizophrenia to be a mental health counselor, nor to be married or divorced to be a marriage and family therapist. Why, then, should addiction have such a perceived requirement?
Concern over certification and education
Shortly after the death of the Indiana bill, I began to research addiction counseling programs in higher education in the U.S. I quickly found that field was lacking--a disparity in standards was evident.
Coming out of mental health and a marriage and family therapy graduate education, I was familiar with the history of both professions with regard to the connection of academics and a scope of practice. They had competencies; they had set a template for the addiction field to follow.
The field of addiction counseling was an area that "cared for its own." Those who had experienced addiction themselves were called upon, or offered their help to those who wanted to overcome addiction. Experts, theories or treatment programs did not exist.
Over time the field moved toward providing a basic level of education with workshops, trainings and conferences. In time, "training institutes" were established as businesses to offer "courses." The institutes provided a valuable opportunity to prepare for certification to enter the field. They also helped individuals to keep current in maintaining certification.
Yet critics of the field and this approach saw flaws. For one, there was concern over course composition, and questioning of the lack of validity in content and effectiveness. The background and credentials of those providing the training were also questioned. If states did require some form of education, content, learning objectives and hours, the requirements varied.
Addiction counseling remained counter to the allied professions in how one became a counselor. In the allied professions one went to school, graduated, sat for a certification (or, if needed, licensure) exam and went into practice. For addictions, one simply studied for a certification exam, and if passed went on to counsel. Only then, and if the person wanted to, would one go to higher education.
Some academic programs existed, mostly at community colleges in a certificate or associate's degree program. There were a few bachelor's programs. In reviewing higher education programs, inconsistencies were found. Some states with more than one program had varying credit hours and course content. In one state with two colleges with addiction programs within a few miles of each other, the programs did not match in several respects.
In interviewing various state officials assigned to the creation of addictions standards, they admitted they did not have addictions expertise. They were given the task by the governor or a state agency, and due to a lack of resources they wrote very minimal standards.
Also of concern was the lack of graduate-level programs. Some graduate programs in addictions were available, yet accreditation was an issue. An interesting finding regarding some programs was that they were "accredited" but lacked the accepted "gold standard" of accreditation from the Higher Learning Commission (HLC).
What was evident in the addiction work-force was an increase in counselors holding graduate degrees in something other than addiction counseling. Many of these programs did not until very recently require graduates to take a course in addictions. In essence, many graduates would enter practice unprepared to address the issue of addiction and could be found negligent. To the credit of those in the workforce, they did seek out addictions certification to address the need and to be ethical in practice.
For the addiction field to have viability, it needed its own addiction-specific graduate programs and a coordinated, standardized curriculum.
A pilot program
In 2006 the Substance Abuse and Mental Health Services Administration (SAMHSA) established an education grant to Indiana Wesleyan University (IWU). The grant was to assist in the development of the first pilot program addressing academic opportunities in addiction counseling and to increase the addictions workforce.
IWU had developed a respected national presence in its approach to higher education, with offcampus education and online education in addition to traditional education. The goals were to expand TWU's existing bachelor'slevel addiction counseling degree program with the creation of an Addiction Studies Center (ASC).
Through the ASC the initiative was to develop the first accredited and NAADAC-approved master's of addiction counseling in a traditional setting. 'What followed from IWU was to develop an online format for the bachelor's and master's in addictions counseling, followed by a certificate in addictions. The initiative was based upon SAMHSA's Technical Assistance Publication (TAP) 21, entitled Addiction Counseling Competencies: The Knowledge, Skills and Attitudes of Professional Practice.
The certificate would contain the core addiction courses of the master's in addiction counseling and would be open to current graduate students whose counseling program did not have an addiction component. The certificate also was available to those in allied counseling professions who possessed a master's degree but did not meet competency standards for ethical addiction practice.
IWU's programs were later vetted through NAADAC's "approved provider" standards and received approval as a NAADAC Approved Provider in Higher Education. A feature of the IWU programs was that courses, course content, learning objectives (including supervised practicum) and internship outcomes met all requirements for both NAADAC and the state of Indiana's certification exam through the Indiana Association for Addiction Professionals.
SAMHSA and the creation of NASSCC
With the completion of the IWU program template, the next step was to move forward with the template to a national collaboration. With SAMHSA's continued interest and assistance through NAADAC and the National Certification Commission (NCC), the first national study group was established. The study group was charged with the creation of national curriculum standards for addiction study programs in higher education. The standards were to encompass entry-level certificate courses through a PhD.
The next phase involved creating a national scope of practice and career ladder. In doing this, addictions would move from a field to a profession. This gave hope that the field would not erode away to allied practitioners, but would develop its own identity through higher education and professional equity.
In coordination with SAMHSA, study group members were evaluated and selected from stakeholders in higher education, research, government, practice and the consumer sector. The study group became NASSCC. Convened in 2007, it would meet by phone conferences over the next three years and would develop needs assessment items, priorities, projects and timelines. Toward the final year of the process, several face-to-face meetings were conducted, at which time an advisory group was established, made up of representatives of the same stakeholder groups.
NASSCC then moved to academic degree study groups. Several other accredited degree programs from certificate through doctoral programs were brought in for evaluation, analysis and comparison with IWU programs. Each study group was tasked with researching and developing content of course work, course description, learning objectives and outcomes. In early 2010, NASSCC completed its work and submitted a final report to SAMHSA for review
The process then moved toward establishing the profession's accrediting body. One of the major partners in NASSCC was INCASE, which over the past several years had brought sound research and credibility to higher education efforts in addiction studies programs. NAADAC as well had established its Approved Provider in Higher Education status. Both groups had expertise in various parts of higher education, and in mutual efforts had worked to pool their resources for the profession. That collaboration legally established NASAC in 2010.
While higher education has the HLC, NASAC will be the professional accrediting body for addiction studies programs. NASAC will accredit only programs that have institutional accreditation by the HLC. This will ensure integrity for the profession and student. In short, the profession will have a central place of oversight for the practice of addiction counseling. Higher education in the addiction profession will now direct the components of certification, testing and licensure.
The new era in addiction
As of this writing, the national healthcare reform law is facing challenges from more than 20 state attorney general's offices. The law is set to go into effect Jan. 1, 2014. At that time, Title V of the law will go into effect with regard to educational requirements to provide clinical services in mental health and addictions. This portion of the bill speaks to "integrated services" and delineates the requirements for provision of service.
Regardless of the status of the law, the clinical structure will go forward. The new reality of providing services, originally started by managed care, will go further.
It is here that many in the addiction profession have been given warning regarding new requirements to practice counseling. Many who now provide services will need to evaluate their level of preparation. This also signals the move from "substance abuse counseling" to the term "addictions counseling" in order to incorporate process addictions. With the efforts of NAADAC and INCASE in the creation of NASAC, the addiction profession is assured that it will not be lost or absorbed into an allied profession.
It is now a time of transition to the new realities of requirements for providing addiction services. While the "traditional" door to the profession of a combination of recovery and certification is not closed, it must be understood that this will now come with limited opportunities.
The new door will be through higher education and meeting the standards of the legislative precedent of the allied professions.
Certification and the institutes that provide education and workshops will be needed, but their role will change. For a time there will be a need for entry-level certification and a way for addiction counselors to pursue continuing education to maintain legislated requirements.
For the addiction profession, higher education adds a gatekeeper that previous certification could not. Besides the aforementioned criticisms of certification, another factor was of more concern. In certification, an individual passed an exam or case presentation. While this gave some evidence to mastery of material, there was a lack of an evaluation of engaged competencies to be "fit for practice." The process of higher education, on the other hand, is more protracted and evaluative. More time is given to evaluate the total person as a student and a potential professional.
The efforts of NASAC also provide states with standards and resources in addiction legislation. In this way the process of compatibility in all states will be initiated. States that conclude that their enacted legislation with regard to addiction counseling is adequate will in time need to revisit it. Examples of this can be seen in nursing and physician legislation. States are not licensing nurses or physicians based upon
As new research brings about new understanding, new skill sets and treatment practices are established. Existing legislation will eventually need to incorporate changes, and providers will need to evaluate their credentials to provide services. Another benefit is that as this process becomes integrated, addiction professionals will have a greater ability to relocate, under standards already enjoyed by other professions.
In time, academic programs in addiction studies will increase the workforce. Recent unpublished student surveys in behavioral and social science programs showed a lack of knowledge about addiction as a field. Students simply did know about addiction counseling as something to practice for a career.
Also interesting is that unless there is licensure for the profession, students appear to have no interest. Students in essence stated in surveys that they wanted to go to an undergraduate program that prepared them for graduate school, which in turn prepared them for licensure in a profession to become employed.
Without an academic program, one can conclude there is no interest or recognized need for addictions counseling or to see it as a profession. To assist in this process, NAADAC has and will continue to establish student chapters in NASAC-accredited programs.
Back to Indiana
After many years and with much patience and negotiation, Indiana passed a two-tiered addiction counselor licensure bill, including a grandfathering section with limited scope of practice for those with years in the field and certification but no degree. The bill went into effect July 1, 2011 and will ensure title and practice protection.
At NCAD 2010, Indiana's licensure process was presented in a workshop. Conference attendees saw that the bill answered many of their counselors' and states' concerns. They recognized the bill as a national template for licensure, and that it also answered the concerns and criticisms of the allied professions.
A signature piece of the legislation was the inclusion of higher education requirements. Similar legislative activity in states such as Arizona, Kansas and New Jersey reflects the much-needed and long-awaited changes that will solidify the place of addiction counseling as a profession.
More Online For details of Indiana's licensure law, visit www.addictionpro.com/turner0311.
Donald P. Osborn is the President of NAADAC, The Association for Addiction Professionals and Chair of the National Addiction Studies and Standards Collaborative Committee (NASSCC). He is Director and Professor of Graduate Addictions at Indiana Wesleyan University and Executive Director of the Addiction Studies Center. He can be reached at email@example.com.
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|Author:||Osborn, Donald P.|
|Date:||Jul 1, 2011|
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